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Home My WebLink AboutPermit Electrical 1989-9-15 -:if 1({)0 -'--.-~--'.- ~ ~ ~ 'f) ;~ INSPECTION LINE :1726-3769 '} -Jab Address t~o CtvuTI'2.-IU......lI,Q..-;L Legal Descriptian CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EflERGY SOURCES: Hea t t~a ter Hea ter Range__ ValuE of Hark: Sq. ~q. Owner W~~~ 6"T't>2..R.A AdJress Phone Buil(;ino Permit Info: Describe Work(Le., Build Single Family Residence With Attached GaraQe) Construction Lender Address nES I GN TEN~ (name) Phone (address) (1 ics.' no.) (expires) (pho.ne 0.0..) Primary Structural Electrical 11echani ca 1 CONTRACTORS (name) (address) (] ics. 0.0..) (exoires) (ohone no. ) General PlumbinG P~b Electrical EUU..-rfZ-lcAi- b(\lA~C:;iDA.X iNC, RD.&Y:./2./l./b C17212 2k-4~2, 2.-c: roll lAC; L I [Fef3 'Z~ 2.-72.:>~ ~lechani ca 1 PLUf1l3I NG ELECTRICAL MECHANICAL Each single fixture FEE CHARGE ~ _EEL.Ll:lARG.L -1lD. Res idence of furnace/burner to SQ. FT. ' BTU' s I...EEL J:.liARGL NO. Relocated building (new fix. additional) 2a> New circuits alts. or extensions . 2.."'2..;-0 "22.~"1S Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each SERVICES Reces sed wa 11 Soace heater and vent Storm Sewer Of amps, Appliance vent seDa ra te Stationary evap. cooler Vent fan with , sinole duct Vent system apart from I heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing residence multifamily, comm. or Industrial Additional bath Hater service COMM./IND. FEEDERS Install/alter/relocate distrib.feeders / 1-- Of amps.1 I -~1U2- __[DC) MP I ~o It 5"00 ~i)R:12... - 206 A90J..p 2..2,~12'2.!;D I /^oe:., (d......J \ TOTAL CHARGES Contractor, the electrical portion of this permit and returned to the Building Division I SSUANCF OF PFR~1lT TOTAL CHARGES TOTAL CHARGES WHERE STATE L'IH REQUIRES that the Electrical work be done by an Electrical shall not be valicJ until the label has been signed by an Electrical Supervisor I HAVE CAREFULLY EXAtlINED the completed applicatio.n for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertai~ing to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my registration ~lith the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that o.nly subcontractors and employees who are in compliance with ORS 701.055 will' be used on this project. IW.1E(please print)'Ko(?>ft..Q;I ~~??G'-B_ SIGNATURE-If2I~A~ FOR OrF1CE USE O~LY D/m3/iS~L_ Zone x Fi re Z.one x Flo.o.d Plain x Type/Cons t. Units So. F tri. r1iJ i 0. Bedrooms Occy Load Sq. Ft'J. Access Stories Occy Group Sf]. Ftc). Other Value Value Value TOTAL VALUATION BUILDING PER~1IT Charges and Surcharges Plan Ck. CommlInd 65%/BldCl Per Fee Plan Ck. Res 30%/Bl dq Per Fee Fence Systems Development Cha rge (1. 51,) PLUl1B ING PERMIT Charges and Surcha rges D~mo ELECTRIC,Il,L PERrm Cha rges and Surcharges ~ MECHANICAL PERMIT Charges and Surcharges _ __~_o~__ __-'Sidewalk 300 ..rA/C Paving I Cu~b Cut I ,;To~al Comb. rermi t TOTAL ,f \ 4~.3o-<b 1 II_ ..~. I .~'~ \:1 .~i COMBINATION APPLICATION/PERMIT (CAP) I. PERMIT VALIDATION II. Applicant to furnish A. Job Address 13. Legal Description I. example- Tax.Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Saurces I. example- heat/electrical ceilinq/or forced air qas, 2. example- waterheater/electricalior solar E. Squa re footage or va 1 ua t i on, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-new - if addition, check add, etc. F. Building permit infarmation: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into fami ly raom 3. example - convert single family residence into restaurant (change of use) G. Value af work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must bi able to contact appropriate persons regarding design information or job' site corrections, etc. Abbreviat~d Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the descr~ption portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to. the appropriate item(s) to be installed' B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must electrical contractor for signature supervisor. The general contractor to sign the electrical label. Applicant to. sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. Fees and Charges Plan check fees are due and payable at the time of the applicatian, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. be delivered to the by his electrical is not authorized I I I. IV. v. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE ~CCUPANCY: -'Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: ........ - PLANS REVIEWED BY: /~' A( ~ ~ ~c-c-: ~~ignatu~~_~~, date L v'" L- r L- J........,...' J :::> v /7 ' ~ - - - // :::... <7 -;/8 ~ name :if t:.} /()~' , Ir: I NSPECTI ON LI NE '1726-3769 Jab Address ,'/ .co c: - l.Od r-l~ \ l'Z..1U 't.J I Q..-L Legal Description CITY OF SPRINGFIELD COt1BINATION APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Ileatcr Ranlje ValuE of Hark: INFOR/1ATION liNt 726-3753 Sq. Ftg. r.la i n ~q. Ftg. Access. Sq. Ftg. Other Hew Add Alter Rep. --Fence Demo Change/Use --Other -- -- ~ ~ ~ 'f) Owner W~~~ 6"TD~ Ad<lress Phone , Buil(;ino Permit Info: Describe l~ork(Le., Build Single Family Rcsidcnce With-Attached Garaoe) Construction Lender ^ddress ilLS I GN TEm (namc) Phone (address) _ _._.Uics.' n!LJ (expires) (phonc no.. \ Pri ma ry Structural Electrical 11echanical CONTRACTORS (name) (address) (l ics. 0.0..) lexoires\ (ohone no. \ Gencral Plumbinq "03 lol/lAC; ~ 2..'82.-7ZSS- , , P~b Electrical El.E:G-rfZ-(c.Ai-~b(J.Afi:.u<;iNv'" i",c, p.().&ie l2.I~(, q7212 2k-I..('2,2.-C ~lechani ca 1 PLUflBI NG ELECTRICAL MECHANICAL NO.1 FEE CHARGE NO. FE L _J:l:lARG.L -1.ill...- 1'1'1' CIjARGE. SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) '2.J:Z> New circiJits al'ts. or extensions '2.."'2.':;6 zz..S'6 Fl aar furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each SERVICES Recessed wall Soace heatpr and vpnt Storm Sewer Of amps. Appliance vcnt seoa ra te Stationary evap. coaler Vent fan with sinole duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and duct Waod stove/heater Sewer Temparary Construction Change in existing residenc~ multifamily, camm. or Industrial Addit i ana 1 ba th ~'a ter servi ce COMI.!. II ND. FEEDERS Install/alter/relocate distrib. feeders Of amp~ IF!uz..o-.:U2. ~ /66 /'l.Mr IS"" i~oO '1- ~v/UZ.... - 2D6 Atup 22.':1> 22- ~ TOTAL CHARGES TOTAVCIlARGES WIlERE STATE L'\H REQUIRES that the Electrical I"ork be dane by an Electrical shall nat be valj,j until the label has been signed by an Electrical Supervisor ISSUANCF OF PFRrlIT , oc:: . ~ . TOTAL CHARGES Contractor, the electrical portion of this permit and returned to. the Building Divisian I HAVE CAREFULLY EXAI1lNED the campleted application for permit, and do hereby certify that all infarmatian hereon is true and correct, and I further certify that any and 'all work performed shall be done in accardance with the Ordinances of the City of Springfield and the Laws of the State of Oregon oertaining to. the work described herein, and that HO OCCUPAHCY will be made of any structure without the permission of the Building Divisian. I further certify that I11Y reglstratian ~Iith the Builder's Board is in full farce and effect as required by ons 701.055, that I f exempt the basis far exemptian is noted hereon, and that only subcontractars and emplayees \"ho are in compliance with OP.S 701.055 I.till be used on this project. IW1E(please print)'KD0f2.Q.r~(2_r::::~_F7 _ SIGrlATlJRE~~ FOP. OFFICE USE OHLY DATE c;/tS/~/j Zone Fire Zane Flaod Plain Type/Cons t. Bedrooms Stories Units Occy Load Occy Group So. Ft,!. f1a in Sq. Ftg. Access Sf!. Ftc). Othcr x x Value Value Value x TOTAL VALUATION BUILDING PER~1IT ' Plan Ck. Commll nd Charges and ------------ 65%/Bl do Per Fee Surcharges Plan Ck. Res 30%/Bldq Per Fee PLUt1BING PERMIT Fcnce Charges and ------------ Surcharges D~mo ELECTR I C/l.L PERrm ~ct.i Sidewalk Charges and ------------ ~~ 00 Surcharges 3 A/C Paving MECHANICAL PERMIT Curb Cut Charges and ------------ Surcharaes , Sys terns Deve 1 apmen t ' Charge 0.51,) ;lata 1 Camb. rermit \~':' TOTilL \ 4~3o-e - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job,l\dd res s B. Legal Descriptian I. example- Tax,Lot 100, Lane County Map Reference 17 0343 2. example- Lot 1. Black 3, 2nd Addition to Springfield Estates C. Name. etc. af owner and constructian lender D. Energy Sources 1. example- heat/electrical ceiliniI./or forced air qc 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foat hause. 50~ sq. foot garagE 2. example- if new project, check new - if addition, check add, etc. F. Building permit infarmation: I. example - construct single family house with an attached garage 2. .example - remodel existing garage into family roo 3. example - convert single family residence into. restaurant (change of use) G. Value af wark as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avaid design or construction delays, Building Oivisian Staff must be able to contact appropriate persons regarding design information ar job site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except ~Ihere blank spaces occur in 'the description portion af the Mechanical and Electrical Schedules, the applicant.need fill-in anlythe No. Boxes adjacenl to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available. at the Building Division 1. To canserve space on the permit form the schedule! have been abbreviated 2~ If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fu 11 schedu 1 es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to th electrical contractor for signature by his electrical supervisor. The general contractor is nat authorized to sign the electrical label. - Applicant to. sign and date Whenever possible, the initial application will be used as a worksheet only. Where passible, Building Divisian Staff wi 11 prepa re a type written copy and return it to the applicant at the time the actual permit is issued far his signature. IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges ~re due. and payable when the permit is issued. II. I I I. N. FOR OFFICE USE ONLY l. . -," --.- ~.,,----_._.} -, - CITY OFSPRINGFIEtD " City Hall Springfield, Oregon Office of Community and Economic Development OFFICIAL RECEIPT . 14906 ,Date 561""/. /$, 19 B-~ ( Rec'd From CC.....-=-'--/. /-:th"/~/<PH-5...../ He: , R4P. ~X /::l/y6 . /" Address ;P~/",:J';1:r-~ 972/'2 , ." r - .. Received For: tk"$#B~{!;)76;:;- /~~ " ~ ~p ~ ,(JJ?3~kc9l c.. 6cff). c>-O g,aO .. '<.. c::> ~3# 20 Amount Received ~# t//c::>/ 1-"7~ c::f- ~8 67-~ ID:- // ,-- ~~~ ~~~~/ I :' Frantler BU'SINESS FORMS, INC. 15031342.8149 1587: Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ".Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: \ PLANS REVIEWED BY: .' r" d ~ name-L ~-F:~;::- ~~ignatur A~~"e:. ~date {'...../".. _ - . ,/ / l.-- , p7 , ~ -/8 g----;