HomeMy WebLinkAboutPermit Electrical 1989-9-15
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;~ INSPECTION LINE
:1726-3769
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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:
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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
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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
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, Ir: I NSPECTI ON LI NE
'1726-3769
Jab Address ,'/ .co c: -
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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""/. /$, 19 B-~
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Rec'd From CC.....-=-'--/. /-:th"/~/<PH-5...../ He:
, R4P. ~X /::l/y6 . /"
Address ;P~/",:J';1:r-~ 972/'2
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Received For: tk"$#B~{!;)76;:;- /~~
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~3# 20
Amount Received
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67-~
ID:-
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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
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