HomeMy WebLinkAboutPermit Electrical 1990-5-22
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Owner
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Address 32 '11. () I J..it-lll\ \ 'if (\ M6
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Construction lender 0 U
'. CITY UF SPRINGFIE~D . INFDRllATlDN LINt
CmmlllATlON APPLICATION/PERMIT .... 726-3753
EIIERGY SOURCES: Sq. Ftg, I~ain
Heat ~q. Ftg. Access.
Hater Heater Sq. Ftg. Other
lIew Add Alter Rep,
Range Fence_Demo_change/Use
valU~ wo.rl<: ,.~_ _Other
() (l(J(? ~-P!'('f'
Builriinci Pernlit Info: Describe Work(i.e.. Build Single
Family rlesidence Hith Attached Garaqe'
/bjJl F".ek t E~ r;Ah~
f-' ~M~-"~
Phone
I
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- INSPECTlOII litlE
" i 726-3769
- Job Address 1114- ~lUl ~f\U I) '-f f"rA{J I
legal Description J7-t:J3'~";?.jjO_ .c>2~"""'~'
/
Address
DESIliN IEAf1
(namel
Phone
(address \
(lics.no.l
{exoiresl
(ohone no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address'
(1 ics. no. \
{exniresl
(ohone no.\
Genera 1
Plumbinq
Electrical ~t.c:: M^(\'hLI'" firM"
, '
'11""J",,-qThI;~~'7
2..0 - /4C-
lo-/.qo
'14/-1..1..31&,
~lechanical
PlUlm ltIG
ELECTRICAL
MECHANICAL
NO,
I FEf r:HARGF: NO
CFF rHARr.r NO_
Ftc r~IARGF
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits a1t5.
~'or extensions
,).Y -
Floor furnace
and vent
S.F. Residence
(l bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hetter ~nrl vent
Storm Sewer
Of
COI~I'1. /I NO, FEEDERS
amps.
Appl iance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sin9:1e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res i (teflcc
multifamily, COlTlll. or
Industrial
~Jater service
I
Install/alter/relocate
distrih. feeders
(,0
amps.
If-~
Of
TOTAL CHARGES
WHERE STATE l~H REQUIRES
shall not be valii until the
TOTAL CfIARGES
ISSUANCE OF PFRf1lT
~... TOTAL CHARGES
that tile Electrlcal work be done by an. Electrical Contractor. the electrical portion of this permit
label has been slgned by an Electrical Supervisor and returned to the BUilding Division
I HAVE CAREFUllY EXAMINED the comrleted apr1ication for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Sprlngfie1d and the laws of the State of Orel]on pertaining to the work described herein, and that NO OCCUPAUCY will be made
of any structure without the permission of the Bullding Division. I further certify that my registration \'lith the Builder1s
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7n1.055 will be used on this project.
SIGllATURE f2~q!)~~ ~E ~h ~l
. -. I
FOr. OfFICE USE OI~l Y ,r " I /
,Sq. Ftg. t1ain x Value
Sq. Fta. Access x Value
"'R-? Sq, Ftg, OtherCC',<:2;T. t?H"? r Value:::? - -..;..
TOTAL VALUATION
NAI.IE(please print) Onl; II e. A ,Tha YO
Zone r"/
Fire Zone
Tyoe/Const.
Bedrooms
.,-A7
Uni ts
Occy load
f)ccy Grouf1
Flood Plain
Stories
"2
BUILDING PERNIT
Charges ane:
Surcharges
Plan Ck. Comm/lnd
____________....2.21/R1da P.er Fee
Plan Ck. Res
3D%/BldQ Per Fee
Fence
syste.ms Development
Charqe tl.5~ '
PlUf~BING PERMIT
Charges and
Surcharges
D/IIllo
ELECTRICAL PERr\lT
Charges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
LJ5" ~_ Sidewalk
:<: _ 2..-> A/C Paving
Curb Cut
Tota' Comb. Permit
TOTAL
'7'7- 2S"""
1
.
..
~.
"I
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examp'le- Tax lot 100, lane County Map Reference
II OJ 43
2: ' example- Lot I. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examt'le- heat/electrical ceilinc:/or forced air Qas
2. examDle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cneck add, etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garllge
2. example - remodel existing garage into family room
3. exa~le - convert single family residence into
restaurant (change of use)
-G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. OESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
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, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
o. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III, 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
signa ture.
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 are due and
payable when the permit is issued.
V, FOR OFFICE USE ONLY
Permit Clerk
'"
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
name
,,/~~ date '5" -77--;7i?>
CITY Of SPHINGFIElD
corm IliA 1I ON APPLI CAlI ON/PERM IT
EIIERGY SOURCES:
Heat
l~ater Iieater
Ranqc__.____;-.
'J IrISPECT IOU 1I UE
726-3769
Job Address 1114- Jd.cu"lli%L.Lj} iN'illJ
legal Description J7.~'3.~"2..jJO .c>?~"-O'
/
~~~ J-utOJU
Address ;S 9, '1 '1. i L-t-lll1 , If 1\ rfl n
~p /ljJ(\qh~ J
Construction Lender 0 U
Owner
Address
DE~lliN II:.Ari
Primary
Structural
Electrical
Mechanical
CONTRACTORS
General
INfORl1AlIDN LINt
726-37S3
Sq, Ftg, Hafn
~q, Ftg, Access,
Sq. Ftg, Other
Uew Add Alter Rep.
-Fence Demo Change/Use
Other- -
~
~
~
\)
Phone
Valu' '19 flork: ~ I
...-If;) ,} (Jr) , ,
BuildinQ Permit Info: Describe Work( Le., Build Single
Family nesidence With Attached Garaoel
/€/,fj} P",JL t (l~vo.<'/" 0.lfjAJ,
h., ,')-" ".~ jJ2'~Xcr7
I
(name)
Phone
{addressl
(lies. no.l
(exnires)
(ohone no.
enamel
(address1
(1 i~". no.1
(pxnirpc:.l
(ol1nne no.l
PlumbinQ
1.10rtrfcol (i,~.s Ph~bi.l n \ {J111~,. '114-~. I~
~1echani ea 1
Relocated building
(new fix. additional)
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additfonal bath
NO. '
Each single fixture
~Ia ter servi ce
Sewer
Storm Sewer
2..0-/4-(', lo-/-Qo
'14/-1..1.%
PlUIIBING
ElECTRICAl
MECHANICAl
, FEF 'r.lIM~r.F .JW
qr fWI[)r..~ NO
nr fU!B!i.E.
Residence of
furnace/burner to
STU's
SQ, FT.
New circuits alts.
~ or extensions
Floor furnace
and vent
'))J/.~
\
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
SERVICES
Temporary Construction
Change in existing
r(>'lirlp_n~E:
multifamily, COI11ll. or
Inrlustrial
Appliance'vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole rluct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hoorl and dud
Wood stove/heater
Of
amps.
/
COI~'1. /I NO. FEEDERS
Install/alter/relocate
rlistrih. fppdprs
(,a
n.~
Of
amps.
ISSUANCF OF PFRl1lT
,(,15:- I TOTAl CIlJ\RGES
Electrical Contractor, the electrfcal portion of this
Supervisor and returned to the Ouilding Division
TOTAL CHARGES . TOTAl CIIARGES
WIIERE STATE L\H REQUIRES that tile Electrfcal work be done bY,an,
shall not be vali1 until the label has been signed by an Electrical
I IlAVE CAREFUllY EXAt'lINCD the completed application for permit, and do hereby certify that all infonnation hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Sprfngffeld and the laws of the State of Ore~on pertafning to the work descrfbed herefn, and that 110 OCCUPAIICY wfll be made
of any structure without the permission of the Ouildinl] Division. I further certify that my registration 'tlith the Ouilder's
Ooard is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with Or.S 7Ql.055 will be used on this project.
SIGIIATURE f2~q/~/.dddJE sh ~
f
permit
IWfE(please prfnt) On; II e. A ,Tllayp
Zone r ./
Fi re Zone
Flood Plafn
BUIlDING PERflIT
Charges and
Surcharges
PlUt~BING PERMIT
Charges and
Surcharges
ElECTRICAl PERllIT
Cha rges and
Surcharges
MECHANICAl PERMIT
Charges and
Surcharges
FOr. OfFICE
/
'f
USE mIL Y
S~, Ftg,
Sq. Ft~.
Sq. Ftg.
Type/Cons t.
Oedrooms
Stories
")"-/9'
Units
Occy load
Occy Group
'"B~L
",
t1ain x Value
Access x Value
DtherC=-C,cz;T. t:7B'? r Value
TOTAl VAlUATION
2......-....:-
"2
Plan Ck, Conm/Ind
____________ ~fRldo P.or Foe
Plan Ck. Res
30%fBldo Per Fee
Fence
Systems Development
Charqe tl,5~l '
D/jlI1O
____~~- Sfdewalk
, :<: _ 2-5"" A/C Paving
____ ____ __ Curb Cut
Total Comb. Permit
~TOTAl
'17-:ZS-- ,
.
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
.A. Job Address
B, Legal Oescription
1, . example- Tax Lot 100. Lane County Map Reference
17 03 43
2: 'example- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D, Energy Sources
1. examDle- heat/electrical ceilinQ/or forced air I
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examDle- 1250 sq, foot house. SOO sq, foot gara!
2. exa~le- if new project. check new - if additioJ
check add. etc.
. F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family rc
3. example - convert single family residence into
restaurant (change of use)
.G, Value of 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 be able to contact appropriate
persons regarding design infonmation or jOb site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedule~
A. Except where blank spaces occur in the description '
portion of the Mechanical and Electrical Schedules"
the applicant need fill-in only the No, Boxes adjac!
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 schedul
have been abbreviated
2. If the item(s) to be installed are not covered c
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 be delivered to
electrical contractor for signature by his electrica,
supervisor. The general contractor is.not authorized
to sign the electrical label, ---
Ill, 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
signa ture.
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 cha.rges are due and
payable when the penmit is issued.
V. FOR OFFICE USE ONLY
,:TV OF SPRINGFIELD
Clly Hen
Sprlngftold, Orogon
Development Services
OFFICIAL RECEIPT
\
\
I
.'
17136
Dele M~ 2"2., '9 9D
r
Rec'd From ~ S eC(7'C-/ ...
Address :<'~ .~~~~ r-
Received For: ;:J..:,1"r/'9~c,i/6 k,.~.
. 7!' . _ /. .
~.
c.2?
~
'-/,c;. ~
v-
<' :2..'5>-"'"
)/7. 2:;::' -
.L/~7/Y/
Amount Received
-
y /_ -zS
.
.!!L
~~
. r~ AUTHORlZEDSlGNATUREP
Frantler BUSINESS fOAI,tS. INC. 4!0031:M2.''''
'"''
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project .Information:
PLANS REVIEWED BY:
I
name
t!..o8~ ~~..:;:?Signature~~..-? date '!5-77-"'7P
I.