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Home My WebLink AboutPermit Electrical 1987-8-17 I IrISPECTlOII LHIE 726-3769 ;' Job Address /Rsg '/ Legal Description L.#O .JrA' ~ CITY UF SPRINGFIELD CorIBI ilATI ON APPli CA Tl ON/PERMIT E!lERGY SOURCES: Heat ('Sa ter Hea ter Ranqe ValuE of l'lork: ..,-~- -~ Buih:inQ Permit Info: Describe l'Jork(Le. t Family nes;dence Hith Jl..ttached ~araCle) - ell~ 'lPgll~I~1 5~/HG......~z;> N'e~S Owner ~?,,/7AL //r/~ ~""_'~n..__' Address ~n~ ?/ ItlFORttATlON liNt 726-3753 So. Ftq. (.lain ~q. Ftg. Access. Sa. Ft9. Other 'riel... . Add Al ter ~ep. --Fence Demo Change/Use -Other- - :Sr. Build Single IX) ~ tJ) '-fi V Address UtSlliN TCMI (namel Phone (address) /N"rA-~' 25' &.S-<!!' ~ /g' c:F /I:1'.PHALT ,Z?~ 'yE?:> ~,>) w_.,.~ /i'z=c.~ E_5~~? iiies. no.l (exnires) N C-W' Yd/.?AI:',A/, y: Construction lender , Primary Structural Electrical f1echanical CONTRACTORS (namel (addre~~ ) (1 iC':<:.. no.) (pxnirpc;.) (ohnnp nn _-\ Genera 1 PlumbinQ Electrical /llechanical' PLUIIBIrIG ELECTRICAL MECHANICAL rW.1 -----lEach single fixture IRelocated building (new fix. additional) IS.F. Residence (l bathl IOuPlex (1 bath) each IAdditional bath Hater service FEF (HARr,F JJO > > "- J:JiAB.liE ...llil....1 >>> r>JARGL Residence of SQ. FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall S~~rp hp~tp~ ~~rl ~pnt Sewer ITempOrary Construction IChange in existing res i d_ence multifamily, comm. or !ndustricl1 Storm Sewer Of amps. Appliance vent seo.arate Stationary evap. cooler Vent fan with sinale duct I Vent system apart heatino or A.C. I ~lechanical exhaust hood and dUl't from C0I11.1. /! NO. FEEDERS Install/alter/relocate dic;trih. fppdprc; IOf amps.1 I I I ISSUAIiCF nF PFR!IIT TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES WHERE STATE l~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division Wood stove/heater I HAVE CAREFUllY EXNlINED the completed apfllication 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 Springfield and the laws of the State of Ore~lOn pertaining to the work described herein, and that rlO OCCUPAUCY \'Iill be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055. that if exempt the basi~for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7Q1.055 \ e used 01 this project. Zone Fi re Zone Flood Plain Type/Const. Bedrooms Stories Units Occy load Occy Group S iGilATURE FO~ nFFICE USE OIIlA' . Sq. Ftg. Sq. Ftg. Sq. Ftg. -' IIAHE{please print) (.l~,. \\" \(P\r",,~~ t1ain Access Other ~....,~ x DATE rt/l7/n -- Value Value Value ,5"'~.- , x TOTAL VALUATION BUILDING PERI.IIT Charges ant:: Surcharges I Plan Ck. ____________ ~/Bldo Plan Ck. 30%lBl da I Fence I Demo I Sidewalk I.AlC p,aving r Curb "Cut I Conm/! nd Pj>r Fpp Res Per Fee ISystems Development Charae (1.5~) I I I PLUliBING PERMIT Char.,ges and Surcharges ELECTRICP.L PERI~IT Cha rges and Surcharges I1ECHANICAL PERMIT Charges and Surcharges ~~- Total~Co~b. Permit I TOTAL I~ S- C2 -- 1 - - ',' .' , ''Ii , ^....l COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Applicant to furnish A. Job Address B. Legal Description 1. example. Tax Lot 100, lane County Map 11 03 43 2. example- Lot 1. Block 3, 2nd Addition to ., .Spnngtield Estates._. >'. ... _ C. Name. etc~ of owner and'construction' le~der' D. Energy Sources..... d_ ~ . <-. . -... .. \, ',- ..... 'i:' examole-" heat/electhcal ceiling/or forc"ed air qas 2. examDte~ waterheater/e,lectrica I/or, solar . E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. . example- if new project, checknew - if addition, '\: check add. etc. F. Buil d i n9 permit ; nforma t i on: 1.\ example - construct single family house with an , attached garage 2. example - remodel existing garage into family room 3. examole - 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, DES I GN TEAI'I AND 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. Abpreviated 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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 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. '.> ..-...... ~" ',.:... ~ . . .'~ . -', '. :-.:' - II. be delivered to the by his electrical is not authorized III. IV. V. FOR OFFICE USE ONLY Permit Clerk ,j .1 PROJECT CONDITIONS TO BE SATISFIED BEFORE DCCUPANCY: \ Fiednit \ ' 'j J appl icant exempt_from. regis'tration - - .--~ . -~.,., '-.. , with the Bui 1 der I s ,Board' because':, \ -, .Add-itional Project Information: , , PLANS REVIEWED BY: name L~8/Y'~P~~ s'ig;'a~~~e a:,~ ~,..-" /#'_ ~......-r/ date :F?7''?<:S!'J ~ ~I' :;l~~'~~~~~~ ~;':,~, ~'\:!S~3::~~~,;'~~i;.~' ,.-:~: t~~{,~-~ ~ ~. '- t:..;.",' '-' ~ . , . "''J''. .:. '''''''\-... e , I IrISPECTfON L1f1E 726-3769 Job Address /R~"/ legal Ce~cription . , . ,> / ..40)r'A' CITY Uf SPRINGfiELD COMBIIIATfON APPLlCATfON/PERMIT <. . ,.,. ,'>, "S":.' EilERGY SOURCES: 47". '. Meat Hater Heater '" INFORllATlON LJik 726-3753 SQ. fto. /"ain . ~q. ~tg. Access. So. Fto. Other flew Add A 1ter ~ep. --Fence Cerna Change/Use -Other - - <)~/h'r..,.~.o #€~.; Owner C::;P/;AL /n</t!"=S ~...........''''"._ .._, , i Ranqe o J ValUE of Hork: .<;-~- -~ BullC:;nQ Permit Info: Describe \~ork(Le.. Familv nesidence IHth f1.ttached r.araae) Build Single (X) ~ It!) I~ Address '~n7~ ?/ New ~/.?AI:', A/. Y": Address Ul:.~lljN TEAr,' (name) Phone (address) /N."r4~' 75' &![<!' -( /g' c:F /I.~~#AL7 ,2)A 'y/!'b ~l> c..v_.....~ /i'z::c.~ EA5~~? (iics. no.l (exoires) (ohone no.l Construction lender , Primary Structural Electrical Hechanical CONTRACTORS {name} (address) f1 ico;., no. \ (exoirp<i) (ohonp no_') General Plumbina Electrical ~lechanical' PLUIIBING ELECTRICAL r"Aoo,I 110 MECHANICAL NO. FFF (HARGF NO '" ~~~ nlADr.~ Each single fixture Residence of SQ. fT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (J bath) Duplex (1 bath) each IAdditional bath ~!ater service New circuits alts. or extensions Floor furnace and vent sERV ICES' Recessed wall So~rp h~~tpr ~nrl vpnt Sewer ITemporary Construction IChange in existing rps i rlJ'nrp multifamily, comm. or Inrlu<it.ri<'l.l Storm Sewer Of amps.1 Appliance vent ~poart1tp Stationary evan. cooler" . Vent fan with sinale duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and duc-t C0I11.1. /I NO. FEEDERS I I I I Install/alter/relocate rli<itrih_ fpprlpr~ IOf I I I Wood stove/heater amps. TOTAL CHARGES WHERE STATE L'H REQUIRES shall not be vali1 until the . TOTAL CHARGES that tile Electrical work be done by an label has been signed by an Electrical ISSUANCE nf PERIIIT I TOTAL CHARGES Electrical Contractor. the electrical rortion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFUllY EXMlINED the completed ap!11ication for nermit. 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 Soringfield and the laws of the State of Orel]on pertaining to the work described herein, and that tm OCCUPAUCY \'Ii11 be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055. that if exempt the basi ~for exemption is noted hereon. and that only subcontractors and employees who are in comoliance with OP.S 7nl.055 e used 01 this project. Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy load Occy Group S IGllATURE fO~ nrFlCE USE OIllX . Sq. Ftg. riain Sq. Fta. Access Sq. ftg. Other ~lh""""" . UAI.IE{please print) (.1__ \\..\(p",""""" x DATE ~/nln ---. Value Value Value ,5".::>~.- ~. x x TOTAL VALUATIOII BUILOING PER/lIT Charges anc Surcharges ~ I PIM ~. ___________ 65%/Bldo Plan Ck. 30%/Bldo I Fence I Demo I Sidewalk ------------ I A/C Pavi ng I Curb Cut . ~ I COITll1/l nd Ppr Fpp Res Per Fee ISystems Development I Cha roe (1. 5r,) PLUI1BING PERMIT Char.ges and Surcharges I I I I I ~.::? .s>s Total Comb. rermi t I I TOTAL I~ S- c::? ........ ~ ELECTRICAL PERI~lT Charges and Surcharges I1ECHANICAL PERMIT Charges and Surcharges + , ",.,;,:\'t!'::'~:t~~~'ii.4~4.tl~"~'!j(~'~;,lI:>f~iil8~";':"'J':'''1'., 'TY' '-0" F" S' "p RINGFIELO" ::.:.\~'tiJ ." :'_'.~.~,._'1" :,':'a~~.~..~<':t,~,~:.::,: <;~~';:':':'~~~;l')~~:'~"..".~,~~"f; ~ ". '", ",:-r~.~ ';.-- ..:~ .'.':;, ..~..\.~~:.,..":-: :'~2.: '.~':1~~~~~:':i~br :-~\~<>:~,7:.'< :..'.. .... " City Hell" ',.:" , ..'~ ,,:; . .'~ ..:.~"'..;t......~..,~;;~", .;}.' I' " .' 'Sprlnllleld Orllllon. . , \".1~ \~':~~\.lt.f'~' "~;i"'\.'; r';~. . . I -. . . ~.:. -._,.I':~C~~.':' ,;:' Otftce 01 Community and Economic Developmenl ' 't .. . .~~:'!I!".!~:~1i'{..t:i:~\:t. '''-'''~.'~frlt'~ht /;- - ...,'I,:..y_.'....-, ..~..i$""...,t'-... , 'SE':~"i~~, >OJ,lllIo~~1~r:~.,-ti1 :', l'~ . '-' ,'t "-;:'~1~ """fl'~"""~~I'" .' '''"',11. OFFICIAL RECEIPT -,:'1,',"- . 111 , ;.' COMBINATION APPLICATION/PERMIT (CAP)'" .. ':';'~;",'t'.'(J":I;;..' '~';, . . ;.".,.:,:.~, :',L'; ;,:." ',>:~J:', 10039 . .t\ . ,d~ ".' r. ,-.}. '. .. ....0.., '1,\ ~'t,i"l;,.;;1&").t)i'~:.ml' fA .!f,::: -, . . ,~n':,f-i~~:r:" ~-:.~~. '~, \::.-,.:1;,~;;, '" jJ -. '.: ~. ;":;}!;~;:~WcO~';~~\:';>" "~ ,~:l":'~. U,:::, ~ Ij~~f:\'f~~P1J~~~1~~~'e:~rn;sh '., ~ ,',..,..,,,,, """?"''',; ':~ :~, . Date H-I~. {~. . 19 G' / ",','" "', " B. i~ga~x~~~~;:Pi~~\ot 100. Lane ~~u~ty 'M~~.~:tr:n~;:' C R~c'd From '5T.~;.,~.P/~J~ :...v~~ c:: " ~ II 03 43 ;4 'fl."? ~"r7-1- ~. . . t ": 2. example. Lot I. Block 3. 2nd Addit;on to"':: Address .s~P/..b,,~./f.''9?9''?? ",' .;)pringtield Estates, ,"_,_ ~,~, 1 / C. Name, etc~ of owner and',constructfon lender -\ >"r ( O~. Energy Sources" ...; I '. . '. . . . . ':>... ,",> . 1: example- he'athdectrical ceilinq/or forc'ed' air c 2. examole. waterheater/electrlcal/or, solar , .,,~ ">'''~. E. Square footage or valuation, etc. - . (j: I. example. 1250 sq. foot house. 500 sq. foot garag '. 2. .example- if new project, check-new - if addition check add. etc. . . F. Building pennit information: 1. example - construct single family house with an attached garage 2. examole - remodel existing garage into family ro 3. examole - convert single family residence into (. restaurant (change of use) G,. Value of work as def;ned in SecUon 303 (a) of the Structural Specialty Code H. DESIGN TEAl.' AND 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. C.' ,II. Abpreviated 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 adjacel' .C' to the appropriate ;tem(s) to be ;nstalled B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division ,1. To conserve space on the permit form the schedull ' C' haVe been abbreviated 2. If the item(s') to be installed are not covered or the abbreviated schedules you should consult the full schedules ---- ,"- C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND 'CHARGES ON THE SCHEDULES O. As noted on the CAP. the label must be delivered to tne 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 ~ermit is issued for his Signature. IV. Fees and Charges Plan check rees 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. . ~~j1~~~l~~;;;:;,X~~r' ;. .'. ., :\.'. ",." Received For: j~lI" ~c>.<>9") '.' ii,1 ~ ( '"7/ '!:;tt,o;Y~~~'7. .1 .f"'e>....... ~ l .- (\ ..~ " .,t. ( ~, ~ ; ~#;g/C6 ., ~' 1" ft.. ;~, "':,"" ~ ( !:!.-.t/..... '., \". ....'1 r ~ '~. Amount Received '::> 6 I ,~ . 'I . // .'?::::>~ >: j /A~~/ ' ~ /' F AUTHORlZEO SIGNA luRE /' \, ~... : ':';:"'1" f . il5lU3 I r . BUSINESS FORMS, INC. ' IWIJ42.a1" .' ! . .-.--~-:'-.-. ..-. .....-- -, ..' . ,. V. FOR OFFICE USE ONLY Permit Clerk ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: -. ,! I Prrmit applicant ,exempt from, registration with the Builder's.Board because:. -.. Additional Project Information: ~. t. ". " . PLANS REVIEWED BY: name L~/l3'/V~P~~ s'ignat~'~e 4-'"..~,,-- /4' - /" date g.-/'?75i'~ ,.... ,. ,,~ -_:::..- . ;, '.....- '. t ~ :. ,~:,:;t~~;if~~:~;;;~j;:1~~;s!:i~:~~:\;:~~,;,::::~~~~, ',r.