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Home My WebLink AboutPermit Electrical 1982-7-28 ../." >~ c:1 I J IrISPECTlON LINE. 726-3769 - Job Address ,..;2/G Legal De5cription . CITY Uf SPRINGFIELD COIIBIIIATION APPLlCATION/PERMIT E!IERGY SOURCES: Heat (,later Heater Range ValuE of Hark: . INFORlIATlON LlNt 726-3753 Sq. Ftg. I-lain ~q. Ftg, Access. Sq. Ft9. Other r~e\'" Add Alter Rep. --Fence Demo Change/Use -Other- - ~ St-.. r~()od lJ.J.A.1. P I 0 nriu.atJUJ/) Address :)j ( Q '""YY'ltu fl c0P+:1c-L Construction lender LJ Owner Phone Build;na Pernlit Info: Describe Work(i~e., Build Single Family nesidence With Attached Garaae) Address Ut~lliN ftAr-' (name) Phone (address 1 ~""-~ ~O/L) (~ni res) (l ics. no.) (ohone Primary . II Structura 1 Electrical Mechanical CONTRACTORS tname) (address) (lir:e:, no,) (pxo;res) X lf~ ,... " Genera 1 Plumbina Electrical ritv-mif-frrn fJO(1J. 9fl. &'i 7l:A r ..J..J D-,.0-y 0 , u I ~lechan; ca 1 PLUIIBIrIG ELECTRICAL MECHANICAL NO.1 I FE'F I r.HARr.E Nn I I ~~~ I rI-lA~~~ NO, I I 1='1=1=' 'rs.lA~~~: Eac~ single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) IS.F. Residence (] bath) IDuPlex (1 bath) each [Additional bath 1~later service I Sewer lstorm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~r:p hPntpr nnrl vpnt Of amps.1 Appliance vent spoarilte Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A,C. Mechanical exhaust hnnrl ilnd rlur:t. Temporary Construction Change in existing rp~ j 4e.nr-", multifamily, comm. or lnrlllo;,triill COffi~./IND. FEEDERS Install/alter/relocate rli<:.trih fpprlpr" Wood stove/heater Of amps.[ TOTAL CHARGES TOTAL CHARGES WHERE STATE L,'I~ REQUIRES that the Electrical work be done by an' shall not be valij until the label has been signed by an Electrical ISSUANCE OF PFRlm I TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apr1ication 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 pertaining to the work described herein, and that NO OCCUPAUCY will 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 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 7Ql.055 will be used on this project. WAr.IE (p 1 ea se print/f,AJ1YI d..f;,M ['1.<prT~/c:' S[GIIATUREWJ~..:[ ""Iif.M~~AT;; -b2..8: 8'~._ FO~ OFF I CE USE OIJL Y - I Sq. Ftg. r1ain x Value Sq. Ftg. Access x Value Sq. Ftg. Other x Value Tvpe/Const. Bedrooms Units Occy Load Occy Group Zone Fire Zone Flood Plain Stories TOTAL VALUATlorl BUILDING PERflIT Charges and Surcharges Plan Ck. Comm/lnd 65%1Rlrl(l Per Fpp ------------""Pian Ck. Res 30%lBl da Per Fee Fence Systems Development Charae (].5~) PLUMBING PERMIT Charges and Surcharges D~mo ELECTRICAL PERI~IT Charges and Surcharges /IECHANJ CAL PERMIT Charges and Surcharges _ _ _ _ -LQ,-Ofj . ~/O I-Sidewalk [ A/C Paving I Curb Cut ____________1 Total Comb. Permit /O,;;D _~ TOTAL . , . COMBINATION APPLICATION/PERMIT (CAP) I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. lane County Map Reference 11 oj 43 2. example- Lot 1. Block 3, 2nd Addition to >prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/~lectrical ceiling/or forced air aas 2. examyJe- waterheater/electrical/or solar E. Square footage or valuation, 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 information: 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. DESIGN TEN! 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. 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. 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 the electrical contractor for signature by his electrical 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 penmit is issued for 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 are due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ;9 '1 ""--. PERMIT VALIDATION " ~qL/71 Permit Clerk (1~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ;~ date ....."".-,.- ~.. ~...,,;~.~.,,,,,,,,,." ...-...............-. .V.",., , " .;..,,':.~j:':<;~~.~. .,,;. . -I v. . . !I~/Y\ I LT (:)1'-1 (Name or firm - please print) APPLICATION E"-er/fl , C. OEPARHlElIT OF 'PUBLIC WORKS : BUILDING DIVISION CITY.OF SPRINGFIELD FOR }b)CTRICAL INSTALLATIOrl LABELS '10 (1,,//0 K E ( Ie. F~ fJ lqJ/-f-. I-A Il/F (flailing address) (City or town) (Zip code) (Coun:y) , . P.-20 REV. 12-77 346 l.lain Street Sprincfield, Ol.coon . 97~7i D HOHE m~itER'S - I hereby certify that I am the owner of the property described below, at which location I propose to make an electrical installation for my own use and this property-'s not being constructed for sale, lease or rent. ELECTRICAL COIITRACTOR - Enclosed find S / Q cl Cl. for / (rlumber I IS THIS BEING SUBI1JTTED TO COVER ONE ELECTRICAL JOB? Label electrical installation labels. ~ No. '.RESI DErmAL Residence wiring less than 1000 sq. ft..................@ S 15.00 Residence wiring less than 2000 sq. ft..................@ S 25.00 Residence wiring over 2000 sq, ft.......................@ $ 35.00 Electric heat installation in existing residence,.......@ $ 10.00 ~ YES fro rlo. Amount Recei ved S' S S ~ S ~ S S S S S S SERVICES Temporary Construction Service,........... .'.........,...@ S 10.00 Service change only in an existing residence.......,.,..@ S 10.00 Multifamily ~/ith Central Service,commercial or Industrial: Service not over 100 amperes.....,..,.....,.............@ S 15.00 Service over IOU amperes but not more than 200 amperes..@ $ 25.00 Service over 200 amperes but not more than 400 amperes. ,@ $ 35.00 Service over 400 amperes but not more than 600 amperes..@ 5 50.00 Service over 600 amperes...........,....................0 S 65.00 Service over 600 volts..................................@ $150.00 CO:~:.IERCIAL AlID .HIDUSTRIAL FEEDERS Installation of Alterations or Relocation of Distribution feeders: Not more than 100 amperes.........."...............,...@ S 10.00 Over 100 amperes but not'more than 200 amperes..........@ S 15.00 Over 200 amperes but not more than 400 amperes..........@ S 25,00 Over 400 amperes........................................@ $ 30.00 Feeder over 600 volts...................................@ $ 40.00 S S S' S S MI SCELLAlIEOUS A 510.00 label shall apply for the following installations: A. Each trailer or mobile home space...................@ $ 10.00 B. Each supply for mobile home..........................@ S 10.00 C. Each farm building other than residence..........,..@ $ 10.00 D. Each irrigation pump................,.......,.......@ $ 10.00 E. Each el~ctric sigrl or outline lighting,...........,.@ 5 10.0n F. Each residential swirll11ing pool.......;..............@ $ 10.00 TOTAL SUBTOTAL ADD SURCIIARGE: 4~ of Subtotal DTAl S s S S ~ S S J6 00 S S Ai) S S /() .r-u BRA!iCIi C I RCU ITS -1 One new circuit; alteration or extension................@ $ 10.00 Two or more new circuits; alterations or extension......@ $ 15.00 H011E OWflER - The actual installation will be made by me or by (Name and address) who is a member of my family. Relationship: (Home OWner's Authorlled Signature) Cfjzp~c;.~J~ Electrical Contractor ~gnat~ of S'}IlI<rvisor) / o -L. 7 I, U b'- '..,0 - 8 ~ fectrlca 1 L lcense tlumber '<