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HomeMy WebLinkAboutPermit Electrical 1983-8-5 I INSPECTION LINE 726-376g Job Address Z4D 11 ft7 fJ , CITY UF SPRINGFIELO COMBlilATION APPLlCATION/PERMrT EIIERGY SOORCES: Heat l~ater Heater Range ValuE of Hork: 7'/ Legal Description Owner 01- Address 1.-40 17f2G J.1l17fJ Phone 7'r , INFORllATION UNt 726-3753 Sq. Ftq. flain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Rep. -Fence Demo Change/Use Other- - ~ \}J '-. ~ ~ ~ \ 0 BUllriino Permit Info: Describe Work(i.e.) Build Single Familv nesidence With Att ed Garaoel Construction lender Address UtSlGl1 TEAll (name) Phone (address) Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (address) Genera 1 .. Plumbina ~Q..l^--' flies. no.) f1i~c;.. nn.) <;T!rt4?w;J e t...-r:af?1c. ZI!;tJ /lItI~ t;::tJ6aI[ Electrical Hechanical PLUIIBING ELECTRICAL -1!Q.,.1 lEaCh Single fixture I Relocated building (new fix. additional) Is.F. Residence (I bath) IOuplex (1 bath) each IAdditional bath I ~Iater serv; ce I Sewer I Storm Sewer I I I I I I I FE'F I rHARr.E NO I Residence of SQ. FT. New circuits alts. or exten"s; Dns SERVICES Temporary Construction Change in existing rp}jdrnr.p multifamily, COIllT1. or Tnduc;trirl.l Of amps, COMfI./INO. FEEDERS I Install/alter/relocate dic;trih. fppdprc; IOf amps. I I I TOTAL CHARGES TOTAL CHARGES WHERE STATE L"I REQUIRES that the Electrical work be done by an. shall not be vali1 until the label has been signed by an Electrical I ~~~ I r'1ARG.E. NO I 10-- I I I I I I I I I I I I 'U?, 190 (exoiresl (ohone no.l) * (exoirps) (ohnnp nn.) 20--/<17(; ~/'$I'(!; 4tl/-n~ MECHANICAL. , I ~~~ I rl-l'1B.G..E. 1/ furnace/burner to BTU's Floor furnace and vent Recessed wall Sn~r.p hPntpr nnd vpnt App 1 i ance vent seoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart heatino or A.C. Mechanical exhaust hood tlnd dur:t Wood stove/heater from I SSUANCE OF PFR'lIT Electrical Contractor, the electrical portion of this pe~;t Supervisor and returned to the Building Division TOTAL CHARGES I HAVE CAREFULLY EXNIINEO the completed application 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 OCCUPAIKY 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 ORS 701.055, that if exem the basis for exem ion is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 w 11 be used on thi . roject. 1lAf.IE(please print)~I'tfJf?8Z- J. :;W/.,eTl:?,JSIGllATUR FOr. OFFICE USE 'OIlLY Sq. Ftg. l1ain Sq. Ft~. Access Sq. Ftg. Other Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group BOILOING PERfIlT Charges anc Surcharges Plan Ck. Comm/Ind 65%/Bldo Per Fee Plan Ck. Res 30%/BldQ Per Fee Fence ------------, Demo ~ f'\ c::lC) I Sidewalk ~<;4' ) A/C Paving PLU!1BING PERMIT Charges and Surcharges ELECTRICAL PERI:JT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Curb Cut <"" omt-s--S3 /I x Value Value Value x x TOTAL VALUATION Systems Development CharQe (1.5~) '. I I I Total Comb. Permit J I TOTAL C!)O, t(sD , , COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION J. Applicant 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 springtield Estates. . , C. Name. etc. of owner and construction lender D. Energy So~rces' r 1. example- heat/electrical ceilinQ/or forced air Qas 2. examele- waterheater/electr;cal/or solar E. Square footage or valuation. etc. 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, cnee k add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. exam~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. DESIGN TEAM 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. BOILOING 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 permit 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. - ~ lot 60<6 ~ . . /) V. FOR OFFICE USE ONLY . l.... Clernf(j)~ Permit PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the .Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date