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Home My WebLink AboutPermit Electrical 1984-12-5 I INSPECTION LINE 726-3769 , CITY Of SPRINGfIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Range Valu'. of Hork: Job Address ~"s -m~ Legal Description Owner. J tJ f7.FJ 7/.>>..f!..J . Address ~Rxn . aJ. // OC elmJh&. 0 Kl 91~t;01 . 1 Constructlon lender , INfOR/lATIDN LINt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- -- ).. ~ Do \:) ~ Phone 6~ 7 - ~.;l Builoina Penmit Info: Describe Work(i.e.. Build Single Familv Residence With Attached G3r~op) .~j1ir ~ .~~~U IJ~I J....... ~ Address UI:.~llir. ItAf4 (name) Phone (address I Primary '.'.. Structural Electrical Mechanical CONTRACTORS (name) (address) Genera 1 :;~:::~:al V~qan ~ ~'echanical PLUIIBI NG ELECTRICAL NO. (lies. (1 ir."^ no.' nO'~l (ohane no. v (pxnirp,,) (ohnnp nn MECHANICAL Each single fixture FFE CHARGE NO I CCF rlJAllliE. NO, Res i dence of furnace/burner to SQ. FT. BTU's ./ Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (I bathl Duplex (l bath) each Additional bath I ~Iater service I Sewer IStorm Sewer SERVICES ITempOrary Construction IChange in existing rp$ j qp'nC':p . Imultifamily. camm. or Inrlustrial IOf amps. ICOMfI./IND. FEEDERS I Install/alter/relocate dic;trih. fppdprc;. IOf amps. ~Vdd' I I I I I I I Jr,tH ~i="1=' n"~ Floor-furnace and vent Recessed wa 11 ~n~~p hp~tpr ~nrl wpnt Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct I Vent system apart from I heatina or A.C. . Mechanical exhaust hnnd ;l nd rlur t Wood stove/heater ISSUANCE OF PFR!1IT TOTAL CHARGES TOTAL CHARGES /0 ~ TOTAL CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of'this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAf1INED 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 oerfonmed 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 UO OCCUPArKY 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 O~S 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. SIGNATURE ~~ FOr. OFFI CE USE DIlLY Sq. Ftg. liain Sq. Ftg. Access Sq. Ftg. Other NM1E(please print) ~).nJ A?" f~ Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group BUILDING PER~IIT Charges and Surcharges Plan Ck. Comm/lnd 65%/Rldo Pffr Fpp Plan Ck. Res 30%/Bldo Per Fee Fence ------------, DeRlo _n__JQ=.fl() I'Sidewalk .Vo I A/C Paving I Curb Cut ----:--------1. PLU11BING PERMIT Charges and Surcha rges ELECTRICAL PERI~IT Charges and Surcharges /lECHANICAL PERMIT Charges and Surcharges ~~ DATE J J / 5'/ S' ~:' , x Value Value Value x TOTAL VALUATION Systems Development Charoe (1.5%) '. Total Comb. Permit I I TOTAL J 0 _ <./0 /D. 4:'Q , COMBINATION APPLICATION/PERMIT (CAP) 1. 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/electrical ceilinq/or forced air Qas 2. exa~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house, SOD 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 foam 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 Pl~mbing, 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. --- 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 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 8E SATISFIED BEFORE OCCUPANCY: , PERMIT VALIDATION 'f2# b39sY @ 1fJ-/r/W L'lA! Pennit Clerk I Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name signature date