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HomeMy WebLinkAboutPermit Electrical 1988-10-28 INSPECTION LINE 726-3769 . CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat t4ater Heater Range Valu€ of Work: . INFOR/IATIDN lINl 726-3753 Sq. Ftg. Hain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A I ter Pep. -Fence Demo Change/Use Other - - ~ c:::::s; ~. -....::. Job Address ~G-('... $1-. ~h-.erOV<2."'-r~ Legal Description Wd (~ R,~ - ;).O-l-h stY=!_ (<.v,r.~h'wl\ no,,) ~'Ir.w- AJ^. 105;).0 '- . -l /" Owner '.QrQ'{f" .5~ HI~"; 7Jiv;!>,,,,,, Address ;AI LlI G. I ~./-/., sr. G~ ()~ Q7L/-og Construction Lender Phone'8'.-JlJ, BuilriinQ Pennit Info: Describe Work.(Le., Build Single ~ ~ /~/I Familv Residence With Attached Garaael Ath" CI.,.<LJL GcdCrp.u I )JiWJ -['mal" &...;"Q ~Ch, 'A' ~ -S<z.y v I;~ 0>\ - Address UlSIGN TEAI~ (name) Phone (address) Mechanical CONTRACTORS (name) {address} ; (lies. no.) {exoiresl (ohane no. ) . /ALlf". tl00 '* J . r... t). (1;c<;..no.) (exoire<;.' (1)~(lnP !'In \ Primary Structura 1 Electrical General ~o. 130li l:J.toi'c'K SoJ'bl- UG.-IP 10'675: .:J..-<l-'ir? 9730'1 399-7009 PLUIIBI NG ELECTRICAL MECHANICAL NO. Each Single fixture FEE rHARr.F Nn I I <<< I rI-lAR~1=' fin I I 1='~1=' I rl-lAru:1=' Residence of furnace/burner to SQ. FT. BTU's New circuits alts. Floor furnace or extensions and vent ..:l SERVICES /ooA ;ld,~ <f.5.5!!. Recessed wall Snru"p hp,'ltpl" ;'Inri ....pnt Relocated building (new fix. additional) S.F. Residence (l bath] Duplex (1 bath) each Additional bath Storm Sewer Of amps. I I I I I I I ;; ::l5 I #1./7.),'5' I Appliance v~--- SPOilri\tp I Stationary evap. cooler I Vent fan with s;nole duct I Vent system apart from I hp<lti.,q or A.C. Mechanical exhaust hood and rllJrt Sewer Temporary Construction Change in existing rp$.;r1J'Jl("P multifamily, camm. or tnrllJc:.trial ~Jater service COMM./IND. FEEDERS Install/alter/relocate r1ic:.trih. fpprlprc: Wood stove/heater I I I I I VIe, Of amps. .5'70 &<....J.t:Wf} ISSUANCE OF PFR!\IT TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali~ until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an.-Electrical Contractor, the electrical portion of this perTilit label has been signed by an Electrical' Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon ;s 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 Oregon pertaining to the work described herein, and that NO 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 ORS 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. NAt.IE(please print) R'l t,k ,( BLAl\JS~~tJ SIGNATURE fi.;Af ~DATE IO-2&-~ FOr. OFFICE USE OIIL Y Sq. Ftg. tIain Sq. FtO. Access Sq. Ftg. Other ,. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value x x TOTAL VALUATION BUILDING PERfllT Charges and Surcharges Plan Ck. ____________ .,ill/RIde Plan Ck. 30%IBldo I Fence I D~mo Lf5.0'll I'S1dewalk _Uh_ ..:)~~51 AIC Paving I Curb Cut I ..' Conrn!lnd Pj"r Fpp Res Per Fee Systems Development Charpe ('). 5~) . PLUI~BING PERMIT '.' Charges and..-". Surcharges ELECTRICAL PERmT Charges and \,;\ Surcharges I ITotal Comb. Permit I I TOTAL L( 7, ~5'--1 MECHANICAL PERMIT Charges and Surcharges . . COMBINATION APPLICATION/PERMIT (CAP) ,PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference II oj 43 2. example- Lot 1. Block 3. 2nd Addition to Springfield Estates C: Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examflle- waterheaterjelectrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examyle- if new project, check-new - if addition, check add, etc. F. Building pennit information: 1. examele - construct single family house with an attached garlJge 2. examole - 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. 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 fu 11 schedu 1 es 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. I'~~~~ \ 0 r 2--~ - ~ V. FOR OFFICE USE ONLY Permit Cl erk C12-/ \ , . I 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