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HomeMy WebLinkAboutPermit Electrical 1990-3-30 . '1 ) .'1 I INSPECTION LINE 726-3769 Job Address 4-9SJ~!<-';~.&.uk }('cL , legalOescription /?-C>-<-"Z!i8-<:>C;> ~7=C:S ,/ . CITY OF SPRiNGFIELD COMBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Hark: ?~_ =-C:> Pw{~/-~(' Builoino Pennit Info: Describe l~ork(i.e.. Build Single ~~ Family nesidence With Attached Garaoel M'5rA"LL /~ r?...=/~ft ,;;.~< -/ rYr--=_~ /.?''T-''r ~<2~ c:::::://.?C?-?""~, (l1C"<;. nn..} . INFORJ1ATION liNt 726-3753 Sq. Ftg. '.lain ~q. Ftg. Access. Sq. Ftg. Other liew Add Alter Pep. -Fence Demo Change/Use Other- - I~ ~ ~ ley Owner' L?</Je...... G-a-r"n~ ^ddress"3'7"e~1C /7?A'-/":r _~-er5' /-;>,r, ;::::-/ ~ ---,..~ . L-~~,_~, .~ .... Construction Lender Address UI:.:)1(:iN II:.Af1 (name) Phone (address) (pxnirpc;,) (nhnnp nn. Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (1i('o;;. nn. \ (p'll'rdr,:ac:,\ (nk",W'lp I'ln.1 General Plumbina Electrical p~/,/ S7UcE ~~L~_ k... Fr,"_';"_1:~ .&x 2.SiF'::z.!:.. .2.P--.rrc... /0-/-'7'= ,4PsH~' Hechanical PlUllBI NG ELECTRICAL MECHANICAL NO. FF> r"'lRllL yn C~~ r~ARaE Nn CC~.llIARG.E.. Each Single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) ):. New circuits alts. or extensions '7C>/-f~'?7?E SERVICES <:2-5Z . Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each Additional bath Recessed wall <:'ni"rl'> h"'i"tj:lr i"nrt \t",nt Storm Sewer Of amps. Appliance- vent S~Daratp Stationary evap. cooler Vent fan wi th sinol~ duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and duC':t Sewer Temporary Construction Change in existing res i d_e.nce multifamily. comm. or Industrial ~Iater service CO~1./IND. FEEDERS Install/alter/relocate distrib. f~~ders (Of / c;:>C? amps. Wood stove/heater 6-V I SSUANCF OF PFRliIT TOTAL CHARGES TOTAL CHARGES ?/~ 5C 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 vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of OreC]on pertaining to the work described herein. and that rw 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 701.055 will be used on this project. ~/X~ ~ ST~ ck:.. /7/, - '7.-h- /' IlAI-lE(please print) '/ SIGI1ATURE p~ ..r;- ~~--' FO~ OFFICE USE Dill Y .3-3c>~ ) DA,TE Zone /-/ / Tyoe/Const. Units Sq. Ftg. f1ain x Value Fire Zone Bedrooms Occy Load Sq. Ft!]_ Access x Value Flood Plain Stories Occy Group Sq. Ftg. Other,c-~ c::z=r. OA" ..chalue TOTAL VAlUATImr BUILDING PERHIT Charges anc Surcharges Plan Ck, Comrn/lnd 65%/Rldo Ppr Fpp ------------ Plan Ck. Res 30t/Bldo Per Fee Fence Systems Development Charqe (1. 5~) PlUI~B1NG PERMIT Charges and Surcharges Demo ElECTR 1 CAl PERr~1T Cha rges and Surcharges ___3'2~_ Sidewalk /_ 8;;??' A/C Paving Total Comb. Permit 11ECHANICAl PERMIT Charges and Surcharges Curb Cut TOTAL 3'7'- :;8, . . \ -", . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2. examp.le- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender O. Energy Sources . . 1. examole- heat/electrical ceilinQ/or forced air Qas 2. exam~le- waterheater/electrical/or solar E. Square footage or valuation, etc. I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project. check-new - if addition, cneck. add, etc. F. Building permit information: 1. exam~le - construct single family house with an attached garage 2. example - remodel existing garage into family rcom 3. examjle - 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. OESIGN 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. 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 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 Permit Clerk ~ 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 !-6/7/5/~~ 6..;.....~ignature ~~.-~f~~.........~ate ///Y ~ 7-?~ -7i:? . . . INfORllATlON ell'R 726-3753 Sq. fto. '.Ia i n ~q. Ftg. Access. Sq. Ftg. Other !lew Add Alter Rep. -Fence Denio Change/Use Other- - Buil d Sing 1 e ~ ~ C) Owner L?<;O e... G-a-rd/?~ Address'3'1"87'L /;t;IA';r-/~~5 /-??"l Ranqe ValuE of Hork: ?~, =-Ci> ptfonf' /'z:;J.$ ,Buildino Permit Info: Describe Hork( he.. . Family Ilesidence lHth ".ttached (jaraC'e) =/""'" ~,.--- C-(~~,~".:.-- '_ . ,.. , U"5r#tU.. /~ r?--c/~.rr ~~-<. ~ ?:.Yr~_z>/?'7-"r ~a- c:::::..//?Cvr-/'5"" (li~~. ~l (~~niresl IDhone no.' Construction Lender Address UI:.:>ll:irl ItAf.' (namel Phone (address' Primary Structura 1 Electrical Mechanical CONTRACTORS (namel {address' (li('s. no.' (pxnirpc;\ (r"ltlnnp nn \ Genera 1 PlumbinQ Electrical p~,-/ S7Z-<c.E E.k.chIL.z..~ F(.~-""._~ Box 2. s;P2!: .2. ~-.,f-<j"c:.... IP-/ -9= ,4F5'H.>J' Hechanical PLUIIBIIIG ELECTRICAL MECHANICAL fEE ' CH~RGE NO fff r"A&liE. NO. ..Eff rH<1RliL Residence of furnace/burner to SQ. F1. BTU's New circuits a1t5. Floor furnace ;:. or extensions <::2.5Z . and vent --7C>~ /7.?'?J5" e SERVICES Recessed wall Sn~tpr ~nrl upnt Temporary Construction Appl iance' vent seoaratp. Change in existing Stationary evap. resjqe:ncp. cooler multifamily, COIll1l. or Vent fan with Industrial sin91e duct Of amps. Vent system apart from heatino or A.C. CDMI"./IND. FEEDERS Mechanical exhaust hood a.nd dut':t Install/alter/relocate Wood stove/heater distrib. feeders ( Of / c?C/ amps. /):_v NO. Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath ~later service Sewer Storm Sewer TOTAL CHARGES WHEnE STATE L~H REQUIRES shall not be va1iJ until the TOTAL CHARGES I ISSUANCf OF PFR/lIT ?/~ 5C TOTAL CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXN1INED 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 oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAI~CY 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 Or.S 701.055 will be used on this project. A4/Xj1 ~ sn<ck. UA/-IE(please print) SI(,II^TURE 4X.:L ;;?.A!z;;~ 3-5o'7~) DATE Zone /.,/ / Fire Zone Flood Plain FO~ OfFICE USE OlllY Type/Canst. Units Sq. Ft9. r1ain ,x Value Bedrooms Occy load Sq. Ft9. Access , Value Stories Occy'Group Sq. Ftg. Other"c-C: ~ 0..-9' ,cha1ue TOT^L VALUATlOtI BUILDIIIG PWIIT Charges an~ Surcharges Plan Ck. Comm/lnd ____________ ~/Bldo PH Fpp Plan Ck. ries 30%lB1do Per Fee Fence Systems Development Charoe (!.5~) PLU'~B1NG PERMIT Charges and Surcharges DllRlo ELECTRICAL PERI~lT Cha rges and Surcharges ___'3.2.-;SZ::;- Sidewalk /- 8~ A/CPaving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 373$. . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax lot 100, lane County Map Referencl 11 03 43 2. examele- Lot I. Block 3, 2nd Addition to '~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinq/or forced air 2. exam~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot gar' 2. exam~le- if new project. check new - if addit;c eneck add. etc. F. Building permit information: 1. exam~le - construct single family house with ar attached garage 2. exam~le - remodel existing garage into family r 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. OESIGN 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 Schedule 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 adjac 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 schedu have been abbreviated Z. If the item(s) to be installed are not covered the abbreviated schedules you should consult th 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 electrical contractor for signature by his electric. supervisor. The general contractor is.not authoriz' 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 signa ture. 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 . . _.:\.. I n - CITY OF SPRINGFIELD City Hell Sprlngftold. Oregon Development Services OFFICIAL RECEIPT 16564 Date /~/-? ~/ 19 c;,t:? -}. --' Rec'd From Y/f//C "7Tl/C/'.,/' t::-.::::.Z::<:::7. -:;:>O.~X::?.>&>'Z... Address (E6Z;:;6'~G/ 6X . '~:f/ 9',97- Received Fort .!r;:;/-S7" /7~'~~-r/ > v ~ I ~~ , ~'.p ;L5~ ~,.5'8 /- 88 _ /hqC, ~q . '5.8 ~;fC/~/G. !!.'!-. , 77'. p: B . .>> /~ t'l'''?-rn-- ;:e.--~b,> . V--/AUTHORlZEDSlGNATURE ,/ ___..3 Amount Received IFrDnttrr BUS'HiSS FORMS. 'Ne lSoO)lJ41.'" ...' Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name i'?/7/'/G~ 64"~ignature ~/.h'...-~~:;date /'/'~ ' p -:{'-;::"""" -7?