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HomeMy WebLinkAboutPermit Electrical 1990-2-14 Job Address d'6SLJ I.. CITY OF SPRINGFIELD . INFORlIATlDN UNt COMBINATION APPLICATION/PERMIT . 726-3753 {'-:f\-r::- E!IERGY SOURCES: ...-/ Sq. Ftg. I"ain \. .LU 0, I 'Q'11 Iv ileat _______ ~q. ~tg. Access. (. \ \R'I~te, rHea Sq. Ftg, Other flew Add Alter Rep. --Fence Demo Change/Use ValuE ofr)olh ") ~er-- Builtiina Pe~lft Info: Describe Work(i.eo. Build Single Familv nesidence Uith Attached Garaae). ~ c\.i '5-;0l)'\\ \\Q C't~ JnY , 0 ~ 0 M 5\ \(\i'\ \) 'K\qgn.. y (ohone no. \ ~. .-0 ~ o cJ jINSPECTlON LINE 1726-3769 Legal Description Owner T\\t\\')\Q [)) Vrl.- 14(0- ::~E" W0%'l' W.t71J7 Address DES I GN TEAI1 (name) Phone "(a"ddress)--' (1 ics. no.) (exoiresl Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (1 ;('<;, n(\~) (~\ (.Qhnn". nn. \ Genera 1 Pl umbi no ElectricaN.R. Brabham, Inc., 10-D West "Q" Street, Spf1d., OR 97477 20-87C 10-1-90 747-6638 ~1echan;cal PLUIIBI NG ELECTRICAL FEE rHARGF Nn ~J:'r: r"ARliE. NO Residence of SQ. FT. \ New circuits alts. rD!1S) or extensions SERVICES MECHANICAL NO, r:E.L .QJARlil Each single fixture furnace/burner to BTU's Relocated building (new fix. additional) Floor furnace and vent $.F. Residence (1 bath) Duplex (1 bath) each Additional bath Recessed wall ~nnrp hp~tpr ~nrl ~pnt Sewer 11 0\s~@L~cOh,a. ARt=)~ . 1'" ' Temporary Construction Change in existing ree;. i qr.rlCP multifamily, camm. or Industrial Storm Sewer Of amps. Appliance- vent seoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood and durt Wood stove/heater Water service COffi1./IND. FEEDERS Install/alter/relocate distrib. feeders Of amps. ~~ \':),W TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the TOTAL CHARGES c5y(..),.~ ISSUANCE OF PFR!lIT. 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 EXAMINEO 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 OCCUPAHCY 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 ORS 701.055 will be used on this project. 'i ~- L Af\lT'2.. SIGrIATURE~ ~ti Q,'S DATE 2.J lL.j J '1D llAJ.1E(please i>rint) _ I \ M FOR OfFICE USE DIlLY i:.S Zone Type/Canst. Units Sq. Ftg. riain x Value I Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value Flood Plain Stories Occy Group Sg. Ftg. Other x Value TOTAL VALUATION BUILDING PER~IIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldo Ppr F~e ------------ Plan Ck. R-es 30%/Bldo Per Fee Fence Systems Development Charqe (1.5~) PLU'1BING PERMIT Charges and Surcharges , D~mo ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges _dHd .W (lo .t~ Sidewalk AIC Paving Total Comb. Permit TOTAL I i 33<(;,~ Curb Cut J ,. COMBINATION APPLICATION/PERMIT (CAP) . "-- . . ,---- - - . I. Applicant to furnish A, Job Address B. legal Description 1. example- Tax Lot 100. lane County Map Reference 17 03 43 2. example- lot 1. Block 3. 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction" lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. examole- 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. example - 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permi t . '~ .' , - - - . PERMIT VALIDATION' , i. ~ ~G ~~/P &d- 1J\\~ , I': II I Cl",(jDClJ Permit applicant exempt from registration with the Builder's Board because: Additional Pro~ect Information: PLANS REVIEWED BY: name signature date