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Home My WebLink AboutPermit Electrical 1982-8-17 jY 1 INSPECTION LINE. 726-3769 Job Address JIll ('3 -I-ekl in Legal Description /7- tJ3-:J,;;.,!-';//J Ownerh.~ lA /, J...e... Address a fJ _,--. 71' -lL..-AT. rv[t'ld f)~1 ,,~ Construction l~nder ~ Address DESIGN TEAl.! Primary Structural Electrical f1echanical CONTRACTORS - ~ INFORlIATlON liNt 726-3753 Sq. Ftg. l'lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. Fence _Demo_Change/Use x,Dther CITY UF SPRINGFIELD COMBlIlATlON APPLlCATlDN/PERMIT ErrERGY SOURCES: Heat \~ater Heater Range ValuE of Work: l:; o l\\ -I 0- ~ ~ ... .... .c:. ... 7"L. ~ /IYJ ) if ^/f.r , . Phone / r~ I Buildina Permit Info: Describe Work(Le.. Build Single Family nesidence With Attached Gar~Qe) / II (f-i}(( h UOd I (t'-r<< JH-IC?.... oJ. p~ ,,"ckn fl. d" t2 A-/.IfY?~\ (name) Phone (address) (ohane no. (lics.no.1 (exo;res) (name) L-e'f.,e. ('".,..r;t IU-n-?i. Genera 1 Plumbina Electrical flechanical [;V~ ND. Each single fixture (address) (lies.no.1 /7/ ~~ (e}Co;resl ;(JrJ {AV (ohanp nn.) Ct ~(C n (IV)'"'''- ( L ",...J tv- ~ -h I 3L/9'-~1 PLUIIBIrIG ELECTRICAL MECHANICAL FEE CHARGE NO ~~~ rHAR~~ NO. ~H rHARhf Residence of furnace/burner to BTU's. SQ. FT. Relocated building (new fix. additional) S.F. Residence (] bath) Duplex (1 bath) each Additional bath I I I I I I I I TOTAL CHARGES I. TDTAL CHARGES /tJ.Q') TOTAL CHARGES //.. .<",-, WHERE STATE L'\H REQUIRES that the Electrical work be done by an."Electrical Contractor. the electrical portion 'of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division ~Jater service Sewer Storm Sewer I New circuits alts. or extensions Floor furnace and vent IfJ<n SERVICES Recessed wall Snn~P hp~tpr ~nrl vpnt Temporary Construction Change in existing rP::..irle.nl"P multifamily, COItlTl. or 'nrl"...t.rial Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart heatina or A.C. Mechanical exhaust hood and dur:t. tj,-'~Q Of from amps. COMM./IND. FEEDERS J Install/alter/relocate rli...t.r;n. fpprlpr... Wood stove/heater Of amps. ,,~:;. ,-",eS ::l.ne- I SSUANCF OF PFRlllT /0,00 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 performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of OrelJon 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 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 701.055 will be used on this project. IW1E(please print)l1nk f.1 I! eel 20ne 12-:J.. Fi re Zone -- Flood Plain __ BUILDING PERflIT Charges and Surcharges PLUI1BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges DPTd;''\~_..17 II-L I Type/Canst. - Bed rooms Stories S IGIIATURE FO~ OFF I CE USE OiIL Y ...... S€'!. Ftg. riain Sq. Ftf). Access Sq. Ftg. Other x Units Occy Load Occy Group R-.:2. x x Value Value Value TOTAL VALUATIDN Plan Ck. Comm/Ind ____________.,/Bldn Pj:ll'" ~pj:l Plan Ck. lies 30%/Bldq Per Fee Fence ~/:3.., Systems Oevelopment Charqe (1.5%) Demo ______JAQQ_ Sidewalk 1'10 AIC Paving /14, SD I Curb Cut nn_n_,-&f.,-I Total Comb. Permit TOTAL ~ 3/1 Ie? - ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN .- I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map Reference 11 03 43 2. ~xamp]e- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources , 1. examole- heat/electrical ceilinq/or forced air qas 2. exa~le- waterheater/electr;cal/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, check add, etc. F. Building permit information: 1. exam~le - construct single family house with an a ttached garage 2. examole - 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 jab 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 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. clerkji2~~ fA ,c.k. M,P ~% '-It 1"3 / hI 50 .rob . E{ p. ~% /0.00 ,<to \. ~/. (pC;- ~ S"?S7j/ V. FOR .0FFICE USE ONLY Permi t PROJECT CDNDITIONS TO BE SATISfIED BEFORE OCCUPANCY: Permit applicant exempt from registration' with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ';g'''"'' il '-- . j name date Y-If-~.l...- ~.........-.....-_..- .......~..... ~---~~-.. . . I INSPECTION LINE. 726-3769 Job AddreSS,-j/l11 (j~7~ W..zr Legal Description 17 -0'3 -7_7_- /f) Address .,{e-€.- q 2 (! ~ nA dJ Phon-IRS-If:}; Le~~ CITY UC SPRINGFIELD Cm1BIfIATION APPLlCATIDN/PERMrT EilERGY SOURCES: Heat T L .~ I 00 \~ater Heater Range ValuE of Hork: lrIFDRIIATIDN LINE 726-3753 Sq. Ftq. I.lain ~q. Ftg. Access. Sq. Ftq. Other fle" Add Alter Pep. --Fence Demo Change/Use -Other- - D<) ~ -- ~ Owner' Construction Buil(i;no Permit Info: Describe \~ork(Le.. Build Single Familv nesidence With Attached Garaael ~/H.JJ/ p I , nlt.VY}UHfJfA I J Address Ul:.~ It:iN HAl-' lname) Phone (address) flies. no.) (exoires) (ohone no. Primary Structural Electrical Mechanical ~.<1,"(-{ {[......,....l"'-~ PI(\. CONTRACTORS - Inamel r ,]Jb7 ff.;zrc:V~""(J""~ hop ~ ....,.n~'t' '20, /3 ~ PB (address)-..;;or"~ ~ (1ic~,. nn.) 1-31-f{"3 (p)(o;rps' ?~ -~ /:;,-/ (nhnn~ nn \ Genera 1 Plumbino Electrical ~lechanical PLUI1BING ELECTRICAL MECHANICAL NO. FEF r:HARhF NO ~H r~l1RG.E. NO. ~~ L- -.CHARG.E Each single fixture I 5. cD Residence of SQ. FT. furnace/burner to BTU's IRelocated building (new fix. additional) IS.F. Residence (] bath\ IDuplex (1 bath) each IAdditional bath I ~later servi ce [Sewer I Storm Sewer I I I I I I New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt Of COMM./IND. FEEDERS Install/alter/relocate rl;~trih. fpprlpr~ amps. Appliance vent ~~oarate Stationary evap. cooler Vent fan with sinale duct Vent system apart from I heatina or A.C. Mechanical exhaust I hood and dur.t Wood stove/heater I I I I Temporary Construction Change in existing rps j 4e.nrp multifamily, COlTlll. or Jnrll/~t.riill Of amps.1 TOTAL CHARGES WHERE STATE L~H REQUIRES shall not be valid until the ISSUANCE OF PFRriIT C;. OD TOTAL CHARGES TOTAL CHARGES tha t the El ec tr; ca 1 work be done by an.:El ectri ca 1 Contractor, the e 1 ectri ca 1 portion"of thi s perlilit label has been signed by an Electrical Supervisor and returned to the BUilding Division I HAVE CAREFUllY EXMlINED 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-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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in romoliance with OP.S 7nl.055 will be used on this project. IWIE(please prin~_ ~ 1~ ~ SIGIIATURE 1< a0) P 4 "7L/e.r' DATE~-;t?-~ c ~ FOP. OFFICE USE miL Y / Zone Tvpe/Const. Uni ts Fire Zone Bedrooms Occy load Flood Plain Stories Occy Group BUILDING PERmT Plan Ck. COIll11/l nd Charges and ------------ 65t/Bldn PI'>I" Fpp Surcharges Plan Ck. Res 30%/Bldo Per Fee PLU'1BING PERMIT _______6~m Fence Charges and Surcharges .7.1" Demo ELECTRICAL PERI~IT 'Side"al k Cha rges and ------------ I A/e Paving Surcharges MECHANICAL PERMIT Curb Cut Charges and ------------ Surcharges Sq. Ftg. t1ain x Value Sq. FtQ. Access x Value Sq. Ftg. Other x Value TOTAL VALUATION Shstelils Development C arqe (1.5%) Total Comb. Permit "--1 5,:L0 ~ ..-- TOTAL I . . 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 03 43 2. exa~le- Lot 1. Block 3, 2nd Addition to Spflngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. exam~le- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, cheel< add. etc. F. Building permit information: 1. example - construct single family house with an a ttached garage 2. example. remodel existing garage into family room 3. examOle - 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 TEM4 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 8. 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. !JQ750 tf . oD 5 Ljto ' 20 V. FOR OFFICE USE ONLY Permit Cl erk ~~d>/ 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 d~te ~-;:r~~~~...._~---.~~~:::'":,';;:.":.:~...~..:::..Z""..:.r-~~:;''''_:::;i,:!:.o:.---:::,,,,,,,,,,,,,-:'''--'..,.-e - ,--..::tt'_......\,;o;,'-'-"'.........L..:.............................~_......... ...--