HomeMy WebLinkAboutPermit Electrical 1988-4-18 (2) Job Address"'- A. I t-""l.,A'j;"...r M._ Legal Description '<:( '16 ~ L.cn.-,;, c..rr A,....o~ Owner /v\ ':l~ ~o b.s U ~ I INSPECTION 'LiN'E 726-3769 Address Construc~ Lender ~-- . Add~--. U~luN flAM (name) Primary -' S~rIu;al EAal Mechanical CONTRACTORS General ~ '"Plumolnb... " .~ enamel ~ (.-0 Electrical ~ .Ah.I(t,~ ~l L~1t ~an;c'rr PLUMBING ~ '7FF nMRr,F Rel ated building (new ix. add;tional)~ S,F, Ii idence / (] bath Duplex ( bath) ~ch Additional bat~ Water NO,I Sewer Storm Seier / / / / \-\v, TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be val;~ until the Zone Fi re Zone Flood Plain BUILDING PERfIIT Charges and Surcharges PLU!~BING PERMIT Charges and Surcharges ELECTRICAL PER!HT Cha rges and \ }. Surcharges ....., MECHANICAL PERMIT Charges and Surcharges -~ .'",,::'h'.~- ._. . .0...... . _._ ._....,,__.~~. _ .. 'L.~.t,~ . . INFORllATION UN" 726-3753 Sq, Ftg, !,Iain ~q. Ftg. Access. Sq, Ftg, Other !Iew Add Alter Pep, --Fence Demo Change/Use -Other - - , 1 '->(J 00 a ,~ I I CITY U, SPRINGFIELD COMBItlATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range Valu, of Hark: Phone BUildino Permit Info: Descr be Hork(i,e,. Build Single Familv ~esidence With Attached Garaae) t::,..,. _: -: -/ ~,,-.t...~ ,q/./: l. k?U~ ~ Phone (address) (exoiresl (ohone no.' flies. no.) ~US- I Sl.OO vl/I'b (addres5 ) (1 iC5. no.) (pxoi rpc;) (ohonp no, , ~ ....-< -'-< ... .....r . , 3<'1.2~ (J 0"- d:, "-4 q ..,010 r (.-""c. to,I_f'1 <;,1..2. :l!A-II?... ~ . Temporary Construction Change in existing l"P~ j n..E:nrp multifamily, comm. or Tnrludria1 MECHANICAL / I rl-l~ _1Il[1 I II ~~~ " furnace/burner t~ ,j \ BTlJS oar furnace / an vent Rece ed wall! Sn,cp p'tPJ1,nrl vpnt Appliance ent seoarat~ Stationam vap. roolpl" r Vent f7 wi th sinole uct Vent sy tern ap rt from h~atin or A.C. MechanIcal exha t hond ahd duct Wood jtove/heater / / / / ISSUANCE TOTAL CHARGES I r'JARG.E. ELECTRICAL Nn I >>> Residence of SQ, FT. New circuits alts. )<, or extensions u,~ - .. SERVICES Of amps. COMI.I./lND, FEEDERS Install/alter/relocate n;c:trik fppdprc; Of amps. le Electrical work be done by an' 'Electrical Contractor, the electrical portion of this pemit s been signed by an Electrical Supervisor and returned to the Building Division TOTAL CHARGES Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value I HAVE CAREFULLY EXA~1INED 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 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 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 comoliance with ORS 7nl.055 will be used on thi~ject. HAt,IE(please print) M"Q..'\-".j) <y ,..;_t_~ . __ ,u_,_ SIf,!IATURE ??1~J tI~ DATE 11--/3',)-1-' FO~ OFFICE USE mil Y Sq. Ftg. riain Sq. Ftg. Access Sq, Ftg, Other x x TOTAL VALUATION Plan Ck. Comm/Ind 65%/B1 do Ppr Fpp ------------ Plan Ck, R"es 30%/Bldo Per Fee Fence Demo <;;(;;t" ~ I Sidewalk ----/~-1-3---1 A/C Paving I Curb Cut ------------ I Systems Development Charoe (l,5~) , {;;/Cc:. ~c./ I *" I~/ le..- I I ,';<D ITotal Comb. Permit I I TOTAL , ;( 3. '63 .--. -,.;:.-- , .~ - .;.....- . COMBINATION APPLICATION/PERMIT (CAP) " I. Applicant to furnish A, Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2, example- Lot 1, Block 3, 2nd Addition to ,prlngtield Estates '. C. Name, etc. of owner and construction lender O. Energy Sources _' 1. exam~le- heat/electrical ceilin~/or forced air Qas 2. exa~le- waterheater/electrlcal/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. examele - construct single family house with an attached gan~ge 2. examele - remodel existing garage into family room 3. examele - 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 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 BE SATISFIED BEFORE OCCUPANCY: 1 . PERMIT VALIDATION 'rl* <0>-e.t'- II 3 ~ t/- ,->, Permit Clerk a,G?~ . l Permit applicant.exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature , date