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Home My WebLink AboutPermit Electrical 1981-4-1 I'NSPECTION~'. 726-3769 , I Job Addre n I I I Own,,'''--.,\\O~SL ~~\,")\G\q ~-\-\r~ II Add",. ~~C\~^I ~Q~^Q IO--XU(f. Phon. q t.A 't\ I J '041r..('/63P - I ConHructlon L :d -) ( - . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT " t INFORMATION LINE 726-3753 I ()) - o ~ ~4p., L\- 0,0-."tLu Xl U,) ~, l.gol omdP,;on-I3()O_J1,Q):<; 2Z 7rf\ I ENERGY SOURCES: Heal I Sq. Ftg, Main Sq. Fig. Access. 5q, Fig. Other _New.._Add_Alter__Rep. _ -Fence __Domo_Chongel Use __Other. ; Water Heater ~ Ranqe Value of Work: DESIGN TEAM (name) I~(address) Building Permit Info: De~crjbe Work (Le., Build Single Fomilv 1ll"",i.-!..ncfO With A"",ched GorCl!'!!} , , .. I ~~in.~u_o ~11 '~~~ tUY1PLJ I (I"., no,) ("p;".) ~ (phon. no,) Address phone Primary Structural Electrical Mecharoicol CONTRACTORS (nome) :I{address) (lies, no.) (e.xpires) (phone no,) Generol' PlvmbinQ Electrical \\. (J \) ~~ 'f ~ 0 t1<"t !\.Q L\ 4: 'S \'\ _ 't \ \-'C'\\;"\1"\ ~d' \ ~t\n l"'.rA, ,Qq <;( - RR'1 Y Mechanical PLUMBING ElECTRICAL MECHANICAL NO, feE f CHARGE NO I FEE i CHARGE NO. I feE ICHARGE I I Residence of furnace/burner to Il,TU's Appliance vent separate Stationary evap. cooler Vent fan with sinqle duct Vent system apart from hellting or A.C. Mechanical exhaust hood and duct Each sinqle fixture ReJocoted building (new fix. additionoll S,F. Residence (1 balh) Sq: ft. New circuits, aherations or extensions SERVICES Duole..: (l bath) 80ch Temporary Construction Addilional bolh I: Amps, Water service Sewer Wood stove/heater Storm Sewpr FEEDERS Heat Pump Air handler to 10,000 CFM Air handler over 10.000 CFM Amrs, ISSUANCE OF PERMIT TOT At CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that tho Electrical work be done by the Electrical Contractor. the electrical portion of this permit shall not b. valid until a label has been signed by an Eledrieal Contractor and anoched to the electrical panel. I HAVE CAREFULLY EXAMINED the completed application for permit, Clnd do hereby corlify that all information hereon is true and correct. and I further certify that any and all worlt performed sholl be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining ta the work described herin. and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I furthur certify that my registration with the Builder's Board is in full forCe and eifect as required by ORS 701.055, that if exempt the basis for exemption is' noted heron, and that only subcantractoli and employee, who are in compliance with ORS 701.055 will be UUtd on thh project. Basis for Builder's Boord exemption: 'Id h" NAME (please print) - j i:{ J, /fJ1t ,o/Ih! cL SIGNATURE ()J~ '(( #:-1fr4! FOR OFFICE USE .9Jri.y 6 DATE _1/ /; Ju.- , ' Zone Fire Zone F/ood Plain Type/ Canst Bedrooms l:tori... llnih (kcy Load t'kcy Group , Sq, Ftg. Main Sq',Ftg. Acce5' Sq. Ffg. Other x Value Val,. VallJ x TOTAL VALUATION. BUILDING PERMIT Charges and Surcharges Plan Ck. Co'mm/lnd . 65%/Stdq Per fee Plan CIo:. Res 30%/ Bldq Per fee System5 Development Chorae {1..5%1 PLUMBING PERMIT Charges and Surcharges Fence .6)0 Demo TOlal Comb. Permit ELECTRICAL PERMIT Charges and Surcharges In.CXj 4() Sidewalk AI C PQ~ina MECHANICAL PERMIT Charges and Surcharges' ---------1 TOTAL 1 () ld) Curb Cut '........ .. ~ . ,.--.. . COMBINATION APPLlCA liON/PetIT I. Applica,,! to furnish A. Job Address B. legal Description 1. exomple-Iax lot 100, lone County Map Reference 17 03 43 2. exomple-lot 1. Block 3, 2nd Addition to Springfield Eslotes C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced air qas 2. exam ole-water heater/electrical/or solar ' E. Square footage or valuation, etc. 1. exomple-1250 sq. fOOl house. 500 sq. foot go rage 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. Volue of work os defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design informction or job site corrections, e,tc. (CAP) II. Abbreviated, Plumbi~g, Mechanical & Electrical Schedules A. Ex~ept where blank spaces occvr 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 abbrevi- ated schedules you should consult the fuil schedules C. BUILDING DIVISION STAFF Will Fill OUT All FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and dote Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issued far his signature. IV. Fees ond Chorges 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 ore due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Project Information: . , PLANS REVIEWED BY, 1 .. nom'" . "',ignatur... . Permit Clery ~~ I PERMIT VALIDATION .JatQo -', ~.. INSPECTION INE-..... 726--3769 - . 1'1(i;I~;.~.?~~~~. ".,'~ .. , ~~!~f::i~f~. ~.,~;. .' Il-.,', _~'~Sl . . .l.:~ ,-4,: "t"'~~ClTy'bF SPR'iNGFiElD~. "~:r . of;' COMBINATION APPLICATION/PERMIT Job Addreu -:iAR ~ ~. ENERGY SOURCES: Cl,("LTu~. Y'l (j I. A' o Heat Water Healer legal Description Ranqe Value of Work: Structural Electrical Mechanical CONTRACTORS I: (address) (nome) General. Plumbinq Elec:tricol C\C'lQ \.l'.l'\.~ 'r ~ 00'+ "\.0 l\Lt'S ". 'i' ~ (lies, no.) .t INFORMA liON LINE 726--3753 (phonll no.) (expires) (phorut no.) Mechanical \ \r'\,;"",", ~d' \ ~X\n ~n\ .Qq')( - xRCJl{ PLUMBING ELECTRICAL NO, FEE FEE ! CHARGE NO, Eoch lin~le fidur!! Relor:ored building (new fix. additional) S.F. Residence (1 both) , Residence of !i .,:ft, New circuils. alterations Of extensions ,: SERVICES Duolu (1 both) each Temporary Construction Addilionol bolh Am'~s. Woter service Sewer Storm Sew,,"r FEEDERS Amps, !; TOTAL CHARGES TOTAL CHARGES I CHA.RGE I I I I I I I I I I I I I I I MECHANICAL NO, I FEE CHARGE i furnace/burner to BTU's Appliance vent seporOle Stationary evap. cooler Vent fan with sino I. duct I Vent system apart from . her.ltinQ or A.C. I Mechanical exhaust hood and d~ct ./ Wood stove/heater Heat Puma Air handler to 10.000 CFM Air handler over 10.000 CFM ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be don~ by the Electrical Contractor, the electrical portion of this permit Ih.all not b. valid until a label ha, been signed by on Electrical Contractor and attached,to the electrical panel. I HAVE CAREFULLY EXAMINED the ccmpleted application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and all worlt performed sholl be done in accordance with the Ordinances of the City of Springfield and Ihe laws of the Stole of Oregon pertaining to the work. described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further . certify that my registration with the Builder's Board i, in full force and 8'ffect a s required by ORS 701.055, that if exempt th. basis for exemption is' noted heron, and thot only subcontractors and employee, who ore in compliance with ORS 701,05.5 will be used on this project. Basis for Builder's Board exemption- , ~d}" NAME (please print) kf SIGNATURE (}I,w/ 'C( IP~~// FOR OFFICE USE tya-v Sq. Fig. Main Sq'. Fig. Access Sq. Frg. Other ,~"I1h: d.. j, lone Fire Zone flood Plain Typel Canst Bedrooms Ctori.. llnih I""lccy Load ""~ty Grou'p BUILDING PERMIT Charges ond Surcharge's Plan Ck. Coinm/lnd 6S%/BldCl Per fee PIon Ck. Res 30%/ BldCl Per Fee PLUMBING PERMIT ChQ~ges and Surcharges' Fence Demo ElEaRICAL PERMIT Charges Qnd Surcharge. In .c:::o 4() Sidewalk AI C Pc vi no MECHANICAL PERMIT Charges and Surcharges Curti Cut .11 .:: I/!J IV- , ' I I DATE . x Value Value Valy_ x .' x TOTAL VALUATION Systems Development Chorae I I .5%1 .tJO I Total Comb. Permit I TOTAL 1 () \cO I. ',~. . ( \ COMBINATION APPLlCATlON/P4lT (CAP) . . I. Applica~ to furnish A. Jab Address B. Legal Description 1. examale.tax lot 100, Lane County Map Referer 2. example.Lot 1. Block 3, 2nd Addition to Springfi Name. etc. of owner and construction lender Energy Sources 1. example.heat/electrical ceiling/or forced oir qa: 2. example-woter heater/electrical/or solor E. Square footage or valuation. etc. I. example.1250 sq. foot house. 500 sq. foat garag 2. exam ole-if new project, check new-if addition, d add. etc. F. Building permit information: 1. example-construct single family house with an at garage 2. -exomple.remodel existing garage into family roo J. example-convert single family residence into '. 'restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Divis Staff must be able to contact op'propriote persons reg design information or job site corrections, etc. C. D., II. Abbrevioted Plumbing, Mechanical & Electricol Schedules A. Except where blank spaces occur in the description po of the Mechanical and Electrical Schedules, the appliCt need fill.in only the No. Boxes adjacent to the approp item(s) to be installed 8. Full Plumbing. Mechanical, and Electrical Schedules . are available at the Building Division 1. To cons.erve space on the permit form the schedules hove been abbrevioted 2. If the item{s) to be installed are not covered on the, aled schedules you should consult the fuil schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible. the initial application will be used as (J worksheet only. Where possible, Building Division S~aff wil prepare a typewritten copy and return it to the applicant c the rime the actual permit is issued for his signature. +- . Fees and Chorges 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 ore due and payable when the permit is issued. . IV. V. FOR OFFICE USE ONLY 'PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: name . -signatur... I . PERMIT V ALllfA.JN CITY OF SPRINGFIELD City Hall Springfield, Oregan Department of Public Works OFFICIAL RECEIPT 'No. B 56200( Date~f)i\'\ ~ \ 19@, \ Rec'd Fro~ (\~~~ '~~61A- ,( Addr~ss \1\4 S t"I.7 - \~, 'O( I"~ ,.. ( ( c Received For: ( ( ~(':t- \C) pO .4Q .90 ( ( (' <fQ -4% OI;)"5~ <. ( I, ( ( I, (I " (, to j(J 0 dJfM.2M' ...llTON'TU"N.ULL ..""..TIl".' lUGIN!:, Oil .'''01 ..."., ( \~ '. rr lJJji ~" , Amount Received ,.., (j (.1 Q '. Permit Cler~ I I I I I I I I I ,.Jete