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Home My WebLink AboutPermit Electrical 1990-6-15 '1 H1SPECTlOr: L1IIE 726-3769 . CITY OF SPRINGFIELO COMBIIlATION APPLlCATIONfPERMIT EIIERGY SOURCES: Meat l-later Heater Range ~ ~ -.j ~ Address DESIGN TEAf1 {name) Phone (address) INFORlIATION liNe 726-3753 Sq. Ftq. 1,lain ~q, Ftg, Access, Sq, Ftg. Other Ilew Add Alter Pep, -Fence Demo ChangefUse va~~~. N \A- Other-- BUl'lciino Pennit Info: Deser be Work{i'.e., Build Single Familv nesidence With Attached Garaae\ dy~.NN"t'. :S'c7,# jY-C-.k-'~~ p~c~/V..v~<.T ~.7-? ;;q~~;.~, ~. ~/'J?/T< ~ I (lies. no.) . (exoires) (ohane no.. . \' Job Address //9/ I/A':}f ( PGeJ /f P Legal Description /7--<1 ~. 2. 7-~ '2 ~ ~ VA:::> " /?'H/P ~ ~ff/1';r 1/7/~~r>. c.~' AI'> . Phone_ '5?7'L.D ..!!>~. 7f/6-;;OYY Construction Lender I' Owner" Address Primary Structural Electrical Mechanical CONTRACTORS (name) {address} nics. no.' (exnir@s) (ohnnp nn. \ Genera 1 Plumbina Electrical //~&;.A;~P ~1echan;cal ~ ,/. <>_I//lL./ ~o/' ~,,~-= '7'Y.;lP~ /~'1"/ .,r ,... // ;Z=-=.r-, /--rAfe' ~P~l?b':::::;/ 3...q / ~7.>. 9Y;> - 56<< PLUIIBI NG ELECTRICAL MECHANICAL NO, FEF CHARGE NO rrr rH~Rr,F NO_ HI=' rHARG.[ SQ, FT. furnace/burner to BTU's Each single fixture Residence of Relocated building . (new fix, additional) S.F, Residence (1 bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall So~rp kp~tp~ ~nrl v~nt Stonn Sewer Of amps, Appliance. vent seoari'ltj:l Stationary evap. cooler Vent fan wi th !'inole dur.t. Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing rj:l~ j 4ence multifamily, comm. or Tncludrial Water service CO~~,fINO, FEEDERS Installfalter/relocate dic:trib. feeders / Of .::::;- C> amps. /-5:''' TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the TOTAL CHARGES ISSUANCE OF PERIIIT /,')"':. - TOTAL CHARGES that the Electrical work be done by an,'Electricaf Contractor. the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAHINED 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that 110 OCCUPAIICY wi,l1 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 DRS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project. UAI,IE(please print) 1<0<.,""'- 14e-E<.AJlO "270'6'::> SIGIIATURE ~A, ~. DATE b/;:;-};fJ FOP, OFFICE USE DIlLY Zone Tyoe/Const, 'Units Sq. Ftg, t-ta.in Fire Zone Bedrooms Occy load Sq. Ftg. Access Flood Plain Stories Occy Group Sq, Ftg, Other , x x Value Value Value TOTAL VALUATION PLUI~BING PERMIT Charges and Surcharges Plan Ck, Comm/Ind ____________ m/Blda P.l'r Fe. Plan Ck. Res 30%/BldQ Per Fee Fence Syste~s Development Charqe (1,5~) . BUILDING PERflIT Charges an~ Surcharges ELECTRICAL PERI\IT Cha rges and Surcharges MECHANICAL PERHIT. Charges and Surcharges Demo ____I$:- 'Sidewalk -- -.7::> AfC Pavi ng Curb Cut Total Comb, Pe~it TOTAL I /7'- 7S . . . , ( -'. \ " ',. PERMIT'VALI,DATION - . .,.- . " , " 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, exam~le- Lot I, Block 3, 2nd Addition to Sprlngtield Estates' ,. ' C. Name, etc. of owner and'-construction l'ender .. D. Energy Sources. ~ . . ... 'I. ~examQl~- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcal/orsolar E. Square footage or valuation, etc. - I. exam~le- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project. check new - if addition, check. add, etc. F, Building pennit information, 1. exam~le - 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.o~ construction delaY~1 Building Division Staff must be' able to contact 'app.ropriate ",persons regardjng. design ,inforina~fo.n~9r~ ~pb .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-1n 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 0, 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 wi 11. 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 Pennit Clerk 1 PROJECT CONDITIONS TO BE SATISFI.ED BEFORE OCCUPANCY: . ",Permit applicant exempt from 'regis.tration with the Builder's ,Board because.: Additional Project Infonnation: PLANS REVIEWED BY: name ~/VE , ft~~ignatur'i~~" date b -/r-9&:? Job Address //9/ U#}fcP~ , . Legal Description /7-tJ ~. '2. ?-~::2 ~ .at:>'7~ , . -/'rp LITY Of SPRINGfiELD COMBIIIATlON APPLICATION/PERMIT ~. EIIERGY SOURCES: Heat l~ater Heater Range Address DESIGN TEAM (name) Phone (address 1 INfORltATlDN liNe 726-3753 Sq, ftq, Main ~ ~q, Ftg, Access. ~ Sq, Ftq, Other C". New Add A,ter Rep, ~ -Fence Demo Change/Use -.j Va~u7 of Hork: Other- - ""- 7~.o d'r:> --t::.. BUllolna Permit Info: Describe Work{i~e.. Build Single I Family Residence With Attached GaraQel dv?7#~ 5'c7 /fl 7~.z;>e-~ I p~C""h'.H~<7~.R ~, ~'P/7/T. ~ I flies. no.1 lexniresl (nhnnp no.- . , I j INSPECTlOII L!fIE 1726-3769 7JH/P 7' ~ff/"f.r .Y1i7/ ~#L~ AI)" ~hone '5?;C"c..D ~~, 7f"6-?oy<f Construction Lender /' Owner Address Primary Structural Electrical Mechanical CONTRACTORS (name) (addres!>) (lies. no,) (exoiresl (nhOM no. ) Genera 1 Plumbina Electrical.1/~ -c. A;~/J ~'echanical ~ . 1-//- J(/,7J!../ JC#?' ~".a",.~ 7'?;1:P-;;;;> //C'"'Y1,,1 .,r r.- ./'0' r=-c-r- /_~.e .b",,,,~l?b.c . ?~ / , t' J?.7:>. qf? - 7'~?L- PLUI-IBING ELECTRICAL MECHANICAL NO, Ff E CHARGE NO FFF rH~F NO. FFF rHMliE.. SQ, fT. furnace/burner to BTU's Each single fixture Residence of Relocated building . (new fix. additional) New circuits alts. or extensions Floor furnace and vent S,f, Residence n bath \ Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~ h@~tpr ~nrl vpnt Storm Sewer Of amps. Appliance' vent se'Darat~ Stationary evap, cl'll'ller Vent fan with sinall! duct ,Veni system apart from heatina or A.C. Mechanical exhaust hnnrl and duct Sewer Temporary Construction Change in existing \",pc;,iq~ncp multifamily, comm. or Industrial Water service COMfl,/IND, FEEDERS Install/alter/relocate distrib. feeders Hood stove/heater / Of .::::;-~ amps. /.5.' ... I SSUANCF OF PFRllIT TOTAL CHARGES TOTAL CHARGES /<i: - TOTAL CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pen:lit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREfULLY EXAMINED 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 oertaining to the work described herein, and that 110 OCCUPAIlCY will be made of any structure without th~ permission of the Building Division. 1 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 ORS 701.055 will be used on this project. IW1E(please print) \(Oc.&\. HCCC,AItO ?7o<ii", SIGNATURE ~A, ~, FOP. OFfICE USE OIll Y Sq, Ftg, 11ain Sq, Ftg, Access Sq. Ftg, Other_ D~,TE bh~h~ Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value TOTAL VALUATIDrI x x PLUI~BING PERMIT Charges and Surcharges Plan Ck, Comm/lnd 6s%/Blda ~pr Fpp Plan Ck, Res 3D%JBldo Per Fe. Fence Systems Development Charoe tl.s~) BUILDING PWIlT Charges and Surcharges .lI.D~ .........- ELECTRICAL PERI1lT Cha rges and Surcharges liECHANICAL PERMIT, Charges and Surcharges _ ___!r5': --- -Sidewalk ~- _,7:> A/C Paving Curb Cut Total Comb, Permit TOTAL I~ 7S' . . '- . COMBINATION APPLICATION/PERMIT (CAP) -' I, Applicant to furnish A, Job Address B, Legal Description 1. ,example- Tax lot 100, lane Coun~y Map 'Reference II 03 43 2, example- lot 1, Block 3, 2nd Addition to springtield Estates C. Name, etc. of owner and construction lender D. Energy Sour:ces, . '1. example- heat/electrical ceilinq/or forced air qa! 2. example- waterneater/electr1cal/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 roan 3. exa~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, DESIGN TEAM AND CONTRACTORS TO.4void. design,.or construction delays" Building Division Staff must be able to contact appropriate .persons regarding'design information,or job site corrections, etc. .' ,. . , ., , 11. 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 I, To conserve space on the permit form the schedules have be.n 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 0, As noted on the CAP, the label must be delivered to th electrical contractor for signature by his electrical' supervisor. The general contractor is.not authorized to sign the electrical label, --- Ill, Applicant to sign and date Whenever possible. the initial application will be used as a worksheet only. Where possible, Building ~ivision Staff wi 11. 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,,' " o V. FOR OFFICE USE ONLY iiI6lY OF SPRINGFIELD . CllyHaJl , Sprlngftald, Oregon . Development Services OFFICIAL RECEIPT I , J 17385 - ~:O.,.\ !r~,p~ /'s",19&:qE!7 ;' . . . / . Rec'dFrom ~~ At~~#~Ji ' ~7'3 ~/4HT tff"< ~~--:~. Address ~ LoN ,,,...4.-Ce ~... J~G"" ,. .. Received For--k#~7 '!' V ~.?v-'~ /5:. - , . :)S- -L-// f.~ .1 .~ "' \:. /~~ ~~ /':;?-- :;> 5- ~~&. r ,;?AuTHORIZED SI~NA TURE - -- 1,- Amount Received .,!!L . '. ~, """"'1 Pennit C1 erk 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 ~N~ ft~-7~ignatur~~~~~"': " date b-/r-9~ 'I