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Home My WebLink AboutPermit Electrical 1990-3-28 ValUE of 1'lorv'Z-12--. gp.,- BUllcllnQ Pernllt Info Descrlbe l~ork(l e., BUlld Slngle Famlly Resldence Wlth ^ttached Gara~e) fill;; rffLL fS(!iJ tJ!) L fl frSi1 &112- () eYl.. (?~N r:. t>lll/8R r:: I ~l 1) U -.... ..- INSPECTION LINE :1726-3769 . Job Addressfflt f(W{j) /f/;. f. P1JlLJJO benAJ&f]J &A-fE:WA-V Cf Hfl-r<rmlttJ I . 0;;)5' I-JeivlouJ i Owner (~lnI Dr 50RIN6F1eL/) Address Z-z,!; .M. 5. LttL 5 (J R 11J(;, FIE IA). D 1/2.. I . Constructlon Lender , Lega 1 De~cri pt 1 on CITY OF SPRINGFIELD CmlBINATlON APPLICATION/PERMIT EflERGY SOURCES Heat Hater Heater Ranqe Phone Address DES I GN TEAtl Phone (address) (llCS no) (namel Prlmary Structural El ectrl ca 1 : f1echanlcal . CONTRACTORS (name) (address) (llCS no) : Genera 1 I ; --.,',," INFORI1ATlON'L1N!:. 726-3753 Sq. F tq. r la 1 n ~q Ftg. Access. Sq. Ftq Other New Add Alter Pep. --Fence Demo Change/Use -Other - - ~ Ej :J (eXDHes) (phone no.) (eXDlres) (ohone no. ) Plumblnq I ElectrlCalL.r< ~A-l?t+1l1M. !NC1,!f)-J) /1). ~'{)/I~TSptlb; Dt~Cn4-17 2O-Z1C- IO-I-'1{) , ~'echanl ca 1 PLUtm I NG ELECTRICAL NO. ' I FEE I CHARGE fJO. FrF r.HARGF NO Each slngle flxture Resldence of SO. FT Relocated bUllding (new flX. addltlonal) New Clrcults alts or extensions S.F Resldence (1 bath) Duplex (1 bath) each AddltlOnal bath I LD I / ?~~ \ "1\ .;'I~J~ Temporary ConstructlOn ~D '( /\ > Change ln eXlstlng \' \l \I11V/ res 1 dence . t\, t' 7~~~~~~~~~y, comm or~:0\X l! [)~.~(/ Of - amps rf \~/ _ COt1r1./I ND fEEDERS \) t;. a Install/alter/relocate' ~- \~ W:t" dlstrlb. feeders ',~ , Of ' amps I I "" I . ~ ~I E6TWI(~/GN 15,15 /5.75 j I _____ -r- < 1'5.75 -ylTAL SERVICES Hater serVlce Sewer Storm Sewer I ( I TOTAL CHARGfS TOTAL CHARGES WHERE STATE L 'I.\~ REQUIRES that tile Electrical work be done by an' [1 tncal shall not be vallJ untll the label has been slqned by an [lectrlcal Supe 7 If 7,fd;J3~ MECHANICAL rFF r.HARGF furnace/burner to BTU's Floor furnace and vent Recessed wall SDace heater and vent ApDllance vent seDarate Statlonary evap cooler Vent fan wlth slnole duct Vent syste~ apart heatlnQ or A.C Mechanlcal exhaust hood and duct from Wood stove/heater ISSUANCF OF PFR/1IT CHARGES tor, the electrlcal portlon of thlS permlt returned to the BUlldlng D1V1Slon I HAVE CAREFULLY EXAllINED t1e completed appllcatlon for permlt, and do her~by certlfy that all lnformatlon hereon lS true and correct, and I further certlfy that any and all work nerformed shall be done ln accordance wlth the Ordlnances of the Clty of Sprlngfleld and the Laws of the State of Oregon Dertalnlnq to the work descrlbed hereln, and that rm OCCUPAlKY wlll be made of any structure wlthout the permlsslon of the BUlldlng D1V1Slon I further certlfy that my reqlstratlon ~l1th the BUllder's Board lS ln full force and effect as requlred by ORS 701 055, that lf exempt the basls for exemptlon lS noted hereon, and that only subcontractors and employees who are ln compllance wlth ORS 7Tll 0551'1111 be used on thlS proJect. DATE' 3/z;J~ . j' IW1E(please pnnt)L-~ (L. &-~~tM11'\ SIr;rlATUR[ ~".:./ / ~~ Far. OFFICE USE or~L Y / So. r to rla 1 n Zone Flre Zone Flood Plaln TYDe/Const Bedrooms StOrl es Sq Ft'J Access Sq Ftg Other Unl t s Occy Load Occy Group BUILDING 'PER~lIT Charges and Surcha rges Plan Ck Comm/Ind 65%/Blda Per Fee -- -- - -- -- --- Plan Ck. Res 30%/Bldq Per Fee Fence PLUf1B I NG PERMIT Charges and Surcha rges Dt;mo ELECTRICAL PERrm Cha~rges and Surcharges Sidewalk A/C Pavlng t1ECHANICAL PERMIT Charges and Surcharges Curb Cut , x Value x Value Value x TOTAL VALUATION Systems Development Cha rqe (1 5':) Total Comb. rermlt -; Torr,L ____=-'~___..""""'l............._4...,...,..~,;:.~......~,.. .-.........""".....- COMBINATION APPLICATION/PERMIT (CAP) I. Appllcant to furnlsh A. Job Address B Legal Descrlptlon 1 example- Tax Lot 100, Lane County Map Reference 17 03 43 2 example- Lot 1 Block 3, 2nd Addltlon to Sprlngflelo Estates C Name, etc of owner and constructlon lender D Energy Sources I' , 1 example- heat/electrlcal celllnq/or forced alr Qas 2. example- waterheater/electrlcalior solar E Square footage or valuatlon, etc 1. example- 1250 sq foot house, 500 sq foot garage 2 example- lf new proJect, check-new - lf additlon, check add, etc F. BUlldlng perrmt lnformatlOn 1. example - construct slngle famlly house wlth an attached garllge 2. example - remoJel eXht-lng ga.-age 'lllto-fallll'ly.lroom~- 3. example - convert slngle fallllly resldence lnto restaurant (change of use) G. Value of work as deflned ln Sectlon 303 (a) of the Structural Speclalty Code ' H. DESIGN TEMl AND CONTRACTORS To avold deslgn or constructlon delays, BUlldlng Dlvlslon Staff must be able to contact approprlate persons regardlng de'slgn lnformatlon or Job slte '; correctlons, etc II. Abbrevlated Plumblng, Mechanlcal, & Electrlcal Schedules A. Except where blan~ spaces occur ln the descrlptlon portlon of the Mechanlcal and Electrlcal Schedules, the appllcant need flll-ln only the No. Boxes adjacent to the approprlate ltem(s) to be lnstalled : B. Full Plumblng, Mechanlcal, and Electrlcal Schedules are avallable at the BUlldlng D1Vlslon 1 To conserve space on the permlt form the schedules have been abbrevlated 2 If the ltem(s) to be lnstalled are not covered on the abbrevlated schedules you should consult the full schedul 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 dellvered to the electrlcal contractor for slgnature by hlS electrlcal supervlsor. The general contractor lS not authorlzed to Slgn the electrlcal label 111.-- AppllcanL-tu 3lgll'and date ---- ,--- Whenever posslble, the lnltlalJappJlcatlon wlll b~ used as a worksheet only Where posslble, BUlldlng Dlvlslon Staff wlll prepare a type wrltten copy and return lt to the appllcant at!the tlme the actual permlt lS lssued for,hls slgnature IV. Fees and Charges , ' Plan check fees are due and payable at the tlme of the appllcatlon, and no plans wlll be processed untll these fees are pald All other fees and charges are due and payable ~Ihen the pernllt lS lssued. V FOR OFFICE USE ONLY : \ ___a1"....rUU'....,.."=__3.....nd!~-- --.... '1-'"'~ - .1 'II PERMIT VALIDATION lj ~ ~ i i 1 ~ . ~ . ~ 4 -. .. ~ .i ~ . ~ . j ~ . 'i ... ~ . ~ ~ . ~ ~ j ~ ~ ~ j , :0 . i ~ " ~ ~ ~ Permit Cler , PROJECT CONDITIONS TO B~ SATISFIED BEFORE OCCUPANCY: I' ~ Permit applicant exempt from registration ~ith the Builder's Board because: I Additional Project Information: PLANS REVIEWED BY: name slgnature ,c............"'.............,......rl':>nl~j"'p""-.....".,.,..,I::\I}~'1I:........~- -,"'- date - ._.-....=-~...