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Home My WebLink AboutPermit Electrical 1990-4-2 ~ CITY Uf SPRINGfiELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat I~ater Heater J r1dll1~ Phone address NF R/1AT ON 726-3753 Sq. Ftq, Main ,(\ ~q, Ftg, Access. ~~ Sq. Ftq. Other New Add Alter Rep. Range_ -Fence Demo Change/Use ValUE of Work: Other- - ~ BuildinQ Pennit Info: Descr,be Work( Le.. Build Single ~ Familv Residence Hith Attached Garaae: \J Be::c//7/~ ,~~1 1 jINSPECTION LINE 726-3769 Job Address -=? ~~ ' ,-fL~Yl::>~ .~, ~ legal Oe,cription //-O7,-~ "~ t::!!'>~,~,:"" , Owner E W"c=-;8 Address 7.-L/ ~ /~/q~ c--~~_ ~~. Construction lender. ' Phone y.!!:,... ':? 'Y-?' Address Ut~ Juri I tJ\r'l 1 ics. no. ex ires' rnhnne no.)_____ Primary Structural Electrical Mechanical CONTRACTORS I name' (addre" ' General p~.r::; ~~T<jr/#-~r Plumhino (1 ir.o;. no, \ (exoirp,!') (ohone M. ) Electrical " ~1echanical PLUllB ING ELECTRICAL MECHANICAL NO. I I FEE I CHARGE -1'n <Fe 'rH'I!lliE. JiO. FFF r~ SQ, FT, furnace/burner to BTU' 5 Each single fixture Residence of -Relocated building (new fix. additional) $.F. Residence C1 bath\ Duplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~c~ hp~t~r ~nn vpnt Additional bath I Temporary Construction Change in existing res j de.nq> multifamily, comm. or ~ndustri"l t'S" Appliance vent spoarat~ Stationary evap. cooler Vent fan with sin9le duct Vent system apart from heatinq or A.C. Mechanical exhaust hond and duct Wood stove/heater ~Iater service Sewer Storm Sewer Of CO~1,/IND, FEEDERS Install/alter/relocate rl'c;,tr;h_ fpprl~rc; amps. Of amps. TOTAL CHARGES , WHERE STATE L.\\/ REQUJl(lo shall not be valid until the TOTAL CHARGES tnat the Electrical work be done by an. label has been signed by an Electrical I SSUANCE OF PERllIT /5:'~ TOTAL CHARGES Electrical Contractor, the electrical portion of this Supervisor and returned to the Building Division permit 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 pertaining to the work described herein, and that NO OCCUPAIKY 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 compliance with OP.S 701.055 will be used on this project. Zo~e Fire Zone Flood Plain Units Occy Load Occy Group SIr,NATURE~ 1 FOP. OfF I CE USE DIlLY Sq, Ftg, tlain Sq, Ftg, Access Sq. Ftg, Other ~ ~ let... DATE ,.. f-2.-?o , printl4L".IA/ aY/Vll < D ~ NAHE(please Type/Const. Bedrooms Stories ~ Val~e x Value ,x Value TOTAL VALU~TION PLUI1BING PERMIT Charges and Surcharges Plan Ck, Comm/Ind ________-:.___~/Blc:lo Ppr Fpp , Plan Ck, lies 30%/Blda Per Fee Fence syste,ms Development CharQe (1.5~)' ' , BUILDING PERflIT Charges and Surcharges ELECTRICAL PERlIIT Charges and Surcharges D/jl!1o" ___&5::- 'Sidewalk '~:;>~ AiC,P~~ing ToJa' Comb. Pennit TOTAL I ,/.5-: ?';> MECHANICAL PERMIT Charges and Surcharges Curb Cut .. ,..-.--.---- -~ . . ," COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description I. example- Tax Lot 100. Lane County Map Reference II uj 4J 2, example- Lot I, Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and 'construction lender D. Energy Sources 1. example- heat/electrical ceilinqfor forced air Qas 2. example- waterheater{electrlcal/or solar E. Squar~ footage or valuation, etc. - I. example- 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. example - construct single family house with an attached garage 2. exam~le - 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 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 signa ture. 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. /t-0:::. , , 15:75' V, FOR OFFICE USE ONLY Permit' Clerk~~ . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board b~cause: Additional Project Information: PLANS REVIEWED BY: name. ~~~,~~~Signature 4~ date "'7'-7- ~a:> "