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Home My WebLink AboutPermit Electrical 1990-1-19 jINSPECTION lINE 726-3769 -. INFORHATlON UN" .. 726-3753 Sq. Ftg. I~ain Sq. Ftg. Access. Sq. Ftg. Other . New Add Alter Rep. -Fence Demo Change/Use 'Other- - . Address Hulfh; (1,\ f)/LMVYS 9/~ 6 ~ '61-; II1/' I Phone 11/1/ 331tf Range Valu, of l'lork: ~ \:) \) i.\:) ;~ \J\ Job Address Legal Owner (name) Phone (address' BuilriinQ Permit Info: Descr,be Work(i~e., Build Single Familv Residence With Attached Garaae' :J. r;ty;W/,l):{i4 MPrtJ(<d1/r ./4'- , ,;,L3'IJ - .. . I j I 0{ ~ f/:1 n d..LuJaJ...L (1;C5; no. Y (exoires) (ohane no. Construction lender Address UES I GN TEAJ1 , Primary Mechanical CUNTRACTORS lnamel General / I1YYjJ W1if'b Plumbina (address' u~y N. t./;!:3-~tf. . v l1ic~. no.) ~A ~~~ (f15nires) "1 (ohane no.) 3';)/-QD 1!::i~Ft313 Structural Electrical '6i.!d.1y Electrical ~1echanical PlUl1BING ELECTRICAL MECHANICAL NO, FEF 'CH~Rr.E Nn FFF I CH~Rr.F NO, II=FI=' , CilARliE.. 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 (l bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~~p hp~tpr ~nd vp~t Storm Sewer Of amps. Appliance vent <;'~Darate Stationary evap. cooler Vent fan with sinc..le duct Vent system apart from hea t i no or A. C. Mechanical exhaust hood ~nd duct ~Jood stove/heater ~Iater service Temporary Construction Change in existing rpSiclpJl('p multifamily, comm. or Tndustri~l Sewer COMl'I./IND. FEEDERS jlnstall/alter/relocate rlid.rih. fpprlpr<;. Of amps. I SSUANCf OF PERIH T TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\I/ REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and ~eturned 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 OrelJon pertaining 'to the work described herein, and that rm OCCUPAHCY will be made of any structure without the permission of the Building Division. T 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 ORS 701'~~L::>11 be used on this project. NAllE(please print) L.4K~Y 4 31vr../'n-l SIGNATUR~ ~DATE/-19-'(lJ FOR OFFICE USE DilLY 1 SC1. Ftg. f1ain x Value Sq. Ftn. Access x Value Sq. Ftg. Other x Value Flood Plain Stories Units Occy load Occy Group Zone Fire Zone Type/Canst. Bedrooms TOTAL VALUATION BUilDING PERfllT ' Plan Ck. Conm/l nd Charges and ------------ 65%/Bldo Ppr Fee Surcharges Plan Ck, R'es 30%/Bl do Per Fee PlU'1BING PERMIT Fence Charges and ------------ Surcharges I Demo ELECTRICAL PERIIIT 'Sidewalk Cha rges and ------------ Surcharges A/C Pavi ng 11ECHANICAl PERMIT Curb Cut Charges and ----,-------- Surcharges ivI.I h ~.VJ- 'Systems. Development I Charoe (1. 5~ '" dA"; till t 'iifJ , ClfPYOaU1 //,30 -).~ Total Comb. Permit /0' /;0 ;(), () D TOTAL J~,!D , . COMBINATION APPLICATION/PERMIT (CAP) ! L Applicant to furnish A. Job Address B. Legal Description 1.' examp1e- Tax Lot 100. Lane County Map Reference , 17 03 43 2, examp!e- Lot I. Block 3. 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater{electrlcal/or solar E. Square 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. exam~le - construct Single family house wi(h.~n attached garage ..Ii#"" \ ' 2. exam~le - rerr:odel-edsting garage into famny,'room 3. examole - 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 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. --- Applicant to sign and date _ . Whenever possible, the initial application will b~ 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. If III. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: - po PERMIT VALIDATION v (<11/$15 p /~ Pennit Clerk flALL Permit applicant'exempt from registration with the,Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name, ..-:\ signature date : ..