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Home My WebLink AboutPermit Electrical 1981-3-18 i :IINS'?ECT10N LINE 72i~37.69,_\-, ... ~- Job Addren . CV\'LffiC\i n CllY Of SPRINGFiElD COMBINATioN APPLlCATlONJPERM1T e: " INFORMATION LINE 72t..37S:I \ f} (; ?:> CC/\ Q\ ~ t O;~) Own.,\\~~Q'(\ \tro f'X otl Add,... Q '\ f\ 0('{) i A~~,d-'eho_n. CO;"'~~ ~ N-t. 0 - . Ronqe VO/O'k-;" - I ... ~ ./ 'Sq. Fig. Main /' Sq. Fig. Aceen. Sq. Ftg. Olher _Nl'lw._Add_Alter _Rep. d.;:;;::~~e(\~_D,OmO_Chon9111 Use __Oth.- ) " , S'uilding Permit Info: Describe Work (Le., Build Single Family Ruidence With Attached Gareae) /--- 'fl. - J 12) J l ENERGY SOURCES: ,Heat Water Heoter legol Description /' .- Addreu Phone DESIGN TEAM (nome) (oddreul (lies. no.) (upinn) (phone no.) Primary * y",,- Structutol Electrical Mechonicol PLUMBING ELECTRICAL MECHANICAL (~hone.no.l l \~ry I ,\\..\f\ --('fj:.,")( n I I I FEE ICHARGE I CONTRACTORS G...,ol, ~^L\ Q) ""5\.J:l rt PlumbinQ \ (nome) (oddren) (lies. no.) (expires) r ~ 0 a-+ q \0\(') ~ d'\r\Q 1\ 'NYi\ r'\. Electricol (\')()- llol nC _ q -.-~() - <;<:1 Mechanical NO. FEE I CHARGE I I I NO'1 Residence of I I SERVICES I I Temporary COM'ruction I I I Amp.. !J('X:J I I FEE I CHARGE NO'1 furnace/burner to I)TU', Each ,inqle fixture Relocated building (new fix. additional! S.F. Residence (1 hOlh) Sq: ft. New circuits, alterations or extensions Appliance yltnt saporote Stationary ovop. (ooler Vent fan with sinqle duct Vent system aport from heotinq or A.C. Mechanical exhaust hood and duct I I I I I I I I I Duol.... (I hOlhl each Additional both Waler service Sewer Wood stov./heoter Storm SeWI!'r FEEDERS Heat Pump Ai, handler to to.OOO CFM I Air hand I., oVetr 10,000 CFM Amps. I I I r I TOTAL CHARGES I ISSUANCE Of PERMIT I TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES ,hat the Eledrical work b. done by the Electrical Contrador, the .Iectrical portion of this permir sholl not b. valid until a label has bHn signed by an Electrical Contractor and attached to the electrical panel. I HAVe CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hllreon is true and correct, and I further certify that any and all warl.: 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 herin, and thot NO OCCUPANCY will b. mode of any structure without the perm inion of the Building Division. I furthar certIfy that my registration with the Build.r's Boord is in full force and effect as required by ORS 701.055, that if e}l.empt the basis for uemption is' noted heron, ond Ihclt only subcontractan and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board Il}l.emptian. NAME (please prin;) S i c::::..r. "" (, n IPV\P r- SIGNATURE >6. . I f:!,fJLK\ -Vlth) i Q ,VLQ r: DATE?1-J8~81 FOR OFFICE USE ONLY Zone Type/Const. Units Fire Zone A-droams I"'\__y load Flood Plain C;tori-' ""ccy Group BUilDING PERMIT Plan CIc.. Comm/lnd Charges and 65%/ Blda Por Fee Surcharges Plan CIc.. Res 30%/ Bldq Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ElEORICAL PERMIT _\ ~.C-:C) Charges and Sidewalk Surcharges . (O(') A/e Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharges -------- Sq. Ftg. Main Sq. FIg. Accen Sq. Ftg. Other x x "alu. "alue x Value TOTAL VALUATION Systems Development Chorae (1.5%1 I Total Comb. Permit TOTAL /5(d) ....-' . ,< I - COMBINATION APPlICATlON/alT (CAP) I. Applica~ to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lone County Map Reference 17 03, 4~ ' 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates " . C. Name. etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solor E. Square footage or valuation, etc. 1. example-1250 sq, foot hause, 500 sq. foot garage 2. exam ole-if new project, check ~.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. Value of work as defined in Section 303 (0) 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 ore 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 full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 typewritten copy and return it to the applicant at the rime the aC,tuel permit is issued for his signature: IV. Fees and Charges PIon check fees ore 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 OFFIC,E USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Project Information: PLANS REVIEWED BY, name . signatur~ . Permit Clery PERMIT VALlDATIOW l :1 .\ 1 \ ..;otp '.-;:(~, - ',V,fl' ". ft.':; '7'''/'''':Sy..~.....~:; - Job Addreu .' CV\ \'\ \~\\$\ t ~: CITY OF SPRINGFIELD CO~8INATI.ON APPLICATION/PERMIT I ENERGY SOURCES: . INFORMATION LINE 726-..37 S3 INSptCTION LINE 7~7.!_;, " Heat Waler Heater Ranqe Value of Work: >. ," ~ .~it / ./ j'" . .~#' 'Sq. Fig. Main Sq. Fig. Accen. Sq. Fig. O'her _New ._Add_Alter _Rep., ~~':.-;:,~FoI1C~DemO_ChOng./ U 10 __Olher -... De$Crib!" Work (Le.. Build Single At'l:lc!l.nd Garaoe' '. .. J0" ".,. n - (" '" " r-.. '.=--. 'r-. If " Owner . " , .' ~ '- Q '\: ': ';,.. J{" \. .. A (l-t\ Add"" Q 1"\ f\ ,f'{', " 0.~hhop. . . ,~~,~'. 0'\:. (~l (: Conuruction Lender V B~idi~g Permit Info: FomilyRe';1,:n~,: With "'j ,5) J' legal Oescription .-- Addren Phone DESIGN TEAM (name) (addren) (lies. no.) (expires) I (phone no.) Primary Structural Electrical Mechanical Plumbinq GAU Q \ $ ), '")\ <) 0 r(~o~{- (addreu) (lics. no.) (upires) C\ \0\("1 ~\.l ('\ M 0)\ '('(Yi\ " (~hone no.) CONTRACTORS (namlt) G~nltrol. \.. Electrical n')()- lid {)( o - ( =<.n - X I Mechanical NO. I I I I I I I I FEE I CHARGE, NO. I I I I I I elECTRICAL MECHANICAL PLUMBING FEE I CHARGE I NO. I Residence of furnace/burner to IITU's Applionce "ent separale Stalionory evap. cooler Vent fon with sinqlo duct Vent systltm aport from he"ting or A.C. Mechanical e.haust hood and duct ./ Each sinqle ii;dure Rltlocoted building (new fi:c. additional) S.F. Residence (1 bOln) ,q: ft. New circuits, altltrations or e:ctens;orn SERVICES Oualn (I bolh) each Temporory Conslruction . ry'.(\ Amps, /.. ~ _...I' Additional both I I I I I I I I r I TOTAL CHARGES I Water ,ervice Sewer Wood stove I heoter Storm Sew!"r FEEDERS Heot Puma Air hondler to 10.000 CF M Air handler over 10,000 CFM Amps. TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES thot the Electrical work be done by the Electrical Contractor, the .Iedrical portion of thil permit shall not be valid until a label has been signed by an Electrical Conlractor and attached to the .Iectrical panel. I HAve CAREFULLY EXAMINED the completed opplication for pltrmit, and do herltby certify that 011 information hereon is true and correct, and I (urther certify that any and all wor~ performed sholl be done in accordonce with the Oi-dinonces of the City of Springfield ond' the laws of the Slate of Oregon pertoining to the work described herin, and thor NO OCCUPANCY will be mode of ony structuro without the permission' of the Building Di.,ision. I further certify thot my registration with. the Builder's Board is in full fcrce Clnd effect O~ required by ORS 701.055, that if exempt the basis for ..emption is' noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board e.emption: ~ ,- NAME (please print) - .r I ...r, V" t-. n IP!I'd:? Y' o;lGNATURE .\ ,(J, '0 n~ :'l. I ..'f7LAI\ "'~i-I tl l \. :..1....0.: , DATE,?l-J8~~ I FOR OfFICE USE ONLY Zone Typel Canst. Ullih Sq. Ftg. Main Fire Zone Bedrooms nccy Load Sq. FIg. Acces- Flood Plain Ctori" I""\ccy Group Sq. Ftg. Other BUILDING PERMIT Pion Ck. Comm/lnd Chorges and 6s<J;,1 Blda Per Fee Surcha,glts . Plan Ck. Res 30%/ BIdet Per Fee PLUMBING PERMIT Charges ond Fence Surcharges Demo ELECTRICAL PERMIT \~ ~ Chorges and SidewQlk Surcharges ( d__:j AI C pc.,ina MECHANICAL PERMIT Chatgn and Curb CuI Surcharglts -------- x "alue . Value . Volue TOTAL VALUATION Systoms Oevelopment Char.,.o 11.5~;'1 Totol Comb. Permit I TOTAL /5&:0 III. Applicant ta sign and date Whenever possible, the initial application will be used as a worksheet cniy. Where possible: Building Division Staff will prepare a jypewritten copy and return it to the applicant at the rime the ac.tuel permit is issued for his signature. IV. ~~:~ ;;:c~~:;;::e due and payabie at the time of.t~'ilcipp;tation, . .. ~~;,;~:;~; and no pions will be processed until these fees are po!d. All. :- other fees and charges are due and payable when the permit..". ". is issued. . - COMBINATION APPLlCATION/paIT (CAP) I. Applicant to furnish A. Job Address B, Legal Description 1. example-lax lot 100, Lone County Mop Reference 1 i 2. example. Lot 1. Block 3, 2nd Addition to Springfield E: C. Nome. etc. of owner and construction lender D. Energy Sources 1. example.heat/electrical ceiling/or forced air qas 2. exomcle-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example. J 250 sq. foot house, 500 sa. foot garage 2. examole-if new project, check ne;.,-if addition, check add. etc. F. Building permit information: 1. example-construct single family house with an attach garage 2. exomple-remodel existing garage into family room 3. examole-convert single family residence into restaurant (change of use) G. Vclue 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 Stoff must be able to contact appropriate persons regorc design informction or job site corrections, etc. 'II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description porti< of the Mechanical and Electrical Schedules, the applican1 need fill-in only the No. Boxes adjacent to the appropria 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 fo'rm the schedules heve been abbreviated 2. If the ilem(s) to be installed ore not covered on the ar ated scheduies you should consult the full schedules C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND CHARGES ON THE SCHEDULES V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, . neme signatur... .Jote / ,~ . ", PERMIT VALIDA TIOrr. ." "~ 6'- \ CITY _OF, SPRINGFIELD City Hall Springfield, Oregan Department of Public Works OFFICIAL RECEIPT No. B 5 6 0 9 7 ( Dote~"' \~) 19n\ . Rec'd Fro"L~'~..~..\~\~~ &. ,,<:\ ~o ~ ( Address q INGt \-5-u:0. QJL\XYi:,.\,~) ( ( (' .. c / .'-' n~ 9/ 10 c::D J' c:;t tJl t., I to 'Z-l CR~\(J( ~ ~f\(j(JY) _.. \L~.Ol) ~) , loO ( Received For:' ( { P r-e.P<) <JV ~ 0..0 t ct ~Lr:T ( ( t. ( ( ~ . ~~) lnU (t .k , ';:""",~?;-': 'Af!!i~I!U ( Amount Received ( \, ( ~.,,,.. ( ~"ILTO"'TU~".UlL ~~'''TI'''' . IUGI~I. 0.. IUD' ( Permit CierI> I j. .' I J ) 1 I