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Home My WebLink AboutPermit Electrical 1980-09-04INSPE 726-3 COI1BI ;iATi ON APPL I CATION/ i'ERMIT 37 Struc tura I E l ectni cal Job Address l-egal Description llater Heater Ranqe EIIERGY SOURCES Heat Value of l,lork So. Ftq. l.'lain_ Sq. Ftg. Access._ Sq. Ftq. 0ther__ _l'l ew_Ad drAl te r_Pe p . _Fence_Demo Change/Use 0ther Owner Buiiiing Pernrit Info: Describe llork(i.e., Build Singie Farni Iy Residence l,lith Attached Garaqe)Mdrd:{5/ U Construction Lender B w Addres s Phone ohone no^DESIGN TEAI.1 name no ex0t res Pri ma ry El ectri ca i NOFEECHARGENO Each single fixture ng 0n a I ) Relocated buildi (new fix. additi Recessed wal I ;Snaap heatFr and vpnf, S , F. P.es i dence ( I bath)SERVICES Duplex (l bath) each Temporary Constructi orrAdd.i tional bath Change i n exi sti ng rps i dpncp Stati onar-v evap cool er Apol iance vent separate l,later servi ce Vent fan w'ith sinole ductI ndustri a I multifamily, cornm. orSewer 41 ..r,/ot ?10 anps.Vent systern apart from heatinq or A.C. :Storm Sewer c0r,fi.l./IND. FEEDERS Mechan i cal exhaust hood and duct l,Jood stove/heaterInstal l /a1 ter/relocate d.istrib, feeders I: i ISSUANCI OF PFRIt.IT TOTAL CHARGES TOTAL CHARGES dqlo WHERE STATE L1\ll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division and correct, and I further certify that any and all r.rork performed shall be done in accordance with the 0rdinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NC OCCUPAI,ICY will be made of any structure without the permission of the Building Division. I further certify that my registration vlith 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 ernployees who are in comcliance with 0l?S 701.055 vlill be used on this Droiect. : tlAl.lE ( p1 ease pri nt )S IGiIATURE I HAVE CAREFULLY EXAMINED the compl t, and do hereb.y certify that all information hereon is trueap r)rpecat0n TOTAL CHARGES : DA.TE Ftg Ftg Fts Zone Ix Uni ts Gro 'I ue Val e/Const. Load SqFire Zone Bedrooms Flood Plain Stories l'la i n TOTAL VALUATION Val ue Access. 0ther rqe (1.51 Svs Cha terns Deve opmentPlan Ck. Comm/lnd 65%/81do Per Fee BUILDING PERMIT Cltarges anC Surc ha rges PIan Ck. Res 30%/81dq Per Fee Fence ,eO PLUI4BING PERMIT Charges and Surcha rges Demo Sidewalk Ab,ooTotal Comb. Permit ELECTRICAL PERI|IT Charges and Surcha rges _as_,49_ ,A/C Paving Curb Cut 4ao,ooTOTAL MECHANICAL PERMIT Charges and Surc harges Mechani ca I ha nical PLUIJBI NG Residence of ELECTR I CAL SQ. FT: MECHANICAl- ; furnace/burner to BTU. s Floor furnace and vent New ci rcui ts al ts. or extensions .o-l-- Lnrut -4 Phone ( addre ss FFF a t{a pGF 0f amps (n COMBINATION APPLICATION/PERNIT (CAP) I. Applicant to furnish A. Job AddressB. Legai Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1 Block 3, Znd Addition to SprlnlTield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources1. example- heat/electrical ceiling/2. examFTe- waterheaTEiTETecEilcalToE. Square footage or valuation, etc. or forced air gasr solar G. Value of work as defined in Section 303 (a) Si:ructural Spec ial ty CodeH" DESIGI! TEAM.AND CONTRACTORS . To avoid-design or construction delays, Bui1 Division Staff nrLrst be able to contact persons regardring design information or 1. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- if new project, check new - if addition,. check add, etc. ,F. 'Building permit information:1" gIgIp]S - construct singie family house 11iith an attached garage :?. example - remodel existing garage.into iejmily room- :1. qxlJnple - convert single family resiciencd ini:oiEsTilFant (change of-use) ,of theIi ,.0rng a pproRr' job di iate 'te correcti ons , etc. IAbbrevia'Led Plumbing, I'lechanical, & Electribal SohedulesA. [xcept where blank spaces occur in the descr,ilrtionportion oi" the Mechanical and Electrical Schedules, the applicant need fill.'in only the No. Boxes adjacenttu the appropr'iate item(s).to be installedB. Full Plumbing, Mechanical, apd E)ectrical Schedules are available at the Building Division :1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are nol coverer{ on' the abbreviated schedules you shoulci consdll t li)e C. BUILDING DIVISION S'TAFF I.IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES ID. As noted on the CAP, the label must be.de'livered to theelectrical contractor for sisupervisor. The general conto sign the electrical label nature by his el:ectrical ractor is not authorized g L III Applicant to sign and date Whenever possible, the initial application wil l be used asa worksheet only. lllhere possible, Building Division Staffwil) prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his signature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans rvi)1 be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY : ,.. IV V t .t {I I t 1 t ; i i I I I ! { :.: { .1it I I I aI ) i ! { i PERMIT VALIDATION -----7G9-\*c-) @--t- f erm'it (,.ierk tr ) PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Perm'it appl icant exempt from registration.with-the Builder,'s Board because: Additional Pro;'ect Information : PLANS REVIEWED BY: date ?<-tranames'l I na tu re I I NSPECTION LI}IE 26-37 69 Ct)I,'B I NATI ERI'I I T 726-37 Cil UI * Job Address 1"Lt N r1n sc rgy Sources sy eat G er heater a ter re fenEE d-emol i ti6i- change/u-use otheralue of work o1/- n9 perm n r wor 'I le fam. res. with detached ra Lega l Description -o 0wne r ( name/addres s/ phone )L ,E 7t1 l-oilt tc Construction Lender (name/address/phone) ^.r"= DESIGN TEAI4 name addres s lics. no.exDt res ohone no, Pri ma Structura l EI ectri cal l'lechani cal CONTRACTORS name addres s (lics- no pYnt rpq ohone no. Genera I ouys71 Plumbinq E I ectri ca I Itlechanical PLUI,IB I NG 14ECHAN I CAL ELECTR I CAL N0.FEF CHARGF NO FFF CHARGF NO FFF CHARGF Each single fixture furnace/burner to BTLI' S Res i dence of SQ. FT Relocated bui lding (new fix. additional ) Floor furnace and vent (l/ New ui si ts o S . F. Res i dence(l bath) Recessed wal l Soace heater and vent SERV I CES Duplex (1 bath) each Additional bath Apoi iance vent seDa rate Temporary Constructi on l,later servi ce Stationary evap cool er Cha res nge in existing i dpnce Sewer Vent fan with sinole drrct multifamily, conrm. or Indrrstria l Storm Sewer Vent systern apart from heatino or A.C. Mechanical exhaust hood and duct COMI'I./IND. FEEDERS l,lood stove/heater Insta1 1 /a l terlre1 ocate distrib. feeders 0f i New circuits, alts nr evtcn<innc ISSUANCE OF PERI,IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES l,sP l.lHERE STATE LAl.l REQUIRES that the Electrical work be doneshall not be valid until the label has been siqned by an EIect by an Electrical Contractor, the electrical portion of thirical Supervisor and returned to the Building Division. permr t HA E CAR EFI.ILL EXAt,l I NED t he c 0mp I e te d a pp I i c a t .l 0n for permit, and ormed shal l to the work ion. S IGNATURE do c ert ify that all information he reon is true of the Citywill be made an d.co rrec t an d I further certify that the Laws of the State thout the permission, _\ fi;nn any and a1 of 0regon of the Bui 1 work perf,be n acc the OrdinancesofSprInqfiIdandpe rta 'I n 'I ng herofanystructureId1qDi'I s NA!'IE (please print)DATE FOR OFFICE USE ONLY Zones R- t I 30 Occy Load 0cc Stories - Units U N I tlMAI BUILDING PERI'IIT Charges and Su rcharges Plan Ck. Corffn/Ind 65%/B1do Per Fee 2 ,?t Storm Sewer Connec Plan Ck. Re 30%/81 dq Pe s rF,0ther PLUI,IBING PERMIT Charges and Surcha rges f,cr !,t0 1--0ther Sprinkler System 0ther ITELECTRICP.L PUI{ Charges a Surcharcd Total Comb. Permit A/C Paving tur\ tu\ Si dewai k SDC ]O]AL 5)g-o I 0f amps .ryFd24 Demo. \\t\\\\r\\ \t\\\\ Charges and Surc harges :l I.. COMBINATIOIi APPLICATION/PERI4IT (CAP) Applicant to furnish A. Job Address B. Legal DescriPtion l. example- Tax Lot 100, Lane County Map Reference l7-I3-43 ?. example- Lot 1. Block 3, ?nd Addition to SpriilTieto Estates C. Name, etc. of owner and construction Iender D. Energy Sources 1. exanole- heat/electric?l ceili!g/or fgrced air gas ?, exanclE waterheatEr/electrical/or solar E. Square footage or valuation' etc. 1. gamole- 1250 sq. foot house, 500 sq. foot garage ?. exa,lrgle- if new project, check new - if addition, EIecr add, etc. F. 8ui)ding permit information: l. examoje - construct single family house with an ;ttacna garage ?. examole - remodei existing garage into famiiy room 3. axaffiIe - convert single family residence into iETtiulant (change of use) G. Value of work as defined in Section 303 (a) of the Structural SPec.ialtY Code H. DESiGN TEAi.I AIID CONTRACTORS To avoid design or construction delays' Building Division Staff must be able to contact appropriate persons regarding design informat'ion or iob site corrections, etc. II. Abbreviated Plurnbing, l'lechanical, A. Except r'rhere blank spaces occu porlion of the Mechanical and the appiicant heed fill-in onl PERMIT VALiDATION clrY oF SPRINGFIELD ( CirY Holl Springfield, Oregon Deporlmenl of Public Works OFFICIAT RECEIPT B 52424 I9 (r ( 'ived For: ( & Electrical Schedules lin the description Electrical Schedules,y the No. Boxes adjacent to the appropriate item(s) to be installed B. Fu11 Plumbing, Hechanical, and Electrical Schedules are avai lable 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 scnedu'les you should consult the ful I schedu'l es C. BUILDIIIG DIVISION STAFF l^lILL FILL OUT ALL FEES AND CHARGES OI'I 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 lihenever possible, the initial application wjll be used as a worksheet only. t,Jhere possible, Bui lding Division Staff nill prepare a type written copy and return it to the appiicant 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. Al l other fees and charges are due and payable vrhen the permit is issued. V. FOR OFFICE USE ONLY nt Received SHELIOI'URTBULL'iIITERS Perm'i t Cl erk SIGNATURE €u6Er€ ox er.or d \ Fre PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Additional Project Information : PLANS REVIEWED BY name da te' ,Q-.2,Y49s't I ndtuFQ,,1 rl