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Home My WebLink AboutPermit Building 1992-07-03COMBI Value of l,lork 0wne r l,Jater HeaterLegal Description Job Address EIIERGY SOURCES: IT Sq." Ftg. Access.- Sq. Ftg. 0ther__ llew Add,-Alter PeP. -Fence Dimo Chanse/Use -0ther- n t F .€. t ng ePhoneAddress \too iu,ral u\te.w, Itr{?ar\D 6(.Etr1r.)(, TEl.}A\-f tNRut- uel(frss, eR,41401 be-w ofrlc.bi,ol!€euoo*,, LxhtffiB F@MConstruction Lender NA ^)\ aN 0.. ZAeqtT@ (o"eo*Addres s Phone name Pri Structura l EI ectri cal Mechanical I ics- no-exD I res ohone no.add res sn ame General llgtu c.a^tstTa)g(los l@ VAt 4(M-14t1BtlPBl\ Plumbinq & ,Uo/"r.. u Pu, nl''lechani ca l € MECHANICALELECTR I CAL -J PLUIlBI NG FFF ct.lApGFFFFCHA RGF Iit0N0-FEF CHARGE NO furnace/burner to BTLI' s Residence of FTSQEach single fixture Floor furnace and vent Relocated building (new fix. additional ) New circuits alts. or extensions Recessed wal I Snace hpatpr and ventSERV I CES5. F. Residence(l bath)>VJ:A lwDuplex (l bath) each Apol iance vent qeDa ra t eTemporaAdditional bath Stationary evap. cool prse i n/d dence ) C han rps, i["later service mul ti fami I/,"corrn Tndrrctrial or Vent fan with sinqle ductSewer Vent system apart from heatino or A.C.Storm Sewer Mechanical exhaust hood and ductCOMM./IND. FEEDERS InstaI I /aI ter/re l ocate di <tri h fppdprc }lood stove/heater 0f ISSUANCF OF PFRI'IIT TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES WHERE STATE LIt,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penilit shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAIIINED the completed application for permit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work rrerformed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon pertaining to the work described herein, and that N0 OCCUPANCY will be madeof any structure without the permission of the Building Djvision. I further certify that nry registration vrith 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 employees who are in compliance with ORS 701.055 will be used on this project. rE7*Jc" 2;IlAl'lE(please print I IGNA Fire Zone Bedrooms 0ccy load /(r^ Sq. Ftg. Acces s 0cc.y Group A2 Sq. Ftg. 0ther_____x Val 'r,a,fr"@ Va'lFttt. l'lainits Val ue #575 Zone TOTAL VALUATI Flood Plain Storie PIan Ck. Conrn/lnd 65%/B1dq Per Fee * os'ts Systerns Develooment Charqe fl.5U ) 'N/ABUILDING PERI.IIT Charges anC Surc ha rges /2Afo (o,PIan Ck. Res 30%/Bldq Per Fee FencePLUi4BING PERMIT Charges and Surcha rges Domo Sldewal kELECTRICAL PERI,IIT Charges and Surcha rges A/C Paving Tota'l Comb. Ferm'i t Curb Cut 69/tu T,IECHANICAL PERMIT Charges and Surc ha rges J_A_o_a_ __ _ -7s TOTAL nhnne nn(addressUL5IUN ILAI.I CONTRACTORS w" 0f amps PERMIT VALIDATION Permi t Cl erk b COMBINATION APPLICATION/PER}4IT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference T7-TTZ.32. example- Lot l. Block 3, Znd Addition to SpTiigfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat,/electrical ceiling/or forced air gas 2. exd6iT-e- waterhEl':[EFET6tFita-i7or s6Ta-F--_E. Square footage or valuation' etc.l. example- 1250 sq. foot house, 500 sq. foot garage' 2. example- iF new project, check new - if addition' dhEEF-add, etc.F. Building permit information:1. exdmple - construct single family house with an attached garage2. example - remodel existing garage into family room3. exampTe - convert single family residence into iElTaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or iob site corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description portion of the Mechanjcal and Electrica'l Schedules, the applicant need fill-in only the No. Boxes adiacent to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Divisionl. To conserve space on the permit form the schedu'les have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULTSD. As noted on the CAP, the label must be de'livered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical iabel.III. Applicant to sign and date l'lhenever possible, the initial application will be used as a worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gnature.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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY: permit applicant exempt from registratjon with the Builder's Board because: Additional Proiect Information: date name sig natu re PLANS REVIEWED BY: C'fY OF :>l,t uN(;r:rLLL, 225 FTFTB STREEf, SPRINGFTELD, oRBGON 97477 INSPBCTI0N RBQUESTT 726-3769 OPFICE: 726-3759 PERHIT City Job Number Qtu APPLICATION .q&\D4 u OP ,ON ON Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. COMRACTOR INSTALI.ATION ONLY 3. COHPI.^ETE FEB SCFEDULE BELOS A. Nev Residential-Single or HuIti-FamiIy per dvelling unit. Service Included: Items Cost L000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder $ 8s.00 $ 1s.00 s 40.00 B Services or Feeders Installation, Alterations or Relocation: 1 Sum C*s LwtElectrical Contractor Address Ci ty Phone Supervisor cense Ntimber ltd6 Expiration Date \ constr contr. Number Expiration Date Signa of Supervising Electrician Ovners Name Address 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ Over 1000 amps/vo1ts Reconnect 0n1y c Temporary Services or Feeders fnstallation, Alteration or Relocation $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 $ 3s.00 $ 2.00 00 00 00 00 g 1_ 200 amps or less $ 40.00 201 amps to 400 .rps - g 55.00 over 401 to 600 amps - g 80.00 Over 600 amps or 1000 volts see 'Brl affi D.Branch Circuits Nev, Alteration or Extension Per PanelDr Ci ty ? ^n L^O. Phone OgNER rnstil.r.erroll one Circui t I Each Additional Circuit or vith Servic6 or Feeder Permi t C{ The installation is being made on property I ovn vhich is not intended for sale, lease or rent. 0vners Signature: DATE: E. Miscellaneous (Service/feeder not included) -Each ins tallat ion Prrmp or irrigation Sign/Out1ine Lighting- Limi ted Energy/Res Limited Energy/Comm $ 40. $ 40. $ 20. $ 36. SUBTOTAL OP ABOVB 5X State Surcharge TOTAL RECEIVED B 5 oc) \