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Home My WebLink AboutPermit Building 1991-03-13INSP 726- ON LIIIE CITY OF SPRINGFIELD COI1BI IIATI ON APPL I CATION/PERMIT Job Address EIIERGY SOURCES: Hea t l.later Heater Ran . llai Sq. Ftg. Access.--- Sq. Ftq. 0ther-__ _!{ew_Ad d_A1 te r_Pep . _Fence_Demo_C ha ngel Use 0ther a ou+ Legal Description 'S'15i5eo".,Owner <-cl) Address Phone n Fami s tt ra ;e., BuiId Singler -I, emrr,q. (ACfIS Constructi on {J\x rrl Address Phone DES I GN TEAI,I name address I 1 CS. n0.exDI res phone no Pri ma ry Structura I El ectri cal i'|ec ha n i ca I CONTRACTI 85 n ame addres s (lics. no.'exni rps ) Genera'l s-q Vfr E I ectri ca r'lechanicat n (ft) PLUI4B I NG ELECTR I CAL MECHAN I CAL N0.FEE CHARGE N0.FFF CHA RGF NO FFF CHARGFgEach single fixture b €r Residence of sQ FT furnace/burner to BTLI' s Relocated building (new fix. additional) New ci rcui ts al ts or extensions Floor furnace and vent S, F. Residence ( I bath)SERV I CES Recessed wal l Soace heatpr and vcnt Duplex (l bath) each Additional bath Temporary Construct ion Apol iance vent seDa rate [,Jater servi ce Change in existing rpsi dpncp Stationary evap cool er Sewer multifamily, comm. or Industrial Vent fan with sinole duct 7 ,/e Storm Sewer 0f amps.Vent system apart from heat-ino or A.C- coMr.r./IND. FEEDERS Mechani cal exhaust hood and drrct Instal I /al ter/rel ocate di stri h fppdprs [,Jood stove/heater 0f s. Fal *n '// f.,,4/zc Ba a 772.,I ,ZzrY^ 7t -fu-z Gz B4a 7a rssuANcF 0F PFRllrT /A TOTAL CHARGES P.n TOTAL CHARGES Z*NATOTAL CHARGES WHERE STATE Lltl REQUIRES that tlrc Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apfrlication for oermit, and do hereb.y certify that all information hereon is true and corect, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0reoon oertaining to the work described herein, and that t,l0 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my 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 thatonly subcontractors and er,rployees who are in comcliance with 0l?S 701.055 vlill be used on this oro,ject. i l{Al'lE(please print) ! eqr IGiIA' F ( zone{N\L-ryoe/const. Units i{q. rlain x Value Fire Zone Bedrooms Occy Load Sq, FtC. Access x Va Flood Plain Stories 0cc.y Group _Sq. Ftg. Other/tfr4V4frfrr/farV'Ua uq//rzarz Tfi - rrrrt.eD q i T.T^L v-ar-unr lue I 4raz> Ioil BUILDING PERI'II Charges and Surcha rges ---&=,=3 Plan Ck. Conrn/Ind 65%/81dq Per Fee Ar)r>)^33a.1ch tems rqe Deve 1. 5q opmen /t7-o'' Plan Ck. Res 30%/Bldq Per Fee ) PLUI4BING PERMIT Charges and Surcha rges ____€e::__ ?P Fence Dgno ELECTRICAL PERI1IT Charges and Surcha rges Sldewal k A/C Paving Curb Cut Total Comb. Permit /71.2s zf,ao.2r;TOTAL 7//.za I,IECHANICAL PERMIT Charges and Surc ha rges n_ I oit-74' COMBINATION APPLiCATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. glample- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. Block 3, Znd Addit.ion toSpFin-qTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources el ectri 'li forced air qas r or solar E valuat on, etc II 1. examp-le- 1?50 sq. foot house, 500 sq. foot garage2. elample- if new project, check-iEw - if addit.io;, check add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?_. example - remodel existing garage into family room3. example - convert single family residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Piumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiil-in onty the No. Boxes adjaient - to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the-permit form the schedu.leshave been abbreviated2. If the item(s) to be .instal led are not covered onthe abbreviated schedules you should consult theful'l schedulesC. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to thee1ectrical contractor for signature by h.is electricalsupervisor. The generai coniractor ii not authorizedto sign the electrical labelApplicant to sign and date lJhenever possible, the initial application will be used asa.worksheet oniy. Where possible, Building Division Staiiwili.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. Al l other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III IV V ficrF /z/ry PERMIT VALIDATION 2-D-?r Permit Cler PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name G gnatu re dat e'?-1>7s'r C'TY srrtttt\' -lELt) 225 FIFTU SIREET SPRINGFIBTD, ORBGON 97477 INSPBCf,I0N REQIIBST:. 720-3769 0FPICE: 726-3759 1. LEGAL DESCRIPTION A EI"ECTIUCAL PERHIT APPLICATION City Job Number COHPLETB I'BB SCTIEDULE BELOV Nev Residentlal-Single orHulti-Family per dvelling unit. Service Included: Items Cost 1500 sq.ft. or less Bach addltlonal 500 sq. ft or portlon thereof Each Manufrd Home or -Hodular Dwelllng Service or Feeder $ 85.00 $ 1s.00 $ 3s.00 Servlces or Feeders (10 Branch Circuitsincluded). Installation, Alterationsor Rerocation: a, a"''to' B + c 100 amps or less 101 amps to 400 amps E-401 amps to 600 amps 601 amps to 1000 amps- over 1000 amps/volts _- Reconnect 0nly 3 A I 102a1 DO on- bte ol Sum Permlts are non-transferable and expirelf vork ls not started vlthin 180 diysof lssuance or lf vork is suspended for 180 days. 2. CONTRACTOR INSTALI,JITION ONLY JOB DBSCRIPTION EIectrlcal Contractor Address Ci B t-e /'-cans $ $ $ 00 00 00 00 00 00 35. 60. 90.TMPhone e Number J $130. $300. $ 3s. Supervlsor Llcens Bxpiratlon Date /c Constr Contr. Nuriber Explratlon Date s/-- ture of lslng Blectrlcian rs Name dress Clty phone OVNBR INSTALI.ATION The installatlon ls belng.made onproperty I ovn vhich is not lntendedfor sale, Iease or rent. Oyners Slgnature: DATB: C. Temporary Services or FeedersInstallation, Alteration or Relocatlon 200 amps or less $ 35.00 201 amps ro 4oo amps - $ 40.00 -over 40L to 600 amps - $ S0.00 Over 600 amps or 1000 volts see rrgrr uffi[- D. Branch Circuits Nev, Alteratlon or Extenslon per panel One Circuit Tvo to ten Clrcuits Each Addtrl ten orportion thereof B. Miscellaneous (Servlce/feeder not included) -Each installation Pump or irrigation $ 36.00Sign/outline Lighting- $ 36.O0Signal Circuit or limited energy panel $ 36.00 SUBTOTAL OF ABOVB 5I State Surcharge TOTAL $ 3s.00 $ s0.00 $ 1s.oq 4 RECEIVBD BY: 5