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Home My WebLink AboutPermit Building 1981-10-02CITY OF SPRINGFIELD-_ COIIBIiIATION APPLICATION/PERMIT 726-37 s3 ll Electrical ''it_i Job Address l-egal Description l,Jater Heater EIIERGY Hea t 6 Owner Value of l.lork: Sq. Ftg. Access._ Sq. Fta. Other__ _tlew_Addal ter_Pep. _Fence_Demo_C han ge/ U s e' 0ther Sq. Ft9 . l'lain Builciinq Pr Fami'l y Res I :€., Bui ld SingleAddress -lr/.0 n^ ?z4zz I A t /1inCoristi on Lender unt]!I (Address DESIGN TEAI.,I 'name addre s s lics. no.exD res ohone no^ Structura I Pri ma E I ectri ca I l''lec ha n i ca I CONTRACTORS n ame addres s lics. no.exDl res NO CHARGE NO FFF CHARGF NO CHAR(:F Each single fixture Residence of FTSQ furnace/burner to BTLI' S Relocated bui lding (new fix. additional) New circuits alts or extensions Floor furnace and vent S F. Residence bath )SERV I CES Recessed wal I Snacp hcatpr and vpntl Duplex (l bath) each Temporary Construct i onAdditional bath Apol iance vent seoarate tnlater servi ce Cha res nge i n exi sti ng i dence Stationary evap cooi er Sewer multifamily, corm. or I ndustri a I Vent fan with sinole duct Storm Sewer Vent systern apart from heatinq or A.C. COMI.I./IND. FEEDERS Mechanical exhaust hood and duct Instal l /al ter/re1 ocate dist-rih- feeders l,lood stove/heater 0f amps ISSUANCF OF PFRI,IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I'IHERE STATE L.1N REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Buiiding Division of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 761.055, that if exempt the baiis for lxemption is noted hereon, and thatoniy subcontractors and employees who are in comoliance with ORS 701.055 rvi'll be used on this nroject. I.lAl'lE(please print I GNATURE its Ftg Ft9 Ftg DA Val Const Load Sq. Group Sq fy Ci ty made tca on f and hedo re cert ttha fo rman t on he reon ts ruercompap!')Derm b.y and tcorrec a nd rthefu certr hat t and rkwo sha dobe ne an cc wlrdance tth Ordihe ncena offyanyperfonned the o rl ,f e nda Lawsthe thof SeSpng teta 0 n n to th kwor rdesc bed erehof and tha NCt Y wrDertare0onsOCCUPANC be Zone Fire Zone Bedrooms Flood Plain Stories 0ther Val u Val ue TOTAL VALUATIOII . l,lain . Acce Plan Ck. Conrn/lnd 55%/BIdo Ppr Fpe Svs Cha tems Deve rqe (1.5% opmentBUILDING PERNIT Clrarges anC Su rcha rges "cd) Plan Ck. Res 30%/Bldo Per Fee .\ Fence " 0l -t+T,t ,€UPLUI,IB ING PERMI T Charges and Surcha rges l5 A e) L)60 Demo SidewaIkELECIRICAL PERI1IT Charges and Surcha rges Total Comb. PermitA/C Paving Curb CutMECHANICAL PERMIT Charges and Surcha rges bteaTOTAL l'1echa n i PLUIlB I NG ELECTR I CAL MECHAN ICAL FFF ,f I 0f amps /r,1- € i^1 PERMIT VALIDATION .i Permit Clerk I COMBINATT0N AppLICATToN/pERMIT (CAp) Applicant to furnish A. Job AddressB. Legal Description I. example- Tax Lot 100, Lane County 17 03 43?. example- Lot 1. Block 3, Znd AddiSpiiffiietd EstatesC. Name, etc. of owner and construction /electrical ceiIi r e ' Map Reference tion to 'lender or forced air gas sol ar D. Energy Sources 1. example- heat2, example- wateE. Square footage or vaiuation, el. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage ?. example - remodel existing garage into family room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESI6N TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc,II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the appiicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedu'les are available at the Building Divisionl. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal]ed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF t.lILL FILL OUT ALL FEES AND CHARGES ON THT SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractolis not authorizedto sign the electrical label.III. Applicant to sign and date Whenever possible, the initia'l applicat'ion wilI be used as a worksheet only. Where possible, Building 0ivision Staffwili prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gnature. IV. Fees and Charges PIan check fees are due and payable at the time of theapplication, 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{CY: Perrnit applicant exempt from registration with the Builder's Board because: Add'itional Project Information: 0,L, e PLANS REVIEWED BY: datenameSignatu tru EC 37 TI 69 ilLL - COI,IBI iIA APPL I CATI 37 )Job Address l-ega1 Descript'ion 2 Hea llater Heater EIIERGY Ranqe Val ue of l,lork Owner Sq. Ftq. tlain_ Sq. Ftg. Accesll- rSq. Ftq. 0the I ter --nep . Change/Use. .€., Build SingleAddres s P Builrlinq Pernrit iilfo: Describe [,lork( Fani1y llesidence jl,,ith At!4led Q-qlqge_ I A t_ n-7, ./.1 nA ? z4 z z .\'l 0)tion LenderCons lAddres s Iics- no.exD resDESIGN TEAII'name ss P ri mary Structura'l El ectri ca l l'lec ha n i ca l E l ectri ca I ''I i CHARGF NO FFF .HA ACF N0 FFF PLUIlB I NG ELECTR ICAL MECHAN I CAL l. HA AI:F Each single fixture Residence of FTSQ furnace/burner to BTU' s Relocated bui lding (new fix. additional) New circuits alts, or extensions ( I Floor furnace and vent S . F. Res i dence ( l bath)SERV I CES Recessed wal I SnaaF hpetpr rnd vpntl Duplex (l bath) each Additional bath Temporary Constructi on Apoi iance vent seDa rate l,later service Change in existing res i dence Stationary evap coo l er Sewer multifamily, corrn or Indrrstrial Vent fan with sinole duct Storm Sewer 0f s.Vent system apart from heatinq or A.C. coMr.r./IND. FEEDERS Mechan ical exhaust hood and duct Instal I /al ter/re1 ocate diqtrih fppdprs l,Jood stove/heater 0f amps ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE Llt'l REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Bui'lding Division i HAVE CAREFULLY EXAIIINED the completed application for oermit, and do hereby certify that all information hereon is true and correct, and I further certif-v that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO 0CCUPA['|CY will be madLof any structure without the rrermission 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 baiis for exemption is noted hereon, and thatoniy subcontractors and ernoloyees who are in comoliance with ORS 701.055 will be used on this Droject. llAtlE(please print)I GiIATURE Par@-:A;il Zone T'yDelConst.AItsFtg Fire Zo Val ue . 0ther x Val l'la i n Acces s TOTAL VALUATION--- cy Load Sq. Ft! c.y Group Sq. FtgFlood Plain Stories 0c P lan Ck. Cornm/ Ind 55%/Bldo Per Fee Svstems Deve charqe fl.57' 0pmefltBUILDING PERNIT Charges anC Surcharges .(_{_)a\J_\)_Plan Ck. Res 301,/B1da Per Fee \ Fence ',!1qPLUI4BING PERMIT Charges and Surcha rges t5--C)U60-Demo SidewalkELECTRICI,L PERTIIT Charges and Surcha rges Total Cornb. PermitA/C Paving Curb CutI1ECHANICAL PERMIT Charges and Surc ha rges TOTAL bt n( Ii (,U /r\\-, \ nhonc nn (-I)N IRACT0RS name { a ddrps s tcq_ n6, General At11 v:. n t/ i I COIIBINATI ON APPLI CATION/PERHIT ( CAP) I. Applicant to furnishA. Job Address B. Lega l Descript ion 1. example- Tax Lot 100, Lane County Map Refer l7-T3-43 ?. examole- Lot l. Block 3, 2nd Addit.ion toS!'FTnlTietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources l. examole- heat/electrical ceilinq/or forced2. exarno i e- rva te rhEETETe-TEEIiltIlTor soTa-F--E. SquaE-?6-otage or va I uation, ;tc. 1. examoJe- 1250 sq. foot house, 500 sq. foot2. example- if new project, check-new - if add check add, etc.F. Bu i 1 d i ng permi t i nforma ti on :l. example - construct single family house witattacned garage 4. example - remodel exist.ing garage into fam.i3. examole - convert single family residence iElTiTFant (change of-use)G. Value of work as defined in Section 303 (a) ofStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, BuildinrDivision Staff must be able to contact appropriipersons regarding design information or job sitrcorrections, etc.. Abbreviated Plumbing, Mechanical, & Electrical ScherA. Except where blank spaces occur in the descript,;portion of the Mechanical and Electrical Schedulthe applicant need fill-in only the No. Boxes act0 the appropriate item(s) to be instailedB. Full PIumbing, Mechanical, and Electrical Schedr,are availab'le at the Building D.ivisionl. To conserve space on the permit form the sch have been abbreviated2. If the item(s) to be installed are not coverthe abbreviated schedules you should consuitful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be deliveredelectrical contractor for signature by his electsupervisor. The general contractor is not authoto s i gn the e l ectri ca l 'l abel .. Appiicant to sign and date lJhenever possible, the initial appiication will be uta.worksheet only. Where possible, Building Divisionl_will prepare a type written copy and return it to thj-aPplicant at the time the actual 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, All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONIY CITY OF SPRINGFIELD CitY Holl Springfield. Oregon Deportmenl of Public Works OFFICIAT RECEIPT I No. B '.j7 :, )i I - Rec'd From I { ( q, ( q ( ( \ ,-4.(--) Received For (o, II III \r re Amounl Received ,L. \.1 (^ AY (1 SIGNATUFE SHELrOk rUinru!L PirnlERS ( IV V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additjonal Project Information: \ PLANS REVIEWED BY: name dateeSignatu { (