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Home My WebLink AboutPermit Building 1990-12-06CITY OF SPRINGFIELD COMBI NATION APPLICATION/PERMIT JobAddress Lla S. S.=oSb Sr, l-egal Description i o Range EilERGL S0URCES;i"it q a s- Fsea,.\ lrt l,later Heater - owner EsasgN . -:z/JC. Value of l,lork:2-,Src.:> Sq. Ftg. l'lain i ttoSq. Ftg. Access. .- Sq. Ftq. 0ther ? -l'lewidd/(lG'_ IeP. - _Fence_Demo Change/Use 0ther Pho"S,lrLq/ r Builci in Fami'ly q Permit Info: Describe Work(' Residence I'lith Attached Garaqd .e., Bui'ld Single Strc-nDeG-r6zD- 64 oFG,<.t &s>rbcl Construction Lender.l oAJe- Address Phone S r- \\a\ DES I GN TEAI.,I name addres s exDt res phone no. Primary Sct_n A,tl Structura I EI ectri cal Mechani cal CONTRACTORS n ame address lics. no.(expi res 'ohone no- )Seut= ni ,$Genera I Pl umbi nq PLUI.lB I NG ELECTR I CAL 14ECHAN I CAL NO FEE CHARGE NO FFF THAAAF NO FFF CHARGF Each single fixture 6q Residence of SQ. FT furnace/burner to BTU, s Relocated buiIding (new fix. additional )Z New c i rcui ts al ts or extens ions Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Soace heatpr and vpnf Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seDa ra te flater service ge in existing dence Chan res i Stati onar-v evap. cool er Sewer mul ti fami 1y, I ndu stri a I comm. or Vent fan with sinole duct Storm Sewer 0f s Vent system apart from heatino or A.C. COMI.I./IND. FEEDERS Mechanical exhaust hood and duct InstaI I /aI ter/re l ocate di stri b- feeders l'Jood stove/heater I 6*rG;,J^ fu"ts-nt.,l1a 3.,.-r (0 DLISSUANCE OF PFRIlIT TOTAL CHARGES tr&TOTAL CHARGES TOTAL CHARGES WHERE STATE L,1I,I REQU shal l not be val i,l unti I IRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitthe label has been signed by an Electrical Supervisor and returned to the Building Oivision I HAVE CAREFULLY EXAI{INED the completed appl.ic and correct, and I further certify that any ani all work oerformed shall be done in accoidance with the 0rdinances of the Cityof Springfield and the Laws of the State oi Oreqon pertaining to the work described t...:n, and that NC 0CCUPANCY will be madeof any structure without the permission of the ouiliing Diviiion. I furthei ie.iitv inat my registration yr.ith the Builder,sBoard is in full force.and effect as required by ORS 701.055, that if exempt tne Uaiii ior Lxemption is noted hereon, and thatonly subcontractors and employees who are in comcliance with 0l?S 701.055 wi]l be used on this oroject. S i GNATUREtQ)"-t'lAl'lE(please p DATE G De.c1orint) l-4ner< L,- Flood Plain Stories 0cc.y Group_ Ftg Ftg Ftg itsZone Load Sq Sq x 'I Cons t.lul'la i n Fire Zone Bedrooms Val ueAccess. 0ther Plan Ck. Comm/Ind 65%/81dq Per Fee sterxs opmext 1 BUILDING PERI'IIT Charges and Surcharges Plan Ck. Res 30%/Bldq Per Fee FencePLUI4BING PERI4IT Charges and Surcha rges L5.q) 1 Dgmo Sldewal kELECTRICAL PERIlIT Charges and Surcha rges Total Comb. PermitA/C Paving Curb CutHECHANICAL PERHIT Charges and Surc harges C,bZt.25 TOTAL 43 0f amps TOTAL VALUATION---. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1. Block 3, 2nd Addition to SErlngTield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources 1. example- heat/electrical ceilinq/or forced air oas2. Ex amETE- wa te rE-eITeFIeTedTiJlITor so-Tlf--E. Square footage or vaiuation;;Tc. 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. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. exampie - convert single family residence into restaurant (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, Building Division Staff must be ab'le to contact appropr.iate persons regarding design information or job sitecorrections, etc.IL Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the appiicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful1 Piumbing, Mechanical, and Electr.ical Schedules are available at the Building Divisioni, To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult the fu'l I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGLS ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor .is not authorizedto sign the electrical 1abel.III. Appf icant to sign and date lJhenever possibie, the initial appl.ication will be. used asa worksheet only. Where possible, Buiiding Division Staffwili prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gna ture.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed unt.il thesefees are paid. Ail other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION 2*t o'?o %c(d #-g?tq Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Bu'ilder's Board because: Additional Project Information: PLANS REVIEWED BY: name si g nature date t-otO S oAS €- 225 FImIil S1?8Er SPRINGPIELD, OREGON 97477 rNSPEcrroN REQUESTT 126-3769 0FPfCE: 726-3759 1.. LOCATION OF INSTALIATION SPRIT IELO EIJCTRICAL PERI{IT APPLTCATION Ctty Job Nuaber f tems Cos t s 8s.00 s 1s.00 $ 3s.00 COI{PI,STB rEE SCBEDI'I^E BELOU Nev Resldential-Slngle orHultl-Farnily per dvilltng unlt.Servlce fncludedi 3. A IJGAL DESCRTPTION JOB \t tront B. Electrical Contracto r |\a^r\il,+gf#.lpr4L Address btlo {W Gts U< ci L.,e--Yl<Phone {,:gdz>u5 Supervlsor License Number Zqb 5 Expiratlon Date o Constr Contr. Number H 2o-r{5C c. Explration Date D L Signa ture of Supervislng BIec trlclan D. Address lt\5 a2 ci ,7 .B ,tb I Permits are non-transferable and explreif vork ls not started vlthin 1g0 daysof lssuance or if vork is. "u"p"niea for180 days 2. COIrIRACTOR INSTALIATION OI|TLY OVNER INSTALINTTON The installation ls belng made onproperty I ovn vhlch ls not lntendedfor sale, lease or rent. Ovners Signature: 1500 sq.ft. or 1ess Each addltional 500sq. ft or portion thereof Each l,lanufrd Hone or -Hodular Dvelllng Servlce or Feeder Servlces or Feeders (10 Branch Circultslncluded). Instal1ation, elteraitonsor.Relocation: Sum 00 00 00 00 00 00 Sgs $60 $go z 100 amps or less 101 amps to 400 amps ,- 401 anps to 600 anps T601 amps to 1OOO anpsover 1000 amps/volti -Reconnect 0nly s130 $300 S3s Temporary Servlces or FeedersInstallatlon, Alteratlon or Relocation 201 amps to 400 amps - S ao.oo0ver 401 to.600 amps - S S0.60over 600 amps or.rbooE'IIs ;";-;;; a6E Branch Circults Nev, Alteratlon or Extension per panel One Circult Tvo to ten Circuits Each Addtrl ten orportlon thereof &:s 3s.00 $. s0.00 s 1s.00 E.Hlscellaneous (Servlce/feeder not lncluded)-Each lnstallatlon lymn.or irrigatton S 36.00Stgn/outline Lighttns- i 3;:OOSignal Clrcult orIimited energy panel_ S 36.00 DATE:5. ST'BTOTAL OP ABOVB 5Z Stite Surcharge TOIALRECEIVEDBY: 0 -dz €ac- zla-,7 a c>c> 0vners N"r" Bcla,Oa,rll , t,r.fC , a a