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Home My WebLink AboutPermit Electrical 1983-10-17IIISPECTIOII LiIIE 726-37 69 -TTTYI-SPRTNGFIELD COI1BI IIATI ON APPL I CATI ON/PERMIT INFORIIATION LiNt 726-3753 oo (/ N oN Job Address Legal Descripti EIIERGY SOURCES Hea t l,later Heater Ranqe So. Ftq .l'lain Sq. Ftg. Access._ Sq. Ftg. Other_ J{ewadd-Al ter_Rep. _Fence_Demo_Chan ge/ U se 0ther( Value of l,lork: 0wner Address nn."" d]rg2 BuiIciir Fami I y nq Pernrit Info: Describe Work(i 'e. , Bui ld Single Residence liith Attached Garaqe) Construction Lender Addres s Phone DESI(iN TEAI.,I name address 1 CS. nO.exDt res ohone no. Primary Structura I El ectri ca I Hechani ca I name addres s (lics. no.)exDl res ohone no. Genera I *4rC\-f{l(l.- Pl umbi ng 1 PLUtlBI NG ELECTRICAL MECHANICAL FFF CHARGF NO FFF CHARG F t'10 FFF (:HARGF Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated bu'i Iding (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence ( I bath)SERV I CES Recessed wal I Soace heater and vent Duplex ('l bath) each Addi t'iona l bath Temporary Constructi on Apoi iance vent seDa rate Llater service Change in existing rpc i dpncp Stationary evap. cool er Sewer multifamily, comn. or I ndus tri a I Vent fan with sinole duct Storm Sewer 0f Vent system apart from heatinq or A.C, COI,II.I. /IND. FEEDERS Mechanical exhaust hood and duct I n sta 1 I /a I ter/ rei ocatedistrib. feeders lrlood stove/heater 0f amps ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES HHERE STATE LAtl REQUIRES that tlre E'lectricai work be shalI not be valiC untiI the label has been signed by an done by an Electrical Contractor, the electrical portion-of this permit E'lectrical Supervisor and returned to the Building Division IHAVECAREFULLYEX/\}1I IED the compieted application for oermit,and do hereby certify that all 'information hereon is true and correct, and I further certif-v that any State of and al'l work performed shalI be done in accord ance with the 0rdinances of the City of Spriof any Board i ng fi el s truct d and the Lavrs of the 0regon the Bu i oertaining to the work described herein, and that NC OCCUPAI'ICY will be made ure without the permission of 'ldi ng 70t Division. I further certify that my registration vrith the Builder's s in full force a effect as required 0Rs 055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and loyees urho a ,l liance with ORS 701.055 wi]1 be used on this proiect l{Al.lE(please print I Zone nst. Units Sq.Ftg l,la i Acc Val Fire Zone Bedrooms Occy Load Sq. Ftg Val Flood Plain Stories 0cc.Y Gro Va1 ToTAL VALUATI0il_ Ftg 0ther BUILOING PERl\IIT Clrarges and Surcha rges Plan Ck. Conrn/Ind 65%/81do Per Fee teris e 1.51 Plan Ck. Res 30%/Bldq Per Fee PLUI,.IBING PERMIT Charges and Surc ha rges Fence D6mo ELECTRICAL PERIIIT Charges and Surcha rges _J5-0_Q_ .1,00 Sidewal k t&t^{.0 . L rffg(,?b A/C Pavi ng Curb Cut Total Conb. Permit I1ECHANICAL PERMIT Charges and Surc ha rges TOTAL { rs. ro ( :TORS 3 COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. ggp.l_C.: Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. Block 3, Znd Addition toSpringfield Estates 9. Name, etc. of otvner and construction IenderD. Energy Sources I examole- heat/ example- waterre footage or electrical cei I in or forced air gas 2 ter e ec ca or soTarE. Squa valuat oo' example-. examp i e- check add 1250 s q. foot house, 500 sq. foot garageproJect, check new - if addition,2 lT-new etc II. F. Building permit information:1. example - construct single fami)y house with anattached garage ?. example - remodet existing garage .into family roomJ. examDte - convert single family residence intoiEtifFant (change of-uie)- "' - G. Value of work as defined in Section 303 (a) of the.. Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construct.ion delays, Build.ingDivision Staff must be able to contalt appropriitepersons.regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrica.l SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electrica.l Schedu.lei,the applicant need fill-in only the No. Boxes adjiient_ !o-!h9 appropriate item(s) to Le installedB. Full Plumbing, Mechanical, and Elecirical Schedu.lesare available at the Building Divisionl. To conserve space on the-permit form the scheduleshave been abbreviated2. If the .item(s) to be instailed are not covered onthe abbreviated schedujes you should consu.lt theful l schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to theelectrical contractor for signature by his electricai - supervisor- The general con[ractor ii.not authorizedto sign the electrical 'label Applicant to sign and date llhenever possibie, the in.itial application will be used asa.worksheet only. l^there possibli, Auilding Division Staiiwill.prepare a type written copy ind ""tr"n it to theapplrcant 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 wiit-Oe proceiied until theseTees are paid. AII other fees and charges are due andpayabie when the permit is issued. FOR OFFICE USE ONLY III. IV v PERMIT VALIDATION Pelrmi t Cl erk ;d u trLtq PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: t applicant exempt from registration with the Builder,s Board because:Permi Additional Project Information : PLANS REVIEWED BY: name da tes'l g na tu re IiISPECTION LiIIE 726-37 69 CITY OF SPRIIIGFIELD COMBI iIATI ON APPL ICATION/PERM IT INFORI1AIION LINI 726-3753 00 C^) O) B Job Address 3oS SoaL/ qt|S/,EIIERGY SOURCES Hea t l,later Heater Ranoe So Sq Ftg .l.lain Ftg. Access._ Sq. Ftg. 0ther_ l{e'.,Jdd^AtTe[_]eH- _Fence_Demo_C ha n gel U se 0ther l-egal Descri ption "'5t15-.oo/, n^',4.-Owner y'-pt J tt !l Address 3 O .^.,uLln 41L ,Phone c.I sidence I'Jith Attached Gara .€., Build Single !-,,^^f.(J b-.f?r![-,; - R l). Construction lender /// I 1o l1 r'/torl Address Phone --/ DES I GN TEAI.I name address cs. no.pxo i res ohone no- Primary ,{/ I Structura I El ectri ca l Hechani ca I name address (lics. no.) (exoires ohone no - I />a El ectrical l'lechanical PLUTIB I NG ELECTR I CAL MECHAN I CAL N0.FFF CHARGF NO FFF CHARGF NO FFF Each single fixture furnace/burner to BTU' S Relocated building (new fix. additionai) Floor furnace and vent S.F, P,esidence(1 bath)SERV I CES Recessed wal l Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apof iance vent seoa rate l.later servi ce Chan res i ge in existing dence Stationary evap cool er Sewer multifamily, comr. or I ndus tri a i Vent fan with sinole duct Storm Sewer 0f amps.Vent system apart from heatinq or A.C. COMI.I. / IND. FEEDERS Mechanical exhaust hood and duct InstaI | /aI ter/re l ocate distrib- feeders l'Jood stove/heater 0f _ amps ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES l.lHERE STATE LAl.l REQUIRES that the E'lectrical work be done by an Electrical Contractor, the electrica 1 portion of this permit shall not be vali,l until the labe'l has been signed by an Eiectrical Supervisor and returned to the Building 0ivision I HAVE CARE FUL L Y EXAHI the comp et a p !')c a t 'I on for Derm 'I t and do he reb.y ce rt fy t ha t a I I 1 nfo rma +i on hereo n i s true the CityI be made ilder's and that a nd co rrec t a nd I fu rt he r cer t 1 fy tha t a ny a nd a 'I I wor k pe rformed sha I I be don e 'I accordanc e WI +h the 0rd 'I n an ces f 0 f spr I ng fi e I d a nd the La vrs of the Sta t e o f 0req on DE rt a 'I nt ng to th e work descri bed here i n a nd th a t l,lc OCCUP ,ANCY w'l I of any structure without the permission of the Building Divisi n I furthe rf exempt .055 wi l I cert 1 fy th +my reg 'I s trat I on v,t th the Bu Boa rd I s 'I n fu I I fto rce an d e f fec t a s requ '|red by ORS 7 0 1 05 5 t ha t 1 th bas 1 s fo r exemp ti on '|s noted hereon on 1y s ubco n trac to rs and etxp I oyee s who a re 1 n comc 'I ,l a nce wl t h ORS 701 U5 ed on th I s D roJ ec t l{Al.lE(please print)S I GNAT F t-- tz. Zone Tyoe/Const.Uni t s Sq. Ftg . t'la i n x Val ue-- Fire Zone Bedrooms ccy Load Sq. Ftg. Access x Val Ip Flood Plain Stories 0cc.y Group-$q. Fts Val ue TOTAL VALUATION- 0ther BUILDING PERNIT Charges anC Surcha rges @ P'l an Ck. Corm/ Ind 65%/8ldo Per Fee Svsterns Deve' Charqe (1.5%, opment Plan Ck. Res 30%/Bldq Per Fee PLUtlBING PERMIT Charges and Surcha rges Fence Demo ELECTRICAL PERIIIT Charges and Surcha rges SldewaIk A/C Paving Curb Cut Total Comb. Permit I,IECHANICAL PERHIT Charges and Surc harges TOTAL &qqb -) {n--,n 7u. f2D R^. /c.</) En-,u. Plumbino IADAE Residence of s0. FT. New circuits alts. or extensions Y k COMEINATION APPLI CATION/PERMIT ( CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map ReferenceI7-T'T]32. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sourcesl. example- heat,/electrical ceilino/o l. exa[pte- waterheater/electrical/or Square footage or valuation, ETf- r forced air gas !91_er -E II III. 1. examp-le- l4o se. foot house, 500 sq. foot garagez. elample-.if new project, check new _ if addition,check add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?. example - remodel existing garage into family roomJ. examDle - convert single family residence into - ;El6urant (change of"use)G. Value of work as defined in Siction 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contalt appropriitepersons.regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-.in only the No. Boxes adjiient _ to the appropriate item(s) to be instaliedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Divisionl. To conserve space on the-permit form the scheduleshave been abbreviated?. If the 'item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF I,JILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de.livered to theelectrical contractor for signature by his electrical - supervisor. The general coniractor is.not authorizedto sign the electricai labelApplicant to sign and date IJhenever possibie, the initial application will be used asa.worksheet only. l^lhere possible, Building Division Stafiwill_prepare a type written copy and returi it to theapplicant at the time the actuai perm.it is issueJ io" f,issignature. Fees and Charges P'lan check fees are due and payable at the time of theapplication, and no plans wiil-be processed untii thesetees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY IV v PERMIT VALIDATION Permit Cl (/ U6to p'83 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: da tenames1gna tu re IIISPECTIOiI LIIIE 726-37 69 CITY OF SPRINGIIELD COI1BI iIATI ON APPL I CATI ON/PERMIT INFORI1ATION LINE 726-3753 Dea r$ pA \)o Job Address o 4 Legal Descniption EIIE Hea l'H.Wh nt, l.later Heater Ranqe Sg. Ftq . l'lain Sq. Ftg. Access.-- Sq. Ftq . 0ther Va l ue of l,lork: 0wner Addr<jss 3O9 2 I :r.P\ol"v s r r+& LJ4 tI r Ga re., Bui ld Single fu-^* ,o-*jf Cr*til -*,* avJ Construction Lender Jq;-Lil1*4 ll-r, Nc 444.b,* .-:1!t Address Phone 0,.-ff name address 'I ics. no.exn i res ohone no. Primary Structura l E l ectri cal I'lechani ca l CONTRACTORS n ame a ddres s )(l ics- no- )( pxni rps ohone no- Genera I Pl umbi no E l ectri caI r.lechanical ha,-,,-*, YO* C- C*?)/o-,t-trj )qe-rcLt J PLUIlBI NG <t ELECTR I CAL MEC HAN I CAL N0.FFF CHARGF NN FFF {:HARGF NO FFF I^I]A PGF Each single fixture Residence of SQ FT r furnace/burner to /oo, ooo ETLI's r00 tn. 6) Relocated building (new fix. additional) New ci rcui ts al ts or extensions FIoor furnace and vent S . F. Res i dence ( l bath)SERV I CES Recessed wal l Snacp heatpr and vpnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seoa rate tlater servi ce Change in existing res i dence Stati onar.v evap cool er Sewer muitifamily, corm. or Industrial Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C, cotlr.t./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/rel ocatedistrib. feeders lJood stove/heater 0f s. ISSUANCE 0F PFRI1IT 4- TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES 2 WHERE STATE LAN REQUIRES that the Electrical work shall not be valid until the label has been signed by be done by an Electrical Contractor, the electrical portion of this pernit an E'lectrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the comp leted application for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that anyof Springfield and the Laws of the State ofof any structure without the permission of and ail work Derformed shall be done in accordance with the 0rdinances of the City 0regon oe the Buildi rtaining to the work described herein, and that NC 0CCUPANCY will be made ng 701 Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 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 r.rill be used on this oroject llAl''lE( p l ease pri nt)G-E.P ra u <)..o SIGIIATURE 2 _{.e^;DA rE lo-q-f3 FON C i*Z---rtpe/const. St9 un its . Ftg . t'la i x lue Fire Zone Bedrooms Load Sq Crorr@Sq Ftg. Acce Value Flood Plain Stori es Ftg . 0ther x Val /fi47v77 1? L PzVza 47 4rv4,? <2,ToTAL VALUATIoN_ BUILDING PERI'IIT Charges and Surcharges Plan Ck. Comm/Ind 657"lB1do Per Fep Svstens Deve Charqe (1.5q opment Plan Ck. Res 30%/B1dq Per Fee Dtrn.tL PLUI4BING PERMIT Charges and Surcha rges Fence &20 o.oo D6mo ELECTRICAL PERIlIT Charges and Surcha rges Sidewal k A/C Pavi ng Curb Cut Tota'l Comb. Permit IlECHANICAL PERMIT Charges and Surc ha rges =,qo--TOTAL 3Dqtp ul N ILAI'I COI4BI NATI ON APPL I CATI ON/PERHI T I. Applicant to furnishA. Job AddressB. Legal Description (cAP) c D 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpTingfield Estates Name, etc. of owner and construction iender Energy Sources1. examol e-2. examol e- squaF-TiITas hea t,/el ectr i ca I ili forced air gas wa te a e solar E e or vaiuat on, etc. II l. examp_le--1250 sq. foot house, 500 sq. foot garagez. elample- if new project, check new - if addition, check add, etc.F. Euilding permit information:1. example - construct single family house with anattached garage ?. examp-le - remodel ex.isting garage into family roomJ. example - convert single family residence intore:;taurant (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 appropriitepers0ns regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiil-in only the No. Boxes adjacent - to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Divisionl. To conserve space on the permit form the schedu.leshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you shoujd consuit theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de'livered to theelectrical contractor for signature by his electricai - supervisor. The general coniractor ii not authorizedto sign the electrical labelApplicant to sign and date Hhenever possible, the initial appl.ication wilI be used asa.worksheet only. Where poss.ible, Building Division Staiiwill prepare a type written copy and returi it to theapplicant at the time the actual permit is issued for his s i gna ture. Fees and Charges PIan check fees are due and payable at the time of theapplication, and no plans will be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is issued. III. IV. V. FOR OFFICE USE ONLY W,.P+ bK1Y Permit Cle I tc783 PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: E ?< Gz PLANS REVIEWED BY: date /A -78=name s i gnatu l PERMIT VALIDATION (tu