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Home My WebLink AboutPermit Electrical 1990-4-4 .1 INSPECTION I.INE . 726-3769 Job Address \ Li 4T~\ '\ ~ '\ l\ \' Qj\O ) Legal Oescription \,{')?-dCCS Q?:::,cYJ\C1J ()I\ ~~5L f\) IMri - ) CITY UF SPRINGFIELD . .!NFORlI.~TION UN' COMBINATIor: APPI.ICATiON/PERMIT 726-3753 EllERGY SOURCES: Sq. rtg. T-lai n Heat !:q. Ftg. Acc~ss.__,_ Water Meater Sq. Ftg. Other --1~ew__Add__Alter-"~eo. Range_ Fence Demo Change/Use ValuE of 17\ ') Other- BUiIG~ ~ermif"1nfo: Descr,be Work(i.e., Build Single Familv ne~idence With Attached GaraQ~) {name) Phone (address I U~DHQ \(1_1\0 \ )Hmit ~ ~I ] Construction lender. Address DESIGN TEAI1 (lies. no.) (exo;res) (Dhon~ no. J Primary (name) (address) (lir.o:;. no.) ~ .~\q' lIA (exoiresl V (ohnne ~ Structural Electrical Mechanical CONTRACTORS no. ) Genera 1 ::::::~:al",mrtL tllJ2l:::r VOfn'i-A \~Cl~(teMr-, ~1echan1cal 11 j <<1 'Xq~<; PLUIIBI NG ELECTRICAL MECHANICAL NO. FFF CHARGF Nn. FEE CH~ NO. "FF CH~ SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building - (new fix. additional) ~ New c;rcu~ts alts. r-J." or extenSl0ns cQQ1- Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall SO;tc::p hP?tpr ;mrl IIpnt Storm Sewer Of amps. Appl iance. vent seoarate Stationaryevap. cooler Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and rluct Wood stove/heater Sewer Temporary Construction Change in existing res5 de.nce multifamily, comm. or Industrial ~Iater servi ce CO~1./IND. FEEDERS I Install/alter/relocate distrib_o f~ders Of I Dt) amps. (S~ ISSUANCE OF PFRmT TOTAL CHARGES TOTAL CHARGES l'3'7.~ TOTAL CHARGES WHERE STATE LAl~ REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical rortion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAr~cY will be made of any structure without the permissior of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon. and that onl SUbcontractors. anffiWt(~l~n3t Ontt't5 will be ust on this project. ;).~? S ) 0/ ID ll.j;VN M~0I27 ___ ~Ir,Il^TURE~. p~ DATE /r;l,,?ho' FOr. OFFICE USE miL Y !r I Sq. Ftg. t1ai~\x Value Sq. Ft9. Access x Value. Sq. Ftg. Other x Value Zone Fire Zone Flood Plain Type/Const. Bedrooms Units Occy Load Occy Group Stories' TOTAL V ALUA TI ON BUILDING PERfl1T Charges and Surcharges Plan Ck. Comm/Ind 65%/Blda P~r Fee ------------ Plan Ck. Res 30%/Bl dq Per Fee Fence Systems Development Charqe (.1.5~) PLur1BING PERMIT Charges and Surcharges D~ll1o ELECTRICAL PERrm Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges _Dt.~~~--- .Sidewa 1 k A/C Paving Total Comb. Permit Curb Cut TOTAL 3q,~ . . , COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax Lot 100, Lane County Map Reference II 03 4j 2. exam~le- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. examole- heat/electrical ceiling/or forced air gas 2. example- waterheater/eJectrlcal/or ~ E. Square footage or valuation, etc. I, example- 1250 sq. foot house. 500 sq. foot garage 2. examole- if new project, check:mew - if addition, check add, etc, F. Building permit information: 1. exam~le - construct single family house with an a ttached garage 2. exa~le - remodel existing garage into family room 3. exam~le - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. OESIGN TEAM ANO CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing. Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-,n only the No. Boxes adjacent to the appropriate item(s) to be installed B, Full Plumbing, Mechanical. and Electrical Schedules are available at the Building Division 1. To conserve space on the permit fonm the schedules have been abbreviated 2, If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is.not authorized to sign the electrical label. --- III, Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. 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 OCCUPANCY: . .. I . , J PERMIT VALIDATION' ~rfl .t- 17 8 vi \2-d~r 1'D 10/)-1- Permit Clerk ~~ 'Permit applicant exempt. from registration with the Builder's Board because: , , . Additional Project Information: PLANS REVIEWED BY: name signature . date '; IrISPECTION LINE 1726-3769 Job Address \qbi)~ '\ '{\ ~~li(\ 1 . legal Description \f \()Q:::i..~) rcs-wu ~ - Dw~er ~~ ~~O?G.j.~ Addr~~'NrJn~~~11 Construction lender. I - j . CITY Of SPRINGfiELD COMBltlATION APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater INFORJIATIDN UNt 726-3753 Sq. Ftq. 1.lain ~q. ftg. Access. Sq. Ftq. Other lie" Add Alter Pep. _, -Fence Demo Change/Use ValuE ofr{orJi\ l Other-- Builriinq ~efmit Info: Oeser be Work(i~e," Build Single Familv nesi~ence Wit~ Attached Garaqp) . Ranqe Address Ul:.~ HiN II:.Af1 (name) Phone (address) ~o r ~(\~g ~C(j1J) \' . \.. . (lir~ no.) (exo;r~~) (nhnn~ I no'-'\ Primary _Jl~~ ~ Structura 1 Electrical Mechanical Luit7~~:Ju~; InameJ taddrf"ssl nics. no.) (p'lCnil"pc:\ (nhnnP nn Genera 1 Plumbina Electrical ~. . ~l Kf\ '\\ nQ l tr y~\(\Q ~f)\~ \\\Df\IT U)} gJ \.ill r~ PLUMBING ELECTRICAL ~ \O/~1 k10 , '\40- \ (1)2..\ /llechanical MECHANICAL NO. FEF f:HARr.F NO ~~~ r~A~r.~ NO t'j:'j:' r~.nQr.t' Each single fixture Residence of SQ. FT. furnace/burner to BTO's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent IS.F. Residence (J bath) !ouP1ex (1 bath) each IAdditional bath 1~later service Sewer SERVICES Recessed wall ~oacp hp~tpr ~nrl vpnt Storm Sewer Temporary Construction Change in existing res.i df'ncp' Imultifamily, comm. or IndlJ<;trial IOf amps.1 I C0I1I-1. IIND. FEEDERS I~~~~~~~~a~;:~~~~locate I IOf amps.1 I I I I I I Appliance. vent "poa ra te Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\~ REQOIRES that the Electrical work be done by an shall not be vali1 until the label has been signed by an Electrical ISSUANCE OF PFR'IIT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division IWIE(please print) FOr. OFFICE USE Zone Fire ZonE' Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group Sq. Sq. Sq. Dill Y Ftg. Ft9. Ftg. f1a;n Access Other x x Value Value Value x TOTAL VALUATION BUIlDIIlG PERIIIT Charges an~ Surcharges Plan Ck. Comm/lnd 65%/Bldn Ppr F~~ ---------------p;an Ck. Res 30%/Bldo Per Fee Fence Systems Development Cha roe (1. 5%) PlU'1BING PERMIT Cha rges and Surcharges Demo ELECTRICAL PERI~IT Cha rges and Surch~rges MECHANICAL PERMIT Charges and Surcharges Sidewalk A/C Paving ___L~-,~__ Curb Cut -' =t:s Total Comb. Permit TOTAL I I ~CO,q:s I . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100. Lane County Map Reference 11 oj 43 2. example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. examole~ waterheater/electrical/or solar E. Square footage or valuation, etc. ------ I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examp.le- if new project. check-new - if addition, check add. etc. F. Building pennit information: 1. examole - construct single family house with an attached garage 2. examole - remodel existing garage into family foom 3. exa~le - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. II, Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules. the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing. Mechanical. and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is.not authorized to sign the electrical label. --- III. Applicant to sign and date Whenever possible. the initial application will be used as a worksheet only. Where possible. Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. 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 OCCUPANCY: . ,- -. , PERMIT VALIDATION #/(o5Q0 w\~~390 " Permi t Cl"k~ ./ I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date