HomeMy WebLinkAboutPermit Electrical 1981-6-26
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INSPECTION LINE
726-3769
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CITY OF SPIUNGflElD
COMBINAflCN APPllCAJlON/pERMIT
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INFOIlMAflON LINE
7'26-3753
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Job .dd.... ;.v09J:L,-rvl/]Af'OfJO--'3:/
L.gol O..,,;pl;o. I 7 ' ():2. J 2- C) - j i-/ I?_? () D
I ENERGY SOURCES:
He-of
j Water Healer
Ranqe
I Value of Wori:_
Sq. fIg. Main
Sq. FIg. Accen.
Sq. FIg. 0,11.,
_New_Add _Alt., _Rep.
_ __fence _Demo_Changei U ,.
_Olher
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Add,...
Phone
I Building Permit InfQ: --Oescribe Wor.. ii.e.. 8uild Single
Fomdy Resident,.. Wi,h AIt.,ch"d Gorooel
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Owner
__-fA.I.I /VIr} J./J /I. =---7r;v?~/
~-~9l) 'rYJ /l/I/,(';Jl~: illphO..
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Add,."
Conuruction lender
DESIGN TEAM
(namei
(addren)
(li(1. no.)'
(expire,1
(phone no.l
Primary'
Structural
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CONTRACTORS (nome)
O"nttral 1-/r-A7;.J'~:~ -tJ..
Plumbi"q
(address)
flies. no.)
.~~
(u:oiresl lff (chane no.l
Electrical
Mechanical
Electrical
"';~/a/YYi.JJ~ ~?J.PL~
A? 417(18
;;r/4fJMP
d
~b-.~7C- to-IV
Mechonical
PLUMBING
ElECTRICAL
MECHANICAL
NO.1
FE!:
CHARGE NO. I
F::i: i CHARGE NO.
Re,icenc. of
furnace/burner to
:a,ru's
Appliance ...ent
separate
Slatianary .vap.
cooler
Vent fan with
sinqle dud
Vent syst.m aport from
heatinq or A.C.
Mechanical ~llhaust
hood and duct
FEE !CHARGE
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Each sinqle filflur..
R.loca,.d building
(new fill. odditioMIl
S.f. h.iden~.
f1 both)
so: ft.
New circuits. alterations
or e}l;tensions
Ouolu (l both) each
.., '<P ~cP
SERVICES 160a>l1.-i ",'9 - .2-'?..,
'J
Temporary Construction
Addilional bOlh
Amp..
Water senice
Sewer
Wood slo"./heot.,
Star."" Se......r
FEEDERS
Heat Pumo
Air handler to
tO,COO CFM
Amp..
Air handler a".r
1 0.000 CF M
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I TOTAL CHARGES
TOTAL CHARGES
ISSUANCE OF..PERMIT
'2_"5.051-1 TOTAL CH.RGES
WHERE STATE LAW REQUIRES that .h. Ele"ri,al worle b. don. by the El.,tri,ol Contractor, the electrical portiorl of this permit shall not be yalid until a
lab.1 has b_n sign.d b., an EI.ctrjcal Contractor and attached to the el.ctrical panel.
I HAVE CAREfUllY EXAMINED the completed appli,ation far permit, and do hereby certHy that all information hereon is true and ~arre~t, and I further
,.,tif., that any and 011 work performed sholl be don. in accordan<<t with the Ordinan,u of the City of Springfi.ld and the laws of the Slgte of Oregan
p.rtaining to the .....ork dl!lcribed herin, and that NO OCCUPANCY will b. mode of any structure without the permiuion of th. Building Di"ision. I further.
certify that my regisrratian with the Builder's Boord is in full foree and effe" 0 s required by ORS 701.055. that if eX.~mp' the basis for exemption is noted. .
h.ron, and that only subcontractors and employees who are in complian~ with ORS 701.055 will b. used on Ihis projed. " ," ' /'
Basis far Builder's Boord eJeemptianl
NAME (pl.... p.;..) /f:ENA/..C T// tC tv' / N6L-S1GN.TURE ~"<Lt/-7/ ~ 0.TE~-2s:.r:P/i
fOR OFFICE USE ONLY
Zan.
fir. Ion.
flood Plain
(,)1
Type/Con.t ....l---.
~dlaoms
<:tori.~'
"nih
....."y load
""'''y Group
Sq. ftg. M~in
Sq: ftg. Acteu
Sq. Ftg. Olher
Value
Valul
"'olue
. TOTAL VALUATION
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BUllOING P~RMIT
Charges and
Surchorges
Plan Cif.. Com",,/Ind
65~:.1 Bides Per Fe"
Pion Ck. Re.
30%1 Bldq Per Fee
Systems Oe..../opmenl
Choroe (1.5~:'1
PLUMBING PERMIT
Charge, and
Su,,;,arges
Fence
C.ma
I Total Comb. P-"mil
/ 00
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ElECTRICAL PERMIT
Chorg.. and
Surcharges
/1 0
-x,""iq-
i. Or;?
Sidewalk
A.le: Po."in"
MECHANICAL PERMIT
Chalge. ond
Su"horgu
TOTAL
~ to . O~
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicc~ 10 Furnish
A. Job Address
B. legal Description .
1. exomcle.tax lot 100. lane County Map Referer
2. exomcie.lot 1. Block 3. 2nd Addition to Springfi
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole.heat/electrical ceilinq/or forced oir go:
2. examole-woter heater/electrical/or solar
E. Square footage or valuation, etc.
L examale.1250 sq. foot house. 500 sq. foot garcc
2. e)Comole-if new project. check ~.if addition, cl
acid. etc.
F. Building permit information:
1. exam ole-construct single family house with an O'
garage
2. examole-remodel existing gorog& into family roc
J. example.convert single family residence into
restaurant (change of use)
G. Value or work os defined in' Section 303 (0) of the
Structural Specialty Code
. H. DESIGN TeAM -AND CONTRACTORS
To ovoid design or construction delays. Building Divi
Stoff mllst be able to contact appropriate persons re
. design information or job site corrections, etc.
II. .Abbreviated Plumbing, Mp.chcnical & Electrical SchedulE
A. Except where blcnk spaces occur in the description p
of the Mechanical and Electrical Schedules, the appli
need fill.in only the No. Boxes adjacent to the appro
item{s} to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at tl'le Building Division .
1. To conserve space on the permit form the schedull
have been abbreviated .
2. If the item(s) to be installed ore not covered on thl
aied schedules you should consult the fuil schedul,
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES A
CHARGES ON THE SCHEDULES
III.
Applicant .to sign and date
Whenever possible. rhe initiol application will be used a~
worksheet o~ly. Where possible, Building Division Staff 'Y
prepare a typewritten copy and return it to the applican1
the time the actual permit is issued for his signatUrE.
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PERMIT VALIDATION
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CITY OF' SPRINGFIELD (
CIty Hall
Spri~gfield. Oregon
Department of Public Works (
OFFICIAL RECEIPT
No. B 5 6 7 8 9 (
Dote !^_;;J/" 19 81
Rec'd From ~-JI/rn; PIzIYl c:i.U.j~.
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Address toQ~" 76 f(; (' u Ct<lM ~ ' ( '1A ~
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Received F~r: A A
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( , Amount Receivedlf '1fr" 0_0 ~
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.AUTHOlIIll.IED SIQNATUIU:
'''IlLlO...TU"...ULL "","TI"" IlVGIO<Il. 0" "'''0' ..,,,., \.
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IV. Fees and Charges
Plan check fees ore 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 ore due and payable when the permit
is issued.
v. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED . BEFORE OCCUPANCY:
Additional Project Information:
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PLANS REVIEWED BY:
nam"'"
signature
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Permit Clery
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