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HomeMy WebLinkAboutPermit Electrical 1984-1-4 ValUE of I\Qrk: 0 '/$'50 BUilGina Permit Info: Describe Work(i.e., Build Single Familv nesidence With Attached Garaae) r j,f()'hu~~J~ F..lLc.. (\~ , I INSPECTION lINE 726-3769 Job Address &- ~ <.0 c.{ ~ d,-ibu..cf legal Description \,"'1Il.{JO I O:ill)~ ~l~ - ~c~i rL U00- Ol~l~ ~~i0.~IIHL Address lo, "2.,Cc I.( Y1\..~~ ..)..i. Phon"'J:1!...5SS' CITY UF SPRINGfIELD COMBIIIATION APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Heater Range Owner Construction lender Address Phone Ut>IGN I tAt1 (name) (addres s 1 Primary Structural Electrical Mechanical CONTRACTORS (namel (ildrlrp<;.<; l Genera 1 .~J " Plumbino Electrical ~o-vcrvI. ~ ~1echanical PlutlB ING ELECTRICAL NO.1 Each single fixture I FEE" I rHARhf Nn I Residence of furnace/burner to SQ. FT. BTU's I ~l=l= 'n./t1Qr.l= Relocated buildin9 (new fix. additional) New circuits alts. or extensions Is.F. Residence (I bath I I Duplex (I bath) IAdditional bath Water service SERVICES each 1/10 Temporary Construction Change in existing rp5; rtflnrp multifamily, corrrn. or TnrilJ,t.riill Sewer Storm Sewer Of amps.1 COMM./IND. FEEDERS I Install/alter/relocate rlid_rih fpprlpr" 10f amp~1 I I I TOTAL CHARGES TOTAL CHARGES WHERE STATE L'I~ REQUIRES that the Electrical work be done by an shall not be valid until the label has been signed by an Electrical nics. no.l nil'":" nn,) I ~~~ I fl.HIOr.:~ NO I /'5.01) '(.0 I I I I I I I I I I -.It / (,.&.D rf' g&z- 1'6- g' INFORflATlON LINt 726-3753 Sq. Ftg. t.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Rep. --Fence Demo Change/Use Other - - I v<J c.Al ~ () 1:: (exoi res) "(,1 ~/L !Zf0,r- '\) " (ohone no.) ~ (pxoires) (ohon... nn) MECHANICAL Floor furnace and vent Recessed wall ~~~~~ h~~t~~ ~n~ "~nt Appliance vent seoaratp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heating or A.C. Mechanical exhaust hnnrl ...no duc.t ' Wood stove/heater ISSUANCF OF PFRtHT TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work performed 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 NO OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with OP.S ](11.055 wil' be used on this project. IWIE(please print) fSAR \A T 't:"E:R.jIfJ~ _., SIGNATURE ~~ J, ~I\-<A.... FOn OFF I CE USE ot4l Y Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy load Occy Group Sq. Ftg. r1ain Sq. Ft!J. Access Sq. Ftg. Other DATd-I1-.5? L[ I x Value x Value x Value TOTAL V AlUA TI Otl BUILDING PERfIlT Plan Ck. Comm/Ind Shstems Development Charges and ____________.-ill/Bldo Ppr I='ee C arqe (1.5~) Surcharges Plan Ck. Res ..Pi!.u . QU . c..n 30%/Blda Per Fee PlU'1BING PERMIT Fence I ;!:! m:"g rs Charges and ------------ I Surcha rges Oemo ELECTRICAL PERr:IT IS.DO I Sidewalk I I Cha rges and -----.-GB----' A/C Paving ITotal I Surcharges Comb. Permit MECHANICAL PERMIT I Curb Cut I o@ c Charges and IS. '60 Surcharges -----------:-1 I TOTAL ; .r . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax lot 100. lane County Map Reference 11 03 43 2. example- lot I. Block 3. 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examp'le~ heat/electrical ceilinq/or forced air QdS 2. exa~Je- waterheater/electrlcal/or solar E. Square footage or valuation, etc. I. example- 12S0 sq. foot house. SOO sq. foot garage 2. examole- if new project. check-new - if addition, chee k add. etc. F. Building pennit information: 1. example - construct single family house with an attaChed garage 2. example. remodel existing garage into family room 3. example - 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 TEM4 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. 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 electrical contractor for signature supervisor. The general contractor to sign the electrical label. 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 signa ture. 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. , II. be delivered to the by his electrical is.not authorized III. IV. V. FOR OFFICE USE ONLY j 1. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , PERMIT VALIDATION , v?~eA 4b--lo'J-lg{ ! I 1 . . j P,rnit Cl".r1\IMIf W;/ Permi t appl icant exempt from regi strati on with the Buil der' S Board because: Additional Project Information: PLANS REVIEWED BY: name signature date