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HomeMy WebLinkAboutPermit Electrical 1983-3-8 I INSPECTION L1IIE. 726-3769 . . CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Work: Job Address 0') 0 '5 r>;~ 2.-1. Legal Dmription \ ~ DL 3~4 l f)~.-:vY) Owner' (;)~ ~~ J?1a.tdv #~ / 7 ^/q n;;L..Jf 1,o,U'cI. cnr ~ Construction lender INFORlIATION LINt 726-3753 Sq. Ftq. 1,Ia i n ~q. Ftg. Access. Sq. Ftq. Other New Add Alter Pep, --Fence Demo Change/Use -Other- - \)C) vJ --- -- 6' ~ Address Builriina Permit Info: Describe Workli~e" Build Single Phone7~b'l?2J3 'Familv Residence With Attached Garaae) P CluJe r -r~poy'o.. ry Address DESIGN TEAI1 Phone (address) (name) (lies. no.l Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (addr~ssl nics. no.) General Plumbina i Electrical .. ~'echan; ca 1 'I ~ ~(l.Ao, ~ b 17 <./ '1 /??tt.V7U PLUIIBI NG ELECTRICAL NO, ' . FFF . rHARr.F 'lP I ~~~ I r~~ NO Each Single fixture Residence of SQ. FT. Relocated building (new fix. additional) New circuits a1t5. or extensions S.F. Residence (J bath) Duplex (l bath) Additional bath SERVICES ~ la-o-V ~~ (O,OOI/O,OD I I I I I I I I~ I each 0"'- ~ ~pora'"ry' ~~r~n Change in existing rps ; d_p~nr:p multifamily, comm. or Tndustri;il Of amps.l ICOMl'I./IND. FEEDERS l'Install/alter/relocate .dht.rj\1. fp~d.ers IOf f,'J~ Z'::"'L:an,ps.1 I I 'rio I ~Iater service Sewer Storm Sewer (exnires) (ohone no."\ ~ j~ ......... ;~ V -" (pxnirpc;.) (ohonp nn. 7 Yh - ~ 21 ::'5 MECHANICAL . i='i='~ . r...l::lAB.!iE. furnace/burner to BTU's Floor furnace and vent Recessed wall ~nAr:p hPAtpr And vpnt Appliance vent c;.f!oaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I' heatinq or A.C. Mechanical exhaust hood and dud. Wood stove/heater TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the TOTAL CMARGES .'J'.h~ .- TOTAL CHARGES ISSUANCE OF PFRr1IT that the El ectri ca 1 work be done by an. 'El ectri ca 1 Contractor, the e 1 ectri ca 1 portion of' thi s . pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA~lINED 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 NO OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's 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 comoliance with ORS 7nl.055~used on this project. NAlIE(please print) -n';'Of/llA<;. lJ L-Jll~GE _ SIGrIATURE~ ~4 ~ DATod..-9-8'3 FOr. OFFICE USE 0I1L y S~, Ftg, Ilain Sq. Ft9. Access Sq, Ftg. Other Zone Tvpe/Canst. Bedrooms Units Occy Load Occy Group Fi re Zone Flaod Plain Stories BUILDING PER~IIT Charges and Surcharges Plan Ck. Comm/Ind ____________~/Bldn Ppr ~I>e Plan Ck. Res 30%/Blda Per Fee I Fence ------------ 1 Demo _h__~J7~g--sidewalk ~ A/C Paving PLUI1BING PERMIT Charges and Surcharges ELECTRICAL PERr:1T Cha rges and Surcharges MECHANICAL PERMIT I Cha rges and Surcharges Curb Cut , , TOTAL I~ x Value Value Value x x TOTAL VALUATION Isystems Development Charae tl.5~) " IjJ~ ,20 I;,J;tO't9'/ g I I I I .a- 1000 ~ ITotal Comb. Permit ,: ~ . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A, Job Address B. Legal Description 1. example~ Tax lot 100, Lane County Map Reference 17 03 43 2, example- lot I, Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. exampJe- waterheatertelectr;cal/or solar E. Square footage or valuation. etc. - I. example- 1250 sq. foot house, 500 sq, foot garage 2. example- if new project. check new - if addition. check add, etc. F. Building permit information: 1. example - construct single family house with an a ttached garage 2. examole - remodel existing garage into family room 3. examyle. 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 TEM~ 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. ~;~~ bGO~B V, FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ~ I name signature date ".. .. ~.:> , ".1