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HomeMy WebLinkAboutPermit Electrical 1983-4-1 -~ II IrISPECTION LINE. -p26-3769 . Job Address 'f</~/1. (Yla...; n _~f. _ Legal Description ' \1. b2"5Z-6 \ ()I.o 6QL) CITY Uf SPRINGFIELD COMBliIATlON APPlICATlON/PERMlT EilERGY SOURCES: Heat \'Jater Heater , u' INFDRlIATlDN UNt I 726-37S3 Sq. Ftg. /.Iain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. --Fence Demo Change/Use -Other - - Owner 130 b ~eeJon I.f<{ fJs mOo.. ,. 11 .s.o+,/d. Range Valu€ of Work: Address ~f " ,suilcline PennH Info: Describe WorklLe., Build Single PhonqVl-(,/t Familv Residence Hith Attached Garaoe) l.D~--, C\.~J ~ ~ e~~ ';;r- Iv) \,{) - Address UDlliN TEA/1 {name) Phone (address) (lies. no.l \'0 (exoires) {ohooe no"\ ()<;) ~ ~ Construction lender Primary Structural Electrical iLJJ. ~" <? J. J '. ---I ....._.., '( ,,_ , 11echani ca 1 CONTRACTORS (name) (address) (lic:c;. no.) (pxoires) (ahont! nn.) General Plumbina Electrical K:c\~ <( Co. ZIQ.Jr,'Q> <gl(4 s. 38 ""'-~tO~lti. 'Lo-17 2c.- 12-3/-S3 7 'fT-8./(,,/ v ~1echani ca 1 PLUIIBIrIG ELECTRICAL MECHANICAL NO. I I FEE I CHARGE NO I ~~F I rHARr.F Nn_ I 1=1=1= I r~AIH~1= Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions I 10.00 Floor furnace and vent S.F. Residence (] bath) Duplex (1 bath) each SERVICES Recessed wall ~n~cp hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent ~poaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from heating or A.C. Mechanical exhaust hood and rlur:t. Additional bath Sewer Temporary Construction Change in existing rp'l i rlJ'Jlcp multifamily. corrm. or Indu<;trial Water service COMH./IND. FEEDERS Install/alter/relocate di~trib. fppdpr~ Wood stove/h~ter Of amps. 410 lfO ISSUANCE OF PFRliIT TOTAL CHARGES TOTAL CHARGES IIJ. <I: 0 TOTAL CHARGES , WHERE STATE L.'\~ REQUiRES that the Electhcal work be done by an,'Electrical contractor. the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division I HAVE CAREFULLY EXMllNED the completed application for permit. and do hereby certify that all infonnation hereon is true' and correct. and I further certify that any and all work perfonned 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 ;s noted hereon. and that only subcontractors and employees who are in comoliance with OP.S 7nI.055 W~l~ed on this project. I~AlIE(please print) ~fJJ IC{P tl tJ 0 SIGIIATURE~.J/ ~ om FO~ OEFICE USE onLY sc(' Ftg. 11a i n Sq. Ftg. Access Sq. Ftg. Other Zone Tyoe/Const. Bedrooms Units Occy Load Occy Group x Value Value Value Fire Zone Flood PlairJ x Stories x TOTAL VALUATION BUILDING PER/lIT Plan Ck. Conm/lnd Charges and ------------ 65%/Blda Ppr Fpp Surcharges Plan Ck. Res 3D%/Bldo Per Fee PLUMBING PERMIT Fence Charges and ------------ Surcharges D~mo ELECTRICAL PERI:IT _u__J9...:_Q9_ 'Sidewal k Cha rges and Surcharges . \fa A/C Pavi ng MECHANICAL PERMIT Curb Cut Cha rges and ------------ Surcharges Systems Development Charoe (1.5%) Total Comb. Permit TOTAL }().ljO I! i ~, t 1 COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example. Tax Lot 100. Lane County Map Reference 17 03 43 \ 2. exa~le- Lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ce;l;~Q/or forced air Qas 2. examyle- waterheater/electrical/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 attached garage 2. example - remodel existing garage into family room 3. exam~[e - 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-ln 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 "HE 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 ba 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 ~()lo~.. ~83 J '0\ . , IJ I /C;'ZY Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date .~__'_'_~""'''''~:-''~'' ""_'.:..'--"W....___....- _ _;...~,