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Home My WebLink AboutPermit Electrical 1990-5-20 jlNSPECTION LINE . i 1726-3769 , . CITY OF SPRINGFIEcD COMBINATION APPcICATIDN/PERMIT E!lERGY SOURCES: Heat l~ater Heater Range . INFORJIATlON UNt 726-3753 . Sq. Ftg. .'.Ia;n ~q. Ftg"o Access. Sq. Ftg. Other Ilew Add Alter Rep. --Fence Demo Change/Us~ Other- - . I I ~ G\ \J '" Job Address L}yqo VlAtil VI Sf- Legal Description Owner ~ e'iTlJ. ) Address ~o/'~..r7"J~~ i?" ~7'rL 2:>. . ~ Construction lender ~ Phone Valu€ of Hark: A J I k~'~c>_ -:/V /4- I Builoina Permit Info: Oeser be Work(i.eo. Build Single Family Residence With Attached GardQe) ; h ;/"....~<- -:;::>~/'9 <)e;?f'v/co::: Address DESIGN TEAI1 {namel Phone {address I (1 ics. no.) (expires) (ohane no. j Primary ~ Structural Electrical Mechanical CONTRACTORS {namel (address' (lir.c;,. no.) (p-xnirpc;,) (nhnnp nn. \ Genera 1 Plumbina Electrical Kv.a:/>,c-~, ~--==-=/-. . . f- . , ~'echani ca 1 . -:::r;T:::>a C:;. , /.o--/~--:r::?( _ Y.BS-C>?:<:?, PcU/IBING EcECTRICAc MECHANICAc NO. . Each single fixture HE . CHI\RGF NO 'F'FF P~AIU~F' NO_ Residence of furnace/burner to SQ. FT. BTU's F'F'I=' rl-'ARr-..( Relocated building . (new fix. additional) /" New circuits alts. or extel'J.1.ions ? c>/if ~~ SERVICES ~::. Floor furnace and vent S.F. Residence 11 bathl Duplex (1 bath) each Additional bath Recessed wall <;nl'lI"P hpl'ltp,. l'l.,,i \Ion'" Sewer Temporary Construction Change in existing resj(tenc~ multifamily. comm. or Industriil.l Of "2 -- amps. 3'~.2 . Appliance. vent $pnil.ril.t.p Stationary evap. cooler Vent fan with sin9le duct Vent system apart from heatinC' or A.C. Mechanical exhaust hood and du('t Water servi ce Storm Sewer / CO~1./IND. FEEDERS Install/alter/relocate distrib. feeders Wood stove/heater Of amps. TOTAc CHARGES . TOTAc CHARGES WHERE STATE c,'\~ REQUIRES that the Electrical work be done by an shall not be vali1 until the label has been signed by an Electrical ISSUANCf OF PFRrllT b~ ~, TOTAc CHARGES .Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all in.ormation 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 OrelJon pertaining to the work described herein. and that UO OCCUPfi.HCY 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 compliance with ORS 701.055 will be used on this project. NAI.IE(please print) ~1,,:( "- ~/l...I0tV, SIGilATURE .~~ , FO~ OFFICE USE OIKY v Zone Tvpe/Canst. Units Sq. Ftg. t1ain Fire Zone Bedrooms Occy Load Sq. Ftg. Access Flood Plain Stories. Qccy Group Sq. Ftg. Other g~ OATE <;' -~7- 9d x x x Value Value. Value TOTAc VAcUATION BUIcDING PERHlT Charges and Surcharges , Plan Ck. Conm/lnd 65%/Bldo Ppr Fpp ------------ Plan Ck. Res 30%lBldo Per Fee Fence ~ Sys tems Deve 1 opment ~ Charoe (1. 5~) 1 PcuP1BING PERMIT Charges and Surcha rges DllRlo ,..- ~ ~ .S1dewalk ___!;;:::2-__:....____ 5 _ c-<:> A/C Paving Curb Cut Total Comb. Permit I EcECTRICAc PERim Charges and Surcharges MECHANICAc PERMIT Charges and Surcharges TOTAc G'5-- cs:i?> ~ . ..... COMBINATION APPLICATION/PERMIT (CAP) r' I. Appl icant to furnish A. Job Address B. Legal Description . . '\ . 1. examRle- Tax Lot 100, Lane County Map Reference 11 03 43 2. ~xample- Lot 1. Block 3, 2nd Addition to .... _.:--\ \;_.spr;ngfield.E~tates'. I........ .."4.'., C', Name, etc. of owner and constructlon- lender '. ~ ~ O. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition. check 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 TEAM AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate ." :'persons .regarding design infonnation 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 th~~. full schedules C. BOILDING DIVISION STAFF WILL FILL OOT 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. --- 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 ~nd 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. .( .. / ...... .> III. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE DCCUPANCY: . '. . .. , Permit Cl erk j , .....l .. PERMIT VALIDATION -.:-,: , ,. .' ,'. .' .'\, \ .~;. . . " '. , < > -. , , , , Permi t cappl i cant exempt from regiStrati on with the '~ui1 der' s'.Board because: Additional Project Information: PLANS REVIEWED BY: name signature l I .. , date '1 , j m~~mON L !lIE J . · Job Address LfL/10 VV\ Ut'I V\ Sf- 1i , ~ CITY U, S~RING'IELD COMBJIIATlON APPLICATION/PERMIT ElIERGY SOURCES: Heat l~ater Heater . ;;,FORllATlON LINE 726-375~ . Sq. Ftg. .l-1ain ~q. Ftg, Access. Sq. Ftg. Other Ilew Add Alter Rep. -Fence Oemo Change/Us. Other- - ,.' Owner \2 e.n /) S Addre.. 4/~~ r7'7~,4;/ ~. - ... -S~FL Z:>. _ ~ Construction Lender ~ Phone Ranqe Valu' of Hark: 1t:?C>C>_ ....... Bu11tiinQ Permit Info: Oeser.be Work{1\e.. Family nes1dence With Attached r,ardae~ Build Single 1 \J " legal Description 4.. ::.......~t -:::> ~ /'7 c:::;e;:t/'J...........c~ Address UI:.~lliN I IN.' (namel Phone (address) {lies.no.\ Cexoiresl lohone no.' Primary Structura 1 Electrical Mechanica 1 ~ONTRACTORS fnamel (addrp!>s' (lies. no.' 'pxnirpc;,\ (nhnnp nn_ \ Genera 1 Plumbino Electrical 75vA:./,)~.A?<; 2!i::~.7-. r f Mechanical . -::rJT"/0 <; _ /L>-/-~::< Vh5' ~q~ . - ;; { /.. PLUIIBING ELECTRICAL MECHANICAL FEE rHARGE ~n I HI=' rH6JlliE. ..llil... FFF r"~ Residence of furnace/burner to SQ. FT. BTU's New circuits alts. Floor furnace ./ or ext~ i ens ~::. and vent ?~ ~~ SERVICES Recessed we 11 Soar:@ hp"tflr and vpnt NO. Each single fixture Relocated building . (new fix. additional) S.F. Residence (] bathl Ouplex (1 bath) each Additional bath Storm Sewer / Temporary Construction Change in existing res,j qe.nce. multifamily, camm. or Indus.trial Of '2 _ amps. CO~4./INO. FEEOERS Install/alter/relocate distrib. f~pders 3?.:2 . Appliance- vent ~eoa ra te S'tationary evap. cooler Vent fan with ~in~le ~vct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater 1 Water servi ce Sewer Of amps. TOTAL CHARGES HHERE STATE L~W REQUIRES shall not be yali1 until the TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANCF OF PFRl1IT 60 ~ TOTAL CHARGES Electrical Contractor, the electrical portion of Supervisor and returned to the Building Division this permit 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 OCCUPAnCY will be made of any structure without the permission of the Building Division. I further certify that my registratton 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 only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. -e~_OATE <;"" -;1.7- 9d IWIE(please print) ~4d~ ~/L,I(j""'5 SIGrlATURE~ , FOr. OFfICE USE DilLY Zone Tyoe/Const, Units Sq. Ftg. t1ain F1 re Zone Bedrooms Qccy Load Sq. Ftg. Access Flood Plain Stories' ,'kcy Group Sq. Ftg. Other x . Value Value. Va1ue x TOTAL VALUATION BUILDING PERHlT Charges ant: Surcharges . Plan Ck. ConmlInd 65%/Blda Ppr Fee ------------ Plan Ck. Res 30%/Bldq Per Fee Fence Systems Development Charqe (J.5~) PLur1BING PERMIT Charges and Surcharges ELECTRICAL PERrm Cha rges and Surcharges Demo ...... C? ~ Sidewalk ___!i;::;;:?__~____ ;r _ ~ A/C Paying Curb Cut Total Comb. rennit I MECHANICAL PERMIT Charges and Surcharges TOTAL G 3:: .~ - . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 1009 lane County Map'Reference II 03 43 2. exam~le- Lot 1. Block 3, 2nd Addition to , Sprlngtield Estates . , . , C. Name, etc. of owner and constructIon lender' O. Energy Sources 1. exam~le- heat/electrical ce;l;n~/or forced air Qal 2. example- waterheater/electrlcal/or solar Eo -Square footage or valuation. etc. - ~ 1. 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. exam~le - construct single family house with an attached garage 2. example - remodel existing garage into family roo 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. DESIGN TEN4 AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate 'persons regarding design infonmation 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 adjacei to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Oivision 1. To conserve space on the permit fonm the schedul( have been abbreviated 2. .. If the item(s) to be installed are not covered 0' the abbreviated schedules you should consult the fu 11 schedu 1 es C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES O. As noted on the CAP, the label must be delivered to . electrical contractor for signature by his electricaO supervisor. The general contractor is .not authorizel to sign the electrical label. --- III. Applicant to sign and date Whenever possible, the initial application will be used, a worksheet only. Where possible, Building Division Sta will prepare a type written copy and return it to the applicant at the time the actual' permit is issued for hi 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 . ,\ .. PERMIT VALIDATION CITY OF SPRINGFIELD City Hall Sprlngftold, Oregon Development Services OFFICIAL RECEIPT 17185 Dale h?d,... 2~. 19'7'n . .. / Rec'd From tfc//l..Z::>#!7"t.s Re::c:.,-:r: ~ ~ 7" ~e:P~/'r.--r::r- Address /"/~ ~ - ~.:> 50:::2. Received For ~~~~~;'7;/~ . ~;--_ ~O--- ~ ::s~' ~ - b~ ....-.:=s ( f,'.J'- ~~.# . , __/-;?_oc:::> Amount Received &;;;:::t:/. !!L k~~,/? V tY,AUTHORlZEO SlGNArtJRE ,. r- -, Permit Clerk PROJECT CDNDITIONS TO BE SATISFIEO BEFORE OCCUPANCY: Permit .applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature l r1ate