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Home My WebLink AboutPermit Electrical 1989-12-21 I INSPECTION LINE . CITY UF SPRINGFIElD . 726-3769 COMBINATION APPLICATION/PERMIT ~~Oy\( Y\\\illr\ & ~~~~ l~ater Heater Range Job Address INFOR/1ATlON LINE 726-3753 Ftg. 11ain tg, Access. Sq. Ftg. ther New Add lter Pep, -Fence Demo ange/Use Owner. (~'[) l 01u ,(1 f 0 ~(j./ iDO Xh:Jy) ValuE of Horkn. / (l) Other- - 4 ('/ I' lint=\. '~~ , Builtiino Pennit ;1]fo: Oescr be Work(i'.e., Build Single Address _ n "') I I. f"I hone Familv Residence \lith Attached Garaoe' SDbJ 1'0. (UJ/. q -4/1 'K,\ ' construction\lente, , \} ~or~t, !\..IJ\\ ^ t\), Address Phone ~ Uc~lbN ItAM (name) (address' {lies. no.l (exniresl J '- jJ ..Q ,...- (fl - p ~. Legal Description (ohane no.\ Primary Mechanical CONTRACTORS {namel (address' (lics. no.1 \vj .~~ (exoires' ~1 {nhnnp nn. \ Structural Electrical General Electrical (O)l)Y1I~J Plumbino ~1echanical PLUr'BING ELECTRICAL MECHANICAL NO. FEf CH~RGE Nn '-E.EL.l:llARlif. Nn q~ rH~ SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Snac@ hp~tpr an~ vpnt amps, Appliance vent s.~oar:atp. Stationary evap. cooler Vent fan with sin9'e duct Vent sys tern apa rt from ' heatinq or A.C. Mechanical exhaust hoon rind dut"t Sewer Temporary Construction Change in existing res5 qr.nt"{' multifamily, comm. or J nnus tri a 1 ~Iater servi ce Storm Sewer Of CO~1,/INO, fEEDERS Install/alter/relocate distrib. feeders Wood stove/heater Of amps. ISSUANCE OF PER/lIT TOTAL CHARGES \ TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit shall not be valio until the label has been signed by an Electrical Supervisor and returned to the BUilding Oivis'on 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 110 OCCUPANCY will be made of any structure without the permission of the Building Division. I further .certify that my registration \'/ith the Builder1s Board is in full forc~ 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 ORS 701.055 will be used on 'this project. SJf,rl^TURf~ r:!J:,./..-J./;I fOP. DfnCE USE OIlL Y Sq, ft9, Sq, ftg, Sq, Ftg, OATELd_~:}exe! NAr.IE(please print) Zone Tvpe/Canst. Bedrooms Units Occy Load Occy Group t1ain Access Other x Value Value Value Fire Zone Flood Plain x Stories x TOTAL VALUATION BUILDING PERHIT Charges and Surcharges . Plan Ck. Conm/lnd 65%/Bldo PPf Fpe ------------ Plan Ck. Res 30%/Bldo Per Fee Fence 'syste. rns. Development ' Charqe tJ. 5~ . . '. PLut~BING PERMIT Charges and Surcharges Duma' __L:0..DD___Sidewalk . f) ~ A/C Pavi ng Curb Cut Total Comb, Permit ELECTRICAL PERrHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges 1 TOTAL \~,~~ ~ . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I, Applicant to furnish A, Job Address B. Legal Oescription 1. example- Tax lot 100, lane County Map Reference II uj 43 2, exam~le- Lot I, Block 3,'2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examp-le- heat/electrical ceilinqlor forced air Qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq, foot house, 500 sq. foot garage 2. examp'le- if new project, check-nfw - if addition, cned add, etc, F, Building permit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. examele - 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 correctionst 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 fu 11 schedul es 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. ~ *' ISlii xt 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: name signature date Job Address ~\\ Q YfJ "'.)(\ ~ f\ bt-,_ Legal Description I )0 d'~~zrf~ O()/O,::<" Owner ("AN.fu f\ C;; () n\o lru.ti\C1r: Address 4- \11 ~(') ~ \.4. f\ 'vhonc' U\. ,-,~>;.\.~ \ \3XC-" /),rv1,/Yr< I Constructi&;, L~~r) ~ . CITY Uf SPRINGFIELD -. INFDro1ATIDN LINE COMBINATION APPLICATION/PERMIT 726-3753 EIIERGY SOURCES: Sq. Ftq. I-Ia i n Heat ~q- Ftg. Access. Hater Heater Sq. Ftg. Other Ilew Add A Her Pep, Range -Fence Demo Change/Use ValUE ,\\o;n .-/ Other-- Builfiinq Per '1ft Inf~ Oeser be Work(i..e.. Build Single Familv Rasid~ncc Hith'^ttached ~araae\ 'b~~\\ -J \ UJ\u-T t\-~~ 'jINSPECTlON LINE 726-3769 ~ )) - )J Address DESIGN rtAr~ {name} Phone {addressl (1 ics. no.) {exniresl (ohane no.] Primary Structural Electrical Mechanical CONTRACTORS (name) faddrf'!ss \ (1 ics. no.' (pxoirp,,-\ (nnnl1P nt" \ Genera 1 Plumbino Electrical~ \~ ~Iechani ~a 11.\. \\l \ "1\ r~ q PLUIIBING r~b\X\ ~ . L00 ~'6 ~ ~~ ,,~\r\l ,\ 'A\nJ )l-iY) ELECTRICAL I Y \~ijNICAL --'ill.,. FEF CH~ Jill rr~ .C1IARG[I_"n 'll....-.QJAI!liE. SQ, FT. furnace/burner to BTlI's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bathl Duplex (1 bath) each Add it i onal ba th SERVICES Recessed wall ~n~;tJl kpi'tpl" :Inri I/",nt amps. Appliance vent SPDiI ra te Stationary eV!lP. cooler Vent fan with sinole duct Vent system apart heating or A.C. Mechanical exhaust hood and duct. Wood stove/heater ~, Sewer Temporary Construction Change in existing res j df!.nce multifamily, corrm. or lnrluc;.trial \-ola ter servi ce Storm Sewer Of from COM,!. fiND. FEEDERS Install/alter/relocate di,trih. feeder.. Of amps. ISSUANCF OF PFRlIIT TOTAL CHARGES TOTAL CHARGES WHERE STATE L\W REQUIRES that the Electrical work be done by an. shall not be vali~ until the label has been signed by an Electrical TOTAL CHARGES Electrical Contractor, the electrical rortion 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 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 rw OCCUPAIKY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 7n1.0rJ;~e used on this rro.ject. IWIE(please printl.kl/h,Y ~,/.;y'/.) P~<:. ~I"IIATURE'-/fb- ~/ DATE b ),--/R r FOP. OfFICE lISE. DIlL Y ( r , / ' . Sq. Ftg. Hain x Value Sq. Ftg. Access x Value Sq. Ftg. Other x Value Zone Fire Zone Flood Plain Type/Const. Bedrooms Units Stories Occy Load Occy Group TOTAL VALUATION PLU/1BING PERMIT Charges and Surcha rges Plan Ck, Comm/lnd 65X/Bldo ~r Fp~ Plan Ck. Res JO~/Bldc Per Fpp Fence Systems Development Charqe (J.5~l . BUILDING PERfIIT Charges and Surcharges D~mo. ELECTRICAL PERI\IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges 'Sidewal k A/C Paving Total Comb. rermit -1 S. C-r2 _ Curb Cut ,I\~ TOTAL \ ~ .'1S " ,...,.- . . COMBINATION APPLICATION/PERMIT ICAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 11 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. exam~le. 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. exam~le - remodel existing garage into family room 3. exa"!ple - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 la) of the Structural Specialty Code H. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding desigll information or job site corrections, etc. II. Abbreviated Plumbing. Mechanical. So 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. BUILOING 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 genet'al contractor is !!2l authorized to sign the electrical label. III. Applicant to sign and date Whenever possible. the initial application will b~ 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. I}I~ -sq , I~;::A(O V. FOR OFFICE USE ONLY Permit Cler fill) " J PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: ,; PLANS REVIEWED BY: name signature date