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HomeMy WebLinkAboutPermit Electrical 1989-10-20 r\\ . Job Address 4 q L{ () fY/t0fr. Legal Dmription J'7-67.. -:6'2..- t./ I. CITY UF SPRINGFIELD . CDMBINATION APPLICATION/PERMIT . EIIERGY SOURCES: Heat DOt" eo I/ater Heater Range ValuE of Work: IINSPECTIDN LINE 726-3769 Owner &h ~i7m Addrcsst.{q '-/{) ~ Z> 1-4. d. t) r?- Q'7 L{ '7 7 ~ Construction Lender INFDR/IATlON UNt 726-3753 Sq. Ftg. I,'a i n ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - 1 ' C<:) ~ C) ~ ~ Q7/~~ ,~uilGinQ Permit Info: Describe Work(i.e., Build Single Phonc01V':r/~ 4amilv nesidence I~ith Attached GaraQe\ Address DESIGN TEAl1 (name) Phone (address 1 Primary Structura 1 Electrical 11echanical CONTRACTDRS (namel (address 1 Genera 1 Pl umbi no ~ --l~ -~ 't... (lies. no.) ~~(exoires) (1ies.no.' (OhOM no. I (exnirp.s) (ohane no.l Electrical })1JJlj f i!fdrh~ - l{Z~ZZ-II1C/Gtn.'U~ HuJy. ~1fJ. Ii' II Zo- Z 7 Z. /(;-/- 'd gttu'-stj<jZ- I I amps. (~- I?~" I I I ~t7Z-S-0 ~1echanical PLUI1BING ELECTRICAL NO. FEE CHARGE Nn Each single fixture Residence of SQ. FT, Relocated building (new fix, additional) ~ New circuits alts. or extensions ~ 7 6A /7:>Nr'C" SERVICES 5.F. Residence (1 bath) Duplex (1 bath) each Additional bath Temporary Construction Change in existing r~$ j q~ncp' Imultifamily, comm. or , I ndu..~ \ri <!J If 10f -I~ amps, ICOW~./IND, FEEDERS I Install/alter/relocate dif;trib. f~~d~rf; IOf/~ I I I Water service Sewer Storm Sewer 6 TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the TOTAL CHARGES that tile Electrical work be done by an. Electrical Contractor, the electrical portion of this permit label has been Signed by an Electrical Supervisor and returned to the Building Division TOTAL CHARGES 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 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 HD OCCUPAllCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Bu;lder1s Board 1s 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 7nl.055 Wil~sed on this project. IW.IE(please print)~ ~~f"e / SIGHATURE A:::. -8~ DATyb~~ FDR OFFICE USE DIlLY Sq. Ftg. Sq, Ftg. Sq. Ftg. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories Units Occy Load Occy.Group BUILDING PERI-lIT Plan Ck, C011tn!l nd Charges and ------------ 65%!Blda Pj'r Fpp Surcharges Plan Ck. Res 3D%/Blda Per Fee PLur~BING PERMIT Fence Charges and ------------ Surcharges 0,",0 ELECTRICAL PERIHI 'Z t!?Z, ?" c:; 'Sidewalk Cha rges and ------------ Surcharges I ~~ f3. A/C Pavin9 rlECHANICAL PERMIT I Curb C~t Charges and ------------ I Surcharges FFLJ:IiARliE.-1IQ.... n.,5c. I I I I I l';:?~, r;.~ c.. ~ riain Access Other MECHANICAL 'IL J:IiARliE. furnace/burner to BTUI s Floor furnace and vent Recessed wall Soace he~tp~ a~rl ~p~ Appliance vent sena ra te Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatino or A.C. Mechanical exhaust hood il:nd duct Wood stove/heater ISSUANCF OF PFR!IIT x Value Value Value x x TOTAL V ALUA TI ml Systems Development Charqe tl.5~l . I I I ITotal Comb, Permit I I TOTAL I -::? f'::? '~3 I .! .'. ......' .. 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 'II OJ 4J 2. example- Lot I, Block 3, 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Qas 2. exa~le- waterheater/electrlcal/or solar E. Square footage or valuation. etc. - I, exam~le- 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. exam~le - 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 TEM1 AND CONTRACTDRS 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. I f the item( s) to be ins ta 11 ed 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. V, FOR OFFICE USE ONLY Permit Cl erk .. 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 L ~9.#c l'l'6~6'?j'signature ~3. ,date /e::r <4' ~ .--