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HomeMy WebLinkAboutPermit Electrical 1990-8-21 I INSPECTION LINE 726-3769 Job Address uCt LjTJ Legal Description . vVtlMV1 ,9,- CITY U, SPRINGfIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Meat I~ater Meater Range ValuE of flork: . I NFORlIATlDN LI NE 726-3753 Sq. Ftg, 1,1ain ~q. Ftg. ,Access. Sq, Ft9. Other New Add Alter Rep, -Fence Demo Change/Use Other- - I .~ \::::) , o V(I owner,~ 'Bl)~ I-\7IJ~^'dtzrv'\ Address Po (hI)" 02..- construc7:1~~~0 tld Q7c.j77 phone'14fo- <i! 7.Y-I Builrilnq Permit Info: Describe Work(i.e.. Build Single Familv Residence flith Attached Garacel E4fV1d Ode... ('J {rU If -.., ......j I Address DI:.:)IGN TeAM (name) Phone {address' (lics.no.' (exoires) '~.' .,~ I (ohane no.' Primary Structura 1 Electrical Meehan; ca 1 , CONTRACTORS Genera 1 {name} {addres,,' llics.no.' (exnirl?s.~ (ohane no. \ Plumbino Electrical fI6CCtdLWr1n {., h)~U'~?f-fiv~~ 9~2. 77 t.f-1?J-1/ Q'-ll-7or% Mechanical PLUf.1BING ELECTRICAL MECHANICAL Each single fixture I FEE I CHARGE NO, I Residence of FF"- .cJJARf,F NO, FFF rH.lIlGL NO.1 5Q, FT. furnace/burner to BTU's Relocated building (new fix, additional) New circuits alts. or extensions 1~(5l) Floor furnace and vent S.F. Residence (J bath 1 Duplex (1 bath) each Add it I onal ba th SERVICES Recessed wall Soaca haatar and vent amps. Appliance vent seoarate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Water service Temporary Construction Change in existing re!ilclence multifamily, comm. or Tndustrial Sewer Storm Sewer Of COMM,/IND, FEEDERS Install/alter/relocate di~trih" fppdprs Wood stove/heater Of amps. ISSUANCE OF PFRlIIT TOTAL CHARGES TOTAL CHARGES /r:;.c;O TOTAL CHARGES .-" ".-- .. WHERE STATE L\H Rl~UIIll~ tnat the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pen:1it shall not be vali1 until the label has been signed by an Electrical 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 UO OCCUPAI~CY 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 701,055 Wil~ us~n this project. ~~<:()~~. IIAllE(please prlnt)--D/}UIO A- {,1.41i6 SIGNATURE" ,~::/tl.1.../Jt- DATE{~/~;' FOr. OEFICE USEOIIL Y / Sq. Ftg. f1ain )( Value Sq. Ftg. Access x Value Sq, Ft9, Other x Value Zo~e Fi re Zone Flood Plain Type/Const. Bedrooms Stories Units Occy load Occy Group TOTAL VALUATION BUILDING PERfllT Charges and Surcharges Plan Ck, Comm/Ind 65%/Bldo Ppr Fpp ------------ Plan Ck, Res 30%lBl do Per Fee Fence 'Systems, Development Charae 0, 5~ " PLU!~BING PERMIT Charges and Surcharges Demo ELECTRICAL PERIIIT Charges and Surcha rges _LS:..c;!'0______ 'Sidewalk 175 A/e Paving Curb Cut Tota' Comb. Permit MECHANICAL PERMIT Charges and Surcharges TOTAL 11~-1S . COMBINATION APPLICATION/PERMIT (CAPl 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 I. Block 3, 2nd Addition to sprlngtield Estates C. ' Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. examyle- waterheater/electrical/or ~ E. Squa~e footage or valuation, etc. I, example- 1250 sq, foot house. 500 sq, foot garage 2. ,~- if new project. check new - if addition, lcnecJ('add, etc. F. Building permit information: 1. exam~le - construct single family house with an a ttached 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 (al 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 n~ed 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 o. 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 signa ture. 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 ~-23-% pc!. cuSh Redt 18/ 22- Permit' Clerk ~/I/\ 0 - Permit applicant exempt from registratlon with the Builder's Board because: , ^ Additional Project Information: PLANS REVIEWED BY: name signature date