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Home My WebLink AboutPermit Electrical 1985-8-22 Owner Wu./nt/l f1 ~;t, J(()':5 t/ tIJ/l o~ CITY Of SPRINGfIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat \~ater Heater Range ValuE of Hork: OoW5 a)\q'5Q~lZ- .e::' 0 INfORlIATION LIN" " 726-3753 Sq. Ftq. 1,Iain ~q. Ftg. Access. Sq. Ftq. Other New Add Alter Rep_ Fence_Demo _Change/Use _Other se..e... JDJ,if- ~~ ,-..:. ~D , .. j INSPECTION LINE 726-3769 Job Address L/(} .3 Lf /J1czUx.) Legal Description /'7 Of} 3/ ~/ Ig IV) C/) I(S' . Address Ut~H:iN TEAr-' lnameJ Phone (address) '. BuilriinQ Permit Info: Describe Work(i~e., Build Single Familv Residence With Attached Garaae) /)l'Ir!IA-" d dh~ ct!J .,:).::;7 ~ '~r~-/ .' - Phone 71 7 t)c;7/ Address Construction Lender (lies. no.) (~xoires) (ohone no.') Primarv Structura 1 ~~ '~ Electrical Mechanical CONTRACTORS (name) (address) (l ir:c;,. no.) (exoirpc;,) (ohnnp no_ 1 Genera 1 Plumbina Electrical //.;JMPJ (.tJ""T.~ (/~ PLUIIB I NG ELECTRICAL '~I'y ~~O;;;.O 6 - 9'- rG , MECHANICAL "" 'rlJAllJiE..llQ....1 furnace/burner to BTU's 935 l'O~ ~lechanical -illL' , FEE . CHARG, NO Each single fixture Residence of . 1;:1="1=" . r~1lR.G..E., SQ. FT. I I 3'51610 ) 1'10 I / I I TOTAL CHARGES TOTAL CHARGES ';S(" Iff) I TOTAL CHARGES WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an, 'Electrical Contractor, the electrical rortion of this permit shall not be va1i~ until the label has been signed by an Electrical Supervisor and returned to the Building Division IRe10cated building (new fix. additional) Is.F. Residence (1 bath) IDuplex (1 bath) each IAdditional bath I ~Iater service I Sewer I Storm Sewer I 1 I I New circuits a1ts. or extensions Floor furnace and vent SERVICES Recessed wall ~o~r~ hp~t~r ~nrl vpnt Temporary Construction Change in existing rpsidJ'''c~ Imultifamily, comm. or Tnrluc;.t.rial IOf amps.1 ICOMl-I./lND. FEEDERS 1 IInstall/alter/relocate I' rlic;.trih f~prl~r~ IOf ,;;).:z ~ amps.1 //% Appliance vent seoaratp Stationary evap. cnoler I Vent fan wi th sinol~ duct I' Vent system apart from 1 hea t i no or A. C. Mechanical exhaust hood and du('.t Wood stove/heater ISSUANCF OF PFRIIlT Fire Zone I HAVE CAREFULLY EXAMINED the completed apr1ication 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 nd that rw OCCUPAr~CY will be made of any structure without the permission of the Building Division. I further certify th my, registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basi for xemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl.05l will be u on is proje t. . 1lAf-IE(please print) SIGII^TUREl:: ~/Y DATE ;!!?-;:2;!-8c: - , FOr. OfFICE USE OIILY Sq. Ftg, Sq. Ft9. Sq, Ftg. Zone Tyoe/Const. Bed rooms Stories Units Occy Load Occy Group riain Access Other , Value Value Value x Flood Plain x TOT^L VALOATION BUILDING PER~tIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Rlda Per Fpp ------------PTan Ck, Res 30%/Bldo Per Fee Fence syste.ms Development Charoe t1.5~) , PLU!~BING PERMIT Charges and Surcharges I D~mo _ ___ __.3'~.~JS1dewalk / / "" A/C Paving ,"7"U I 1 I jTotal Comb. rermit ELECTRICAL PERIIIT Cha rges and Surcharges I1ECHANICAL PERMIT Charges and Surcharges Curb Cut I ,/ TOTAL i 5 ~-:zrb I . . , ':6 . ...'- -.., COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A, Job Address B. Legal Description I. example- Tax Lot IDO, Lane County Map Reference 17 03 43 2. example- Lot 1.,Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air qas 2. exanrP le- waterheater/electnca (lor ~ E. Square footage or valuation, etc. I. examole- 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 foom 3. exarnyle - 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-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 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 ~ayable when the permit is issued. J/ oiL-- It I~d-' 1 [pc:) /'iC; ')..'d ~ I 0 ~A\D V. FOR OFFICE USE ONLY Permi t Cl erk ~~ I 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 . . ~ S~TY OF SPR1NWLD City Hall ' Springfield, Oregon Department of Public Work. OFFICIAL RECEIPT . . . . No. B 65172 . , Date (l/;).."";}.- 19 g--S- . Rec'd From (' A-IAIlPM7-- t.Qu:t . Address Po hw \d.- 4 l h,w fuJ . . Received For: g50 t30 / QO"Th rrJ . . c; f)jJ L P nJ- 35. UO . . 1-( 79 J- 4n . . . . . . . Amount Received :3&, if D .~ (!~' I . _:~,~~:~~:~~~URE ewe '. --: 1"ol\.11:14I'.~1""