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Home My WebLink AboutPermit Electrical 1982-2-12 (2) INSPECTION LINE 726-3169 . CITY OF SPRINd'fIELO' ... COMBINATION APPLICATION/PERMIT I ENERGy SOURCES: Heat Water Heater RanQe ~ INFORMATION LINE 726-.3753 Address Phone Value of Work: cO 5'aJ ,-- Building Permit Info: De$cribo Work i.e., Build Single Famil.t Re$idence With Attached Garagel ~, I Sq. Frg. Main Sq. Ftg. Aceen. Sq. Ftg. Other _New_Add_Alter_R.p. _Fence_Demo_Change/Uae _Other ~ ~ ..... t-> ~ Job Add,... all.<. Ii? C1r7~ ~ legol Oe"dpt;on 11- 0;;'" - 3~ - ~_-rL, J<tOL2 Owne,-rI?I/l? -r:r.:..;:::- Con$truction Lender Addreu Phone ~r:?NTRACTORS (namel (addreu) (Iie$. no.) (expire$) (phone no.) 'tfl T I' (Iiu. no.) (exeirell bhone no'\ DESIGN TEAM (nome) (addreu) Primary Structural Electrical Mechanicol General (() {j YJ1..P1- Plumbina Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. FEE CHARGE I NO. I FEE I CHARGE NO.1 FEE I CHARGE furnace/burner to BTU's Appliance vent &Oparate Stationary evap. cooler Vent fan with $inQle duct Vent sy.tem apart from healing or A.C. Med10nical exhou.t hood and duct /1 Re.idence of Eoch $inale fixture Relocated building (new fix. additional) S.F. Residence (1 bath) '9' ft. New circuit$, alterations or extension. SERVICES Duplex (I bath) each Temporary Construction Additional bath Amp.. Water .ervice Sewer Wood .tove/heater r ~-20d~' f:4e,l!'-<,,- Aj~ I Heat Pum.) Air hondl.r to 10.000 CfM Air handler over 10.000 CFM Storm Sewer fEEDERS Amp.. ISSUANCE Of PERMIT TOTAL CHARGES TOTAL CHARGES /5:tJlJ TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Eledrical Contrador, the .I.ctrical portio"n of thi. permit .hall not be valid until a label hu. b..n signed by on Electrical Contractor and attach.d to the eledrical pan.l. 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 .hall be done in accordance with the Ordinance$ of the City of Springfield and the law. of the State of o..egon pertaining to the work de.cribed herin, Qnd that NO OCCUPANCY will be mad. of any .tructure without the permission of the Building Division. I further certify that my registration with the Builder's Boord is in full force and effect o. required by ORS 701.0.55, that if exempt the basis for exemption II noted heron, and that only .ubcontroctofl and employee$ who ore in compliance with OR~ 701.0.55 will be usod on this project. NAME (pleo.. p,;n') ~I,I E flPJJot. () SIGNATURE FOR OfFICE USE ONLY {';:_~. ~~OATE /.eP- 61-,"2, Ba.is for Builder'. Board exemption' Zone -A/,I - ;,l.". Type/Const..-it-- III Units ...... Ftg. M~jn Fir. Zone Bedroom. n.'Y load Sq. Fig. Access Flood Plain c:.tories- ^*cy Group~-L- Sq. Ftg. Other BUILDING PERMIT _____Q. ()O plan Ck. Comm/lnd Charge. and 6S%1 BldQ Per Fee Surcharge. 1;;;'0 Plan Ck. Re. 30%1 Bldp Per Fee PLUMBING PERMIT Charge. and Fonce Surcharges Demo ELEOR1CAL PERMIT /S or)' Charges and Sidewo!k Surcharge$ I (pO AIC Pavin'1 MECHANICAL PERMIT Chorgo. and Curb Cut SurchaTge5 -------- x Value Value Value ;::.. a/'lS~ x TOTAL VALUATION Sy.tem. Developm.nt Chare-e fI.5%) Total Comb. Permit 1:(1),8';) TOTAL aO/~!} 'I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant ta furnish A. Jab Address B. Legal Descriptian 1. example-tax lat 100, Lane Caunty Map Reference 17 03 43 2. example-Lat 1. Black 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceilin!;1/or forced a' 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example.1250 sq. foot house,,500 sq. foat I 2. example-if new project, check new-if additi ( add, etc. F. Building permit information: 1. example.construct single family house with garage (~ 2. example.remodel existing garage into fomi 3. example.convert single family residence int restaurant (change of use) Rec'd G. Value of work as defined in Section 303 (a) of ( Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Buildin (v: . Staff must be able to contact appropriate pers( design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & ElectricalSd A. Except where blank spaces occur in the descrip af the Mechanical and Electrical Schedules, the need fill-in anly the No. Boxes adjacent to the. item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schec are ~vailable at the Building Division 1. To conserve space on the permit form the sc hove been abbreviated 2. If the item(s) to be installed are not covered ated schedules you should consult the full sc', C. BUILDING DIVISION STAFF WILL FILL OUT ALL F, CHARGES ON THE SCHEDULES - III. Applicant to sign and date , Whenever possible, the initial application will be , worksheet only. Where possible. Building Division prepare a typewritten copy and return it to the ap the time the actual permit is issued for his signatur IV. Fees and Charges Plan check fees are due and payable at the time 0' . and no plans will be processed until these fees ore 'ather fees and charges are due and payable when is issued. V. FOR OFFICE USE ONLY j,..., PERMIT VALIDATION ( CITY OF SPRINGFIELD City Hall Springfield. Oregon Department 01 Public Work. OFFICIAL RECEIPT Date F ram::11J..Lt.A Address ~ 3 C, '/' Received Far: (,1, /~{p S/% E.p. ~% .s, CJ 0 ,2D IS', tf)tJ ,,(PO ------- €rc (,. ...- ~u; ~ ~;U;>I;)..II ~~t. ~:i ".:;. ( (ar- , - Amaunt ,--l Rec;a. /;) 0, ro ~~ ~ f -.!!-... ~" V AUTHO'HlllD SIGNATUIU;: "'11-' (.... . IHIlLTON.TU",.IULL ....IHTI:".. CUQI:..IE. 0" 1'1.0' ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:. Additional Project Information: , " ./"1 ';'0"'.' A", PLANS REVIEWED BY: name ( ( c ( ( C " , ( J ( -( ( ( ,- '/~/.2-rL- dot:... _ , . _.-:.