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Home My WebLink AboutPermit Electrical 1985-11-19 . U1SPECTlOII L1IIE 726-3769 . J~@ CITY OF SPRINGFIELD COMBIIIATlON APPLICATION/PERMIT EIIERr,y SOURCES: Heat I~ater Heater Range ValuE of Work: /bo.. =c> BuilriineJ Permit Info: Describe Work(Le., Familv nesidence With Attached Garaoe) Job Address '-/-:</9-".1 M/f/# -:>/" Legal De<cr;ption n 01- ~7 ~ 7 n /400 Owner m '7"6 Ve 1//4" Address '::</2 '"3 ~~~v<="y JruJPone ~ ZS-~.c;."C;. 0;:1: ??r~/ ~~'9\Y/ Construction lender Address UE~I{;N TEAl' (name) Primary Structural Electrical Mechanical CONTRACTORS tname) Genera 1 Plumbina I % V) ~ N INFORllATlON LINE 726-3753 Sq. Ftg. I,'a;n ~q. Ftg. Access. Sq. Ftg. Other liew Add Alter Rep. --Fence Demo Change/Use Other - -- Build Single ~<7'V CCe:c7: L/??CC-->/7 7r7 C:;;iE?)~ c:;;~~/:.;-';'"', Phone (address) (lies. no.l (address) f1 ir.e;. no.) c: if '5 6'LZ:--C 7/rrC , /0- I I ITempOrary Construction I IChange in existing I rPs;t1~.rl(,~ Imultifamily. cOrm!. or I tntiu<:.tr;.11 10f amps.1 I ICOMfl./IND. FEEOERS I I Install/alter/relocate I I rli~t~;h fpprlpr" IOf amp..1 I I I I I I I I I TOTAL CHARGES I TOTAL CHARGES / P _ C? e> TOTAL CHARGES WHERE STATE L\li REQUIRES that the Electr;cal work be done by an. Electrical Contractor, the electrical portion of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division Electrical ~1echani Cd 1 PLUI18!1lG NO. FFF Each single fixture Relocated building (new fix. additional) S.F. Residence (j bathl Duplex (1 bath) each Additional bath 1~later service I Sewer I Storm Sewer I I I I I I , MECHAN I CAL FFL J:IJABliE ..1JQ....' I furnace/burner to BTU. s I Floor furnace and vent I Recessed wa 11 _____ Sn~rp np~tpr ~nd vent I ELECTRICAL I CHARr.F I I I I I I I I I I 1 1 I 1 SQ. FT. ~INew c ircu~ts alts. or ex..te~oJls _ ( L/7/' V/ /' . I SERVICES -I lexoiresl (ohane no. ') ~ ~ 17~ IV (pxo;rp"l (ononp nn ) "'?t/"r ::?-=<';)b I_H~ I I I r 1JA&liE .' _I I Appl iance vent "eoa l"'a tp I Stationary evap. cooler I Vent' fan with sinole duct I Vent system apart from I heatinq or A.C_ , I Mechanical exhaust hood and dur:t. Il'JOOd stove/heater I I I ISSUANC, OF PFRllIT I HAVE CAREFULLY EXM1INED 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 Ore~on pertaining to the work described herein, and that rw 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 ORS 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. (I/PcJY/lt'!( (l 1..1 A) L/. Z/d.. DATE /0 r.h~ ~ IlAI-lE(please print) SIGNATURE FO~ OFFICE USE DIlLY II Zone Cc Tyee/Const. Units Sq. Ftg. rl3;n x Value Fire Zone Bedrooms Occy Load Sq. Ft9. Access ,x Value Flood Pia i n Stories Occy Group Sq. Ftg. Otherr( 1!=r 7, , Value_ /c:>o, <$'0 TOTAL VALUATION Plan Ck. Comm/lnd ____________ 65%/BldCl PJlr F~~ Plan Ck, Res 30%/B1 do Per Fee I Fence ------------ I D~mo LO,O:>C:> I Sidewalk --- --~-c/o-I A/C Paving Curb Cut BUILDING PERmT Charges an~ Surcharges PLUt1BING PERMIT Charges and Surcharges ELECTRICAL PERI:IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Systems Development Charae (1.5~) , #./1, I I Total Comb. Permit I TOTAL /c/" <yO , PLANS REVIEWED BY: name~g~; ;:C~';=<-.',-;--signat~;4~ ?c:::._~ ; date 1/-/-5-6~ ~ '.' ~ . , I: '11 I: I, ~' Additlonal Project Information: " Permit applicant exempt from registration with the Builder's Board because: :1 '- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " Permit Clerk V. FOR OFFICE USE ONLY I. Applicant to furnish A. Job Address B. legal Description 1. examole. Tax lot 100. lane County'Map Reference Ii 03 43 2. examole- lot I. Block 3. 2nd Addition to ~prlng1ield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air oas 2. exampje- waterheater/electrlcal/or sofar E. Square footage or valuation, etc. ----- I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project. checklmew - if addition, Cneck add, etc. F. ,Building penmit information: 1. examole - construct single family house with an attached 9ar~ge 2. example - remodel existing garage into family room 3. examole - 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. OESIGN 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. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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. II !I I' PERMIT VALIDATION COMBINATION APPLICATlOII/PERMlT (CAP) . -. . I IrISPECTlOII LlIIE 726-3769 CITY OF SPRINGFIELD COMBlIIATlON APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Ranqe Job Address l/-:?/9-.-I ##/# '?T, legal De~cript;on INFORlIATlON liNE 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Rep. Fence_Demo _Change/Use _Other % V) ~ N Owner m '7"0 v? 1//,4/ ValUE of l'lork: /t>o.. == BuilGinQ Permit Info: Describe Work(i.e., Familv Residence I~ith JI..ttached Garaoe) , Address ;;Z/2-=3 ~~hWv.:=-~ .L--~one .. ' S .--:::.~~, ..-::/'/7': -??7"'<==>/' 9'~-.q)1/ Build Single ?:':Y/C.>7'7? & e:c?: L/?f'c<::-,/r jr7 ,C:;~~ 4~--T~-;-- Additional bath ITemporary Construction I Iwater service I IChange in existing I I rp~jrlJ"...""P I'sewer I Imultifamily. COI11Tl. or I 1 Tnrlll"tri"l IStorm Sewer I IOf amps~ I I I I !cOMl'l./IND. FEEDERS I l I I IInstall/alter/relocate I I' I' rli"trih fpprlpr" I I IOf amp..1 I I I I I 1 I I i I I I I I I I I I ISSUANCE OF PFRlUT TOTAL CHARGES I TOTAL CHARGES /,t? _ (7 ~ .1 TOTAL CHARGES WHERE STATE L\\/ REQUIRES that the Electrical work be done by an. 'Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division Construction lender Address OlSIGN TEAl,' Phone (address) (namel (lies. no.1 Primary Structural Electrical Mechanical CONTRACTORS (namel (addrpssl (l ir:c:. nn..l Genera 1 Plumbina . Electrical c: 4- S 6"'Li?2 7/'rr-C , Hechanical PLUI1B I NG ~!~ ELECTRICAL NO, "L ..QJ^Rr.F "" ccc Each Single fixture Residence of SQ. FT. Relocated building (new fix. additional) ~ New circu~ts alts. or exJ:ell$.l OjlS _ I L /A'/ 1..>/ / . l /;- . SERVICES /0.... f S.F. Residence 11 bathl Duplex (1 bath) each ,'I.' , ., . ' (pxoiresl (ohone no. (pxo;rpc:.1 (ohnnp nn 1 MECHANICAL furnace/burner to BTU's l:'l:' t' 1.Ll1ARG[ -' Floor furnace and vent Recessed wall ~n~~p hp~t~r ~n~ vpnt Appl ianee vent o:;eoaratp Stationary evap. cooler Vent fan wi th stnole duct I' Vent system apart from I heatino or A.Co I'Mechanica1 exhaust hood and durt I ~'Iood stove/heater 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 cerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Ore9on pertaining to the work described herein, and that IlO OCCUPAIlCY 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 ORS 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. IlAl.IE(please print) 20ne C L Fire Zone Flood Plaln SIGNATURE FOr. OFFiCE USE DilLY Sq. Ftg./lain x Sq. Ftg. Access x Sq. Ftg. Other~(' ~r- ~ x Tyoe/Const. Bedrooms Stori es Units Occy Load Occy Group BUILDING PERmT Chargeo:; an~ Surcharges Plan Ck. Comm/Ind 65X/Bldo Ppr Fpp ------------ Plan Ck. Res 30t/Bldo Per Fee I Fence I Deo10 /.,0, C?C> I Sidewalk --- --~-qb-I AlC Paving I Curb Cut I PLUHBING PERMIT Charges and Surcharges ELECTRICAL PERr:IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges OATE Value Value Value /C)O, =1::> TOTAL VALUATION Systems Development Charqe tL5~) , ///1, I I ITotal Comb. Permit I I TOTAL /t/, 7'D ,. ........,........; -~'... "'\.....1~ \ '" "'-'." ,... .l.," . ~ 11 ' COMBINATION APP~ICATION/PERMIT (CAP) ., I. Applicant tJ furnish A. Job Address B. Legal Oescription 1. examp.le- Tax lot 100, lane County Map Reference II 03 43 2. examole- Lot I. Block 3. 2nd Addition to ~prlngfield Estates C. Name. et'c. of owner and construction lender O. Energy Sources . 1. examDle- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or SOlar E. Square footage or valuation, etc. - ,-' L examole- 1250 sq. foot house, 500 sq. foot garage 2. examDle- if new project. check new - if addition, . cneck add, etc. F. .Buildingi! pennit information: . 1. example - construct single family house with an attached garage 2. exam21e - remodel existing garage into family room J. examole - 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. OESIGN TEAM AND CONTRACTORS To avoidi1design or construction delays, Building Oivision!'Staff must be able to contact appropriate persons regarding design infonmation or jOb site corrections, etc. II. Abbreviated Pl~mbing, Mechanical, & Electrical Schedules A. Except where blank spaces Occur in the description portion of the Mechanical and Electrical Schedules, the appljcant 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 penmit 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 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 a~plicant at I,the time the actual pennit is issued for his slgnature. I. . 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 penmit is issued. V. FOR OFFICE USE ONLY 11 , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '. C" ~ITY OF ~~~,NGFIELD '. Springfield, Oregon Department of Public Work. ",' ,. , OFFICIAL RECEIPT ,. ...; ",':" . ',.-- ( . :.~ --'.'F:~' '."; ~ ~ (I No.8 Date Ncv_ I?J '9~ , '/ 'Rec'd From 77fY~> '7& 65659 , . o y/ "k Address 2/'<~ ~rr1'I/.c-.N I~~;'? 0- = , R.c.ivedFor:vI~~8~/C:>5'? n (t cP.. r~ / ",tJ _ er- ~ ...0 o ~/A ( /cP.~O () (I c4P7Z;-YCY) CI Amount Received~ /c:!). y-o d/~~-=-~ /~ V" ~UTHORfZEO SIGNATURE "... -' \\ CI !l("" " . BU5INESSFORWi.INC. 15031"'2.".' .. '....-.. Permit Clerk Permit applicant exemRt from registration with the Builder's Board because: " II' Additlonal Project Information: \>., .-.:". ---. , , PLANS REVIEWED BY: ',,' . . ,'" n ?e. . 'il __. ".,' - , namek.?9'.-Ya::- ;ZCr:-cq:<-'~ ,slgnatur4~ -;;"~ date // -/~"'"6",C:::---