The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1983-7-12 Ii }//11A1-rnu (IA~~A") Address . q;:;.,;). 3 '/11 (lAd ) fLJl:iiTA.lA ;J,.htf1' / ~ Constructio07l~nder 1I v I INSPECTION L1rlE 726-3769 Job Address Legal Description Owner Address Ut~H:jU fE.Af1 Primary Structural Electrical Mechanical CONTRACTORS Genera 1 Plumbino Electrical ~1echanical NO. . . CITY Of SPRINGFIELD CorlBl!lATION APPLlCATION/PERMrT EIIERGY SOURCES: Heat Hater Heater ~f \) ~ ..., I INFORtIATIDN UNo 726-3753 Sq. Ftg. I"a i n ~q. Ftg. Access. Sq. Ftg. Other !lew Add Alter Pep. -Fence Demo Change/Use -Other - - 3dd ~ tr I niD ..CV-h LQ}; , Range ValuE of Hork: Phone BuildinQ Permit Info: Describe Work{i.e., Build Single Family Residence With Attached Garaoe) 9Lt'TIu'lilOV~ ~iJ~.lLrbrj1J flies. no.) (exoires) fohoneno.l - ~ <.>> oe. ..t:: (name) Phone (address) (namel (address) 4 ~ (exoires) ~ (nhnnp nnl (1 ics. no.) I(}r J )fl.Lr ().Btf)O /JYr1)( J (j - PlurlBI NG ELECTRICAL MECHANICAL FH r.HARGF Nn FFF r~AQ~F NO. I FJ:'F' I rI-lARG~ Residence of furnace/burner to BTU's Each single fixture SQ. FT. ../ Relocated building (new fix. additional) S.F. Residence Cl bath \ Duplex (1 bath) each Additional bath Water service Sewer Storm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~~p hp~tpr ~nct vpnt Temporary Construction Change in existing rp".1 rlrflcP multifamily, corrm. or Tnctu"trial Appliance vent sao"ratp Stationary evap.- cooler Vent fan wi th sino 1 educt Vent system apart from heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater Of i'lmps. COI*'./IND. FEEDERS I Install/alter/relocate r1;<:;.trltL fpprlpro;. IOf amp~ I I I ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'll REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 NO OCCUPAHCY 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 OP.S 701.055 will be used on t. project. IWIE(please print~ MlIshm. ..J (lrcH'1er SIGOIATURE ~ DATEV7P~ FOR OFFICE USE b~lY Zone Fire Zone Flood Plain BUILDING PERIIIT Charges an~ Surcharges PlW1BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Tvpe/Const. Bedrooms Stories Units Occy load Occ.y Group Sq. Ftg. rlain Sq. Ftg. Access Sq. Ftg. Other x Value Value Value x x TOTAL V AlUA TI ON Plan Ck. ____________ ~/Rldo Plan Ck. 30%/Bldo I Fence ------------1 Demo /5. ^ () I Sidewalk _______'...1J.___ .Iof) Conm/lnd Pj'r Fpe Res Per Fee .~ Systems Development Charqe tl.5%) .. IJJud {Jniul I ~/ot-f{ I ,dO ITotal Comb. ~re'rmit AIC Pavin9 Curb Cut ------------, I I TOTAL 1//5 go " . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. Lane County Map Reference JI oj 43 2. example- Lot I. Block 3, 2nd Addition to ~pr'ngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examjple- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example. 1250 sq. foot house, 500 sq. foot garage 2. examjple- if new project, check new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. examole - 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 (a) of the Structural Specialty Code H. DESIGN TEM1 ANO CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or jab 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 SCHEOULES 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 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . , PERMIT VALIDATION ''FI:J--t3 . -=tL6/gW 15,00 Jf (/I) tf70 ~O ~ JP /5, gO - 51o!~ Permit Clerk ~/7cUh .. I Permit applicant exempt from registration with the Builder's Board because:. Additional Project Information: PLANS REVIEWED BY: name signature date