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Home My WebLink AboutPermit Electrical 1986-3-17 legal Description 3 3~O ~ 17-0 0> ~ .3 / - ? /- tf .;!srJ-O CITY UF SPRltlGFIElO INFOR/IATION UNE COMBIIJATION APPliCATION/PERMIT 726-3753 EIIERGY SOURCES: Sq. Ftq. "'ain Heat ~q. Ftg. Access. Water Heater Sq. Ftg. Other lJew Add Alter ~ep. Range____.____ -Fence Demo Change/Use ~;al~o~: Other- - BuilciinQ Penmit Info; Descr be Work{i.e.. Build Single Familv Residence With Attached Garaoel . -t~@ . Ilt'SPECTIOIJ 1I1lE 726-3769 n~ .7-~~ Address 3 ar::;, ~ rJ ~ ~ 97<(7J' Construct~on lender Phone 10<;) ~ \) "'- \l' ~ Job Address Owner Address [)t~JliN r~Ar1 (name) Phone (address) flies. no.1 lexoiresl . (ohone nn.) Primary A ....fL._ ~ V~ Structura 1 Electrical Mechanical -CUNTRACTORS Inamel (addrpss) (1 ico;;. nn. 1 (pxnires.l (nhnnp nn Genera 1 PlumbiOQ Electrical f'u:. '('('€ h t.F/ec.t /?J() R-,Il 1;;)<) Ik'fefo. :20-IS8c" 41gb ; 96S-70:2&. ~'echanical PlUIIB IIIG ElECTRICAl MECHAN I CAl NO,I Each single fixture I FFF I rHARr.F jJn I Residence of I ttt' I ru~ Nn I I r:.E.L'...c.HAB.G..E. furnace/burner to SQ. FT. BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt Water service ITempOrary Construction IChange in existing rps. j d_Pft(':p I multifamily , corrrn. or Inrlllc:.trial 10f ICOI~I./IND. FEEDERS I Install/alter/relocate rtic:trih fppti...rc:. 10f I I I 010-0 amps, ?7.50 ~>5' Appliance vent o;;poaratp Stationary evap. cooler Vent fan with sin!;Jle duct Vent system apart heatino or A.C. Mechanical exhaust hnod i'lnd durt from Sewer Storm Sewer amps. I I I I I 15 37. 5~ Wood stove/heater I I I I ISSUANCE OF PFRrllT . Fire Zone 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 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 OCCUPAUCY 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 7Ql.055 will be used on this project. 1..411-1011 e !l;;r,IIATURE/dw~/#L I FOP. OFFICE USE DIlLY ( Sq. Ftg. rialn Sq. Ftg. Access Sq. Ftg. Other DATE :r1~k , IlAI,IE(please print) \Ai A lI.n e I Zone Tvpe/Cons t. Bedrooms Units Occy load Occy Group , Value Value Value x Flood Plain Stories , TOTAL V AlUA TI 011 BUllOIIIG PERfIlT Plan Ck. Comm/lnd IShstems Development Charges and ------------ 65%/Bld~ Ppr Fpe C arqe tl.5~) . Surcharges Plan CL Res I~ 3D%/Bldo Per Fee PlUl1BING PERMIT Fence ~. Charges and ------------ Surcha rges D~R1o IfI:--~(3 ELECTRICAl PERI~IT .J.:. /- J'"'() Sldewalk I Charges and - ---------- Surchaqjes t{ "10 /,5cJ AlC Paving ITota' Comb. Permit MECHANICAL PERMIT I Curb Cut I Charges and ------------ Surcharges I I TOTAl .a.{) '?'- 57-0<0 -:>0-"';) . ~'Ie \../ J ti-f 6 () /66 L COMBINATION APPLICATION/PERMIT (CAP) t. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference I' OJ 43 2. example- Lot I. Block 3, 2nd Addition to ~prlngtield [states C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas Z. examole- waterheater/electrlcalJor solar E. Square footage or valuation. etc. ------ I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-nfw - if addition. check add. etc. . F. Building pennit information: 1. examole - construct single family house with an a ttached garage 2. example - remodel existing garage into family room 3. exam~le - 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 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 pennit 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. . PERMIT VALIDATION ;3 ~?/d-'i -V' ~J. , ];-/7 4? Permit Clerk~~~ I! V. FOR OFFICE USE ONLY 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 .