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Home My WebLink AboutPermit Electrical 1987-12-14 Job Address . ':?t3/ fYI~ Description /70:2 3/ 'II CITY OF SPRINGFIELD COMB illATION APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Heater . INFORl1ATIDN UN" 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Pep. --Fence Demo Change/Use -Other- -- 11r1SPECTIOrl LINE 726-3769 Owner ~(I~~. 's:t;;~ ~Y5'/ mt1j~ Phone 7tf7 5,;2Y/ 00 ~ a ., ~ Bul1dlnQ Permit Info: Describe Work(i.e., Build Single (~ Familv rlesidence Hith Attached Garaael V, rf)M/iTd/IlEr:v. ~ ,,~ ivX/;;A'.&1 CS) CI/l:1rL .1/j.J'in //11I,Jkd;r/;~ . J!(I~ ,.. (lies. no.) (exniresl (ohone no. Range ValuE of Hark: Legal o 2/ooD Address Construction lender Address LJt~lbN Il:.Ar1 (namel Phone (addrp.ss) Primary Structura 1 r;-, I '1. - r. 0 ,.. , :" V I tvI-, Electrical Mechanical CONTRACTDRS (name) (address) 11 ir:<;.. no. (p.xnirpc;) (ohnnp M. \ Plumbina ~ ""'1r V Genera 1 Electrical "'echanical PLUl1B I NG ELECTRICAL MECHANICAL ....!JJh. . FFF . I":HARr,F NO OEL.J:liARli.E. _Nn . OELJ:liARli.E. Each single fixture Residence of SQ. FT. furnace/burner to BlUls Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent ~poa ra tp Stati onary evap. cooler Vent fa"n with sinole duct Vent system apart from hea t i no or A. C. Mechanical exhaust hnnd rind rlurt ~/ater servi ce Temporary Construction Change in existing rp~; dpnrp multffamily. corrm. or Tnrlu<;.tr;al Sewer COMfl.{IND. FEEDERS Install/alter/relocate did.r;h_ fppdpr~ Wood stove/heater -'1 ~~ I Of amps. TOTAL CMARGES HHERE STATE L'H REQUIRES shall not be vali~ until the TOTAL CHARGES ISSUANcr OF PFRmT TOTAL CHARGES that the Electrical work be done by an'"Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXAr11NED 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 Spri ng fi e 1 d and the laws of the Sta te of Oregon perta i ni n9 to the work de cri bed herei n, and UO OCCUPAI~CY will be made of any structure without the permission of the Building Division. I furthe certify that my re ration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exem the b sis for ex ion is noted hereon, and that :~::(:~::::t::~:::s and employee ~~a~:~~:;ith :~:llm:.055 w I be ed on tJ~ DAT~~4 A:~ FDP. OFFICE USE OHL Y / I / Sq. Ftg. t1ain x Value Sq. Ft~. Access x Value Sq. Ftg. Other x Value Zone Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group Fire Zone Flood Plain TDTAL VALUATION BUILDING PERNIT Plan Ck. Conm/lnd Charges an~ ----------- 65%1Bldo PPr Fpp Surcharges Plan Ck. Res 30%/BldQ Per Fee PLUMBING PERMIT ,-' :s 7 ,SO Fence Charges and '5 ------------ Surcharges ) .~ Demo ELECTRICAL PERmT Sidewalk Cha rges and ------------ Surcharges A/C Paving MECMANICAL PERMIT I Curb Cut Charges and ------------ I Surcharges Systems Development Charqe (1.5~) . < -J .Jt1.~ fta.... / :37. SO Total Comb. Permit TOTAL 7b,gg' . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II Dj 43 2. example- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Q3S 2. exar1!Ple- waterheater/electnca(tor solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, SOD sq. foot garage 2. examyle- if new project. check-new - if addition, Check add. etc. ~. Building permit information: 1. examele - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. example - 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 fu 11 schedu I es 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. --- Ill. 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. IO? ~ 10 ld--(C{/~1 V. FOR OFFICE USE ONLY Pennit Clerk {L/ 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