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HomeMy WebLinkAboutPermit Electrical 1986-9-12 Owner, Y/J1l!.e/1t1M j/ezv, p~ t:eJ, il/ S/Jf) Phone ~r9 CJS35 Range ValuE of Work: . Q,~\ql\~:~~~~NLlNt 726-3753 Sq. Ftg, 1.lain ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Rep. -Fence Oemo Change/Use , Other- - 0\) -. u IQ (~, I"!::-,< €': jlNSPECTtON LINE 726-3769 . ~ Job Address 1f'?/rJ ir1 tZ-<4t ~ CITY Uf SPRINGflElO COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Ilater Heater legal Description Address Po ~,<VV , C1'A Hi / /Y> {) - Construction lend~ . BuiltiinQ Permit Info: Descrlbe Workli~e," Build Single Family Residence With Attached GaraQe) 0l-MJ [, C;;tR- r.lh1(2 ~ h Address DES t uN TEAl1 (name) Phone (address) (lies. no.) (exoires) {ohone no. I Primary Mechanical CONTRACTORS (name) (addri='ssl flies. no.) '~ (eXOire~ (ohone no,) Structura 1 Electrical General Plumbino Electrical (A/l./U/h7 w~ tf35 - 70;l,b ~lechanica' PLUI,IBING ELECTRICAL MECHANICAL NO. FEF CHARr.F N" ccc rH~ N" ccc rH~ SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits a1t5. or extensions Floor furnace and vent S.F. Residence (] bath) Ouplex (1 bath) each Additional bath SERVICES Recessed wall S~~~P ~p~tpr ~nn upnt Storm Sewer Of amps. Appliance vent ~eDarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatino nr A.r.. Mechanical exhaust hood and du~t Sewer Temporary Construction Change in existing rp~ j 1pnrp multifamily. comm. or Inc1ustr;al ,later service COMI,I. /lNO. FEEOERS Install/alter/relocate di~trih. fpeder~ Wood stove/heater Of amps. I /)~~ r..IM'..uij- Lj'fo I L;' t5D fdD Is, fd) I SSUANCE OF. PFR!1IT 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 un OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by ORS 701.055. that if exempt the sis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will us d on this project. OATE CJ-I2.-5K" IW,IE(please print)~#IA1/~ F7A2AL~LL SIGNATURE FO~ OFFICE USE OfILY Zone Type/Const. Units Sq. Ftg. Fi re Zone Bed rooms Ocey Load Sq. Ftl]. Flood Plain Stories Occy Group Sq. Ftg. r1ain Access Other x x Value Value Value x TOTAL VALUATION BUILDING PERmT Charges and Surcharges Plan Ck. Comm/lnd ____________~/Bldo Per Fee Plan Ck. R'es 30%/Bldo Per Fee Fence Systems Development Cha rqe (1. 5~) , PLUl1BING PERMIT Charges and Surcha rges De_o, JkC' ~ 'Sidewalk _____L-:='...!____ ,&'t:> A/C Paving Total Comb. Permit ELECTRICAL PERliIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Curb Cut d/i()5C- .20 ~ L.bJ. TOTAL (5, S:O r , - I . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Applicant to furnish A. Job Address ' B. Legal Description I. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to ~prlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project, check-new - if addition, CheCk add, etc. F. Building permit information: 1. exam~le - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examyle - 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 TE~1 AND 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 ~ivision 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 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. f3 ~ 70G ~ q-[2 - tb V. FOR OFFICE USE ONLY t"c Permit Cl erk . 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