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Home My WebLink AboutPermit Electrical 1982-3-16 ,. _- I INSPECTION LINE 726-3769 ..' CITY OF SPRINGfiELD COMBINATION APPLICATION/PERMIT .. INFORMATION LINE 726-3753 Job Address I.~lfl.l rh,~ ENERGY SOURCES: Heat Water Heater lonya I Value of Work: Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _Now_Add_Altor_Rep. _Fence_Cema_ChangefU.. _Other <:lG, t' Legal Description I I~, 4' , ~ '" 7"'_ 7-r)~ -IZR'I".::fh- ~. ( ..... ~-r.. ,vv -. Owner ~ ' " {l.r-'..+'l1.!_', j/i'-"UJ'U'. Ih I. ,,t;uA...L /J lL t) ') ,J.'" 7 Phone Building Permit Info: Describe Work (i.e.. Build Single Family Residence With Attached Garol1e) ~ ~ /{..,.L-/ 77" , Construction lender (,' h >:1:1: ,.,. ,) I.'-~ (nome) (address) (lies. no.) ,...,.., ~~-' Address DESIGN TEAM Phone Primary Structural Electrical Mechanical CONTRACTORS (nomo) (address) (lies. no.) (expires) (phone no.l General Plumbing Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL "0 FEE CHARGE NO, FEE CHARGE NO, I FEE CHARGE Each sinAle fixture Relocated building (new fix. additional) S.F. Re.idence (1 bath) .,.ft. New circuits. alterations 1 or extensions //).PtJ furnace/burner to ~TU's Appliance vent separato Stationary evap. caaler Vent fon with single duct Vent .ystem apart from heating or A.C. Mechanical exhaust hood and duct Residence of SERVICES Duplex (I bath) each Temporary Construction Additional both Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CfM Amps. ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES Ij" ~ TOTAL CHARGES WHERE STATE LAW REQUIRES that tho Electrical work be done by the Electrical Contractor, tho electrical portion of this permit sholl not be valid until a label has been ligned by an Electrical Contractor and attached to the electrical panel. 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 Orogon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the porminian of the Building Oivllion. I furthor cerUfy 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 I. noted heron, and that only subcontractors and employees who are in campliance with ORS 701.055 will be used on this project. Basis for Builder's Bo~rd exemptiCl"" NAME (please print' '; /. \-, Ari..lj~ , ~ \ DATE ~1t~1.L , CIGNATURE FOR OFFICE USE ONLY ,- -...., ....... Zone Fire Zone Flood Plain Type/Canst. II-drooms C.tori~'. Units t")cey Load ''key Group (;,. Fig. Main c,. Fig. Access Sq. Ftg. Other Value Value Value TOTAL VALUATION x BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Bide Per Fee Plan Ck. Res 30%/ Bide Per fee Sy.toms Development Charae n.5%\ PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharge, /I.!.U .:.}l' Sidewalk A/C Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 1/; LJ. 'ii) COMBINA nON APPLlCA TION/PER.P) I. Applicant ta furnish A. Jab Address B. Legal Descriptian 1. example-tax lat 100, Lane Caunly Map Reference 17 03 43 2. example-Lat 1. Black 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example,1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, check add, etc. F. Building permit information: 1. example-construct single family house with an attached garage 2. example-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 nol covered on the abbrevi. aled schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicant ta sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten 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: Additional Project Information: PLANS REVIEWED BY, nam-:- c;ignatur-:- '~MIT VALIDATION " Permit Cler. iate i , '-.