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Home My WebLink AboutPermit Electrical 1982-3-16 (2) I'~ ~ INSPECTION LINE 726-3769 ,I I I I I legal Description n.. C~,; /t7~ CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I ENERGY SOURCES: Heat Water Heater RO"_$I" Value of Work: .. INFORMATION LINE 726-3753 .. Job Add,e" {elf" 1!lt~JI!.V /7-r,;z -fpj.'.:.fJ,- '-!L , Sq. fig. Main Sq. Ftg. Acun. Sq. Fig. Other _New_Add_Alte,_Rep. _Fence_Oemo_Change/UI8 _Other ~ ~ .... ~. Addre" /.(;t..,-u.- Phone Building Permit Info: Describe Work (i.e" Build Single Family Residence With Attached Garcae) ...\::) ~ Owner ~I , I' I Construction lend.r t)~,r7 /0.1 ..-J..-.. I (fLit ."'A",,'1 ,',4.J4 II n~ Add,e.. I DESIGN TEAM I Primary I Structural Elettrical .Mechanical CONTRACTORS General PIJmbina Electrical Mecnanical Phone (name) (address) (lies. no.) (exp;'.,) . i. ' -'r (phone no.) (nome) (address) (lies. no.) (exoi,e,) (ohon" no,) PLUMBING ELECTRICAL FEE . CHARGE NO. FEE . CHARGE NO, Residence of '9' ft. \'"..,... New circuits, alterations i or extensions /1).Pf} SERVICES Temporary Construction Amps. .. FEEDERS Amps. .. .. '.. MECHANICAL NO. . FEE . CHARGE Dualex (I bath) each furnace/burner to '''.TU's Appliance ...ent / separate Stationary ....ap. cooler Vent fan with sinale duct Vent system aport from heatinA or A.C. Mechanical exhaust hood and duct Each sinale fixture Relocated building (n.w fix. additional) S.F. R.sid.nce (1 both) Additional bath Wat.r s.nice Storm Sewer H.at Puma Air handl.r to 10.000 CfM Air handl.r o....r 10.000 CfM " I I I I I I i S.w.r Wood .to..../h.ater ,.~. ISSUANCE OF PERMIT TOTAL CHARGES TorAL CHARGES iJ, iJ.f. TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by .he Electrical Contractor, .he .I.ctrical portion of Ihi. permit shall no' be valid until a lab.1 has b..n .igned by an Electrical Contrador and attadHtd to the olemical panel. I HA VE CAREfULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon I. true and correct, and I further c.rtify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfi.ld and the law. of the Sta_ of o,egon pertaining to the work de.cribed herin, and that NO OCCUPANCY will be made of any .tructure without the permission of the Building Divi.ion. I further certlfy that my registration with the Builder'. Board is in full force and cPffect as required by ORS 701.055, that if exempt the ba.i. for exemption i. noted heron, and that only subcontractors and employee. who are in compliance with ORS 701.055 will be used an this project. . Basis for Builde,'. Board exemptio~ . . NAME (please print) ~ D IJ ,~"'- tC..... CIGNATURE fOR OffiCE USE ONLY 'R._ (f) ~~TE >.l1hLj Zone fire Zone Flood Plain Type/ Canst. 'l.tJdraom. c.'orle~ Unit- ntcy Load "'ccy Group ~. Fig. Main Sq. fig. Access Sq. fig. Other . Value x Value x Value TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Bldo Per Fe. Plan Ck. Re. 30%/ Bldo P.r Fe. System. De....lopm.nt Chara. n.S,,"l PLUMBING PERMIT Charge. and Surcharge. fence Demo l Total Comb. Permit ELECTRICAL PERMIT Charg.s and Surcharge. //.i.?6 . ..f;~ Sidewalk AIC Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut I TOTAL lIt'. Iii) COMBINATION APPLlCA T10N/PER.P) I. Applicant to furnish A. Job Address B. legal Description 1. example.tax lot 100, lane County Map Reference 2. example-Lot 1. Block 3, 2nd Addition to Springfield 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. exomple.1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, chec add, etc. F. Building permit information: 1. example-construct single family house with an atta garage 2. example-remodel existing garage into family roort' 3. example-convert' single family residence into restaurant (ch.ange of use) G. Value of work os defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Bui.iding Divis Staff must be able to contact appropriate persons reg design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedule: A. Except where blank spaces occur in the description pc of the Mechanical and Electrical Schedules, the applic need fill-in only the No. Boxes adiacentto the approl . 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 schedul. have been abbreviated 2. If the item(s) to be inslalled are not covered on th ated schedules you should consult the full schedul C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES" CHARGES ON THE SCHEDULES ( '" CITYr. SPRIN.GFIE~D~ City Hall Springfield, Oregon Department of Public Work. OFFICIAL RECEIPT ,( 'I ptt No. ~ - ( In 19 f(z.. Rec'd From r ~.(JJ fJ/J.<I~L Address fJ ,u.t ~t I ~ ~' Q/J_ Date B 58218(1 ( ,~ i" d _d Received For: tYh. "p,~ 4"-':~ , 4'?~ CI 1I/0,~ ,I#, #//J:ik,- ( (l ( J. f;"\ il ,q Lt r- ! r~ (I ( (I (' (, ,~ I ", " (/ Ii //J, t/() Amount. Receive~.~ ~~ "' -Z',.I lw.L ( AUT"'OIUZI:O SIO,.."TUlUl: .HIUO...YU.....UlL ".'10'11:"1' I:UGI"., 011 ".01 i ..."., \... ( ( III. Applicant to sign and date l-:- , 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 ond payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Project Informotion: PLANS REVIEWED BY: name signaturr-- . Permit Cier" ""ate