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Home My WebLink AboutPermit Electrical 1985-11-8 IIIISPECTION LIIIE 726-3769 . CITY OF SPRINGFIELD COMBlIlATION APPLICATION/PERMIT EIIERGY SOURCES: Meat Hater Heater Ran~e 4tctef1ht, (i; INFORllATIDN LINE 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. -Fence Demo Change/Use Other - - b Uj " ~ ~ ~ :.....;:..J..fi..:. .Job Address dO;)O fJ1tl.l~ J Legal Dmription /'7 0 3 3 itJ if Cl 0;:).5' /lVl .:.- -- IYuaAc- (lfu~ Addressbifc;- /IJ, rzT/f Phone/)(/1 ~ 1((Sd). Construction lender ValUE of Work: Owner Address Ut~l(.iN H.Ar.' (name) Phone (address) BuilriinQ Penmit Info: Describe Work(i.e., Build Single Famill, ReSid;nce IHth Attached Garaoe) ~~/~ ~/W) 111 (lies. no.) (exoiresl ~(ohone + no.') Primary . Structural Electrical Mechanical CONTRACTORS (namel (address 1 (1 if''' nn.l (pltlJirpc;,) (ohnnp no_ 1 General Plumbino Electrical / ~~ALRd/O PLUIIBIIlG / , ~' ~lechan;cal SQ. FT. I MECHANICAL ~r< r"'dl.liE -*l.....1 I furnace/burner to BTU1 s I' Floor furnace /tJf!E. ~ and vent I I ~~cessed wall -----r--~rp hp~tpr ~nd vpnt I Appl iance vent seoaratp I Stationary evap. cooler I Vent fan with ~inole duct I Vent system apart from I heatino or A.C. I Mechanical exhaust hood and c1urt . I \1ood stove/heater liJA~/J I /0-tM~ I ~hlHl) d I H~ I CHARGF ELECTRICAL NO. <FF rHARGF Nn Each single fixture Residence of .' Relocated building (new fix. additional) INew circu!ts a1ts. or extenSlons I + Aa >>f' -"{ , SERVICES S.F. Residence _ (1 bathl Duplex (1 bath) IAdditional bath I ~Ia ter servi ce I Sewer I Storm Sewer each ITempOrary Construction I'Change in existing re~ j qe:nrp Imultifami1y, comma or Tnc1u<;tr;al I I I I I I I 10100 ~~: I HAVE CAREFUllY EXAMINED the completed aprlication for permit, and do hereby certify that all informati~n 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 ld and the laws of the Sta te of Oregon pertai n i ng to the work descri bed herei n, and that UO 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 :~ll:(:~::::t:::::~S a~~l;;e~hO ~~~:~~:~~:~:rl:::~:58=se2l~o:TI DATE II~~_~ FOP. OFFICE USE DIlLY V ~ Sq. Ftg, 11a;n x Value Sq. Ft9. Acces, , Value Sq. Ftg. Other x Value Zone Tvpe/Const. Bedrooms Stories Units Occy Load Oeey Group Fire Zone Flood Plain TOTAL V ALUA TI Ofl PLU'1BING PERMIT Charges and Surcharges BUILDING PERflIT 2D ...., PI an Ck. Charges and P~7 _____-==_____ 65~/Blda Surcharges 1130 Plan Ck. ""_ 30~/Rlrlo I Fence I O~mo ____;?-_~~__i Sidewalk , ~() I A/C Paving ____-2a.'-~:...J Curb Cut .$01 Corrm/Ind Ppr Fpp R-es Per F,=~ Systems Development CharQe rl.5~) " ELECTRICAL PERl:IT Cha rges and Surcha rges Total Comb. Permit ~2~O /~ J/.(j~J . (. - MECHANICAL PERMIT Charges and Surcharges I I TOTAL .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B. Legal Description 1. example- Tax lot 100. lane County Map Reference Il 03 43 2. example- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examele- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - if addition, c/'leek add. etc. F. .Building permit information: 1. example - construct single family house with an a ttached garage 2. examole - remodel existing garage into family room 3. examjle - 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. OESIGN TEAM ANO 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. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES 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. V. FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . , ~ PERMIT VALIDATION ~ 1~5t ( ()A f) It) t(S- ~A7 \ l/ r0\J Permit Cl erk cL- / / Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature \...... ..r . date . r " ',- -' ]