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Home My WebLink AboutPermit Electrical 1982-6-4 7 -- ",;; INSPECTION LINE 726-3769 - CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT - INFORMATION LINE 726-3753 Job Add,... _J ill//) 7htl.J';' 51 legal Description i1 .....03 - ~(."... L\ \ 01\ 00 -~ -;J ~ I ENERGY SOURCES: Heat I Water Heater Ran!=le I Value ~f Work: $I. /!:,~ Pj... Building Permit Info: Describe Work (Le., Build Single Familv Residence With AHached Gerace) Sq. Ftg. Main Sq. Fig. Accen. Sq. Ftg. Other _New_Add_Alter_Rep. I_Fence_OemO_Chonge/use _Other ~ ~ ~ Own., .;!;rr.ab.. 0 JJ.a.,.J-,~ Add,... :lL/L/j) V 71JI1J~ .4-1- ./ A-,t _ n 1'_ ~.tI I CO"Itruction lender Phone J.lu~ J., I~A-- Addreu DESIGN TEAM Phone (nome) (address) (lies. no.) ,.....* (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (nome) (address) (lies. no.) (expires) (phone no.l r.....n".nl Plumbinq Electrical I:!d::bA r;'fJp.A 8/)3') I .J.I./Jiw ,& ('.dhrr ffi~Vf .:J~tJ I 1L.3J..:f2 tfilz - gj/" r Mechanical PLUMBING ELECTRICAL MECHANICAL NO. ' FEE 'CHARGE NO. I FEE I CHARGE NO. l FEE I CHARGE Additional bath Amps. :LfJ1J ~ furnace/burner to lTU's Appliance vent separate Stationary BVOp. tooler Vent fon with single duct Vent system aport from heating or A.C. Mechanical exhaust hood and duct Residence of Each single fixture Relocated building (new fix. additional) S.F. Residence (I both) ,~. ft, New circuits, alterations or extensions SERVICES Duplex (1 bath) ear;h Temporary Construction Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CfM r r I I I I I TOTAL CHARGES I Amos. ISSUANCE OF PERMIT TOT AL CHARGE~ 1~ TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work b. done by the Electrical Contractor, the electrical portion of this p.rmit shall not be valid until a label has bHn signed by an Electrical Contractor and attached to the .Iedrical panel. I HA VE 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 he done in accordance with the Ordinanr;es of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further certIfy that my registration with the Builder's Boord is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption: NAME(PI.o..p';n~lcI j), /<; lTPr VI- SIGNATU~f!JP ~ DATE/'~~- fOR OffiCE USE ONLY I Zone fire Zone Flood Plain Type/Canst. Bedrooms Cltori.- Units nccy load "ccy Group Sq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other "alue Value Value TOTAL VALUATION x x BUilDING PERMIT Charges and Surcharges Plan Ck. Comm/rnd 65%/ Bld~ Per Fee Plan Ck. Res 30%/Brd~ Per Fee Systems Development Charae (1.5%) PLUMBING PERMIT Charges and Surr;harges Fence Demo Total Comb. Permit elECTRICAL PERMIT Charges and Surcharges .~.()f) Sidewalk I. 40 Ale Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL .J6,/) ._~......" - ..-r>" "-~ , - iIo~"""'-:~ COMBINATION APPlICATlON/P~ (CAP). I. Applicant ta furnish A. Jab Address J ,B. Legal Descriptian 1. example-tax lat lOO, Lane Caunty Map Reference l7 03 43 2. example-Lat 1. Black 3, 2nd Additian'ta 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 50lar E. Square footage or valuation, etc. . 1. example-1250 sq. faat house, 500 sq. f06t garage 2. example-if new project, check new-if "addition, check add, etc. F. Building permit information: 1. examole-construct single family house with an attached garage 2. example-remodel existing garage into fqmily 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 abbrevi- ated sohedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 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, name o:,ignaturo. - ,~ Permit Cler~ ~ - ~--"" PERMIT VALIDATION , ,. ~ate --- -- , " . .. ~ CITY Of SPRINGFIELD COMBINATION APPLICATION/PERMIT , INFORMATION LINE 726-3753 INSPECTION LINE 726-3769 Job Add,... ...J iI.!:Lt) 7h~ 51 ENERGY SOURCES: Heat Water Heater Sq. Ftg. Main Sq. Ftg. Accen. Sq. FIg. Other _New_Add_Alter_Rep. _Fence_Demo_Chango/Ui8 _Other <>0. ~ ~ ~ Legal Description Own.' .f)f1...:::t!1. fa .tJ;t'" A./",~ Add,... ;).tIL/.{) 71J n I A< .s r ~....I-:t _ I),P , V - Candruc:tion lender Phone Range I Value ~f Work: $I / SiM Pj... Building Permit Info: Describe Work (i.e.. Build Single Ferna" Residence With Attached Garaee) j'/JI-".L~~ j, uuJN_ /I Address Phone DESIGN TEAM (name) (addren) (tin. no.) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (namel (address) (lies. no.) (exoires) (ohone noJ General Electrical ~A f:P,~ g I) ~ 1 !--.J./Ah--' Pa, (~1.&:..'tPI 2" -'70 /,:3H'2 1 tf112-R//.,C I I plumbinq Mechanical PLUMBING ELECTRICAL MECHANICAL NO, FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE Additional bath AmO', :L1;'1) &~ furnace/burner to 1TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heatins:l or A.C. Mechanical exhaust hood and duct ./ Residence of Each single- fixture Relocated building (new fix. additional) S.F. Residence (1 both) sq. ft. New circuits, alterations or extensions SERVICES Duplex (1 both) each Temporary Canstrudian Water service Sewer Woad stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler oyer 10,000 CFM Ames. ISSUANCE OF PERMIT TOTAL CHARGES TOT AL CHARGE~ 1 .&:,-tJ> TOTAL CHARGES WHERE STATE LAW REQUIRES that the Eledrical work b. done by Ih. Electrical Contractor, the eledrical portion of this permit sholl not b. valid until a lab.1 has b..n signed by an Electrical Contrador and attached to the eledrical panel. .1 HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and carred, and I further certify that any and 011 work performed sholl 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 herin, and that NO OCCUPANCY will be- mode of any structure without the permission of the Building Division. 1 further certify that my registration with the Builder's Boord is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, ond thot only subcontractors and employees who or. in compliance with ORS 701.055 will b. used on this project. Basis for Builder's Boord exemption: NAME (01.0.. o';n~J Ie! j), /<; '7T"Pr Vir SIGNATUR~PP tZ~ DATE/..jf/4L- FOR OFFICE 'USE ONLY Zone Fire Zone Flood Plain Typel Canst Bedrooms __. Ctorie" I 'nits "'tcy Load ':lccy Group Ciq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other x x Value Valul Value x TOTAL VALUATION BUILDING PERMIT Charges ond Surcharges Plan Ck. Comm/lnd 65%/ Bldq Per Fee Pion Ck. Res . 30%/ Blds:l Per Fee Systems Development Charae 11.5%1 PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit ELECTRICAL PERMIT Chorges and Surcharges 3~-, l.."'V Sidewalk J, <!U AI C Po,;no MECHANICAL FERMIT Ch~rges and Surcharges Curb Cut TOTAL 36, '10 , COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Jab 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 QQS 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. l. example-1250 sq. foat house, 500 sq. faat garage 2. example-if new project, check new-if addition, chec add, etc. F. Building permit informution: 1. example-construct single family house with an attae garage 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (change of use) G. Value af work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Oivisic Staff must be able to contact appropriate persons rega design information or job site corrections, etc. II. Abbreviated Plumbing, Mechcinical & Electrical 'Schedules A. Except where blank spaces occur in the description por of the Mechanical and Electrical Schedules, the applica need fill-in only the No. Boxes adjacent to the appropr item(s) ta 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 cavered on the, ated schedules you shauld consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN CHARGES ON THESCHEDULES III. Applicant ta sig~ ~nd date Whenever possible, the initial application will be used as a worksheet only. Where passible, Building Division Staff will prepare a typewritten copy and return it to the applicant at the time the actual permit !s i~sued for his signature. , c.... ( roj c~ OF SPRINGFIELD J . .. City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B 5912 Sir Date t,- <J. 19 gL ( Rec'd From f.~ r;.2..1'-hil. Address ~/) f,2, 7 J Lv, }",J &..:L ( - Received FOr.1F ~ M. 0t , f ( LIP,,() PJ, A'Il.J-f f/ ( t.f all) ( - ~p ,.-' , ( ( !l-('[ ( . ., (I' (I '1 'I '~ q Q (j" (1 ~ (I I, ". CI .JI_~ ;30, t)r) t, If/) '/i-R{." t/- () Amount Received $/ ~r:" lfD "~ jt) A:1 "- AUTHORIZED SIGNATURE "' ..._..~.. iuuoas ~RINTI!:IIIS'L1THOGIIIA~HIEIIIS.IEUGIENIE. OIllIEQON IV. Fees and Charges Plan check fees are due and payable at the time of the applicatian, and no plans will be processed until these fees are paid. All . other fees and charges ore 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: name_,. signaturp Permit Cler~ '.: . "' i ~atp J