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HomeMy WebLinkAboutPermit Electrical 1990-2-23 , , I INSPECTION LINE 726-3769 . Job Address /4f)q Mt/1hV SOJd. ,. Legal Description l!./()~~~-VlJ :::~,A)(J11Ol- CITY Uf SPRiNGfIELD COMBINATION APPLICATiON/PERMIT EilERGY SOURCES: Heat Hater Heater Range - v,J,oO , '0" INfORllATION liNe I 726-3753 . ~ Sq. ftg. '-lain - . ~q. Ftg. Access. 8 Sq. Ftg. Other -.!le,,_Add_Al ter -!qep. __Fence_Demo_Change/Use r-\~ _Other l.L/ 6 Owner A I ~e-vvV'- Address ~ ValuE of Hork: Phone BuilGinQ Permit Info: Describe Work{i~e.. Build Single Familv nesidence With Attached Garaael Address Ot.~lljN TEAl1 (name) Phone (address) IJ ~ Qt~;~ I tC~ ~ "~ (ohone no.'\ Construction lender Primary Structural Electrical Mechanical CONTRACTORS {name} (address) (1;1""- nn.1 (p'l(l)irpc::;\ (I)hnnp no. \ Genera 1 Electrical ~~/fnW / Plu' /,'V)$ , , a/7.0 Ke~c::M..; I.a.M..L- E..I et;;!v i c,.... :?){) -I '"FI e- If) !&t 0 fdtZ ItJ 1(,) Plumbina ~1echani ca 1 PLUilBI NG ELECTRICAL r"A.r.rl NO MECHANICAL NO. FEF CHARGF NO rrr For I r"A'lG.E.. Each single fixture Residence of SQ. FT. furnace/burner to BTU'S Relocated building (new fix. additional) New circuits alts. Il!:OO ,"1'" or extensions '1-.._ . + v ,(/ , I c.\fl.U. . SERVICES Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance- vent seoarilt~ Stationary evap. cool~r Vent fan with sinale duct Veni system apart from heatina or A.C. Mechanical exhaust hood and durt. Wood stove/heater Sewer Temporary Construction Change in existing rp~ j riPpre multifamily, camm. or lnrluc;trial Water service CO~1./IND. FEEDERS Install/alter/relocate rlic::trih_ fpprlpro:: Of amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\l/ REQUIRES that the Electrical work be done by an shall not be vali~ until the label has been signed by an Electrical . ~ I.....~ ISSUANCf OF PFRfllT l"!~:;) TOTAL CHARGES Ele' ntractor, the electrical portion of this Supervisor and returned to the Building Division permit 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 rf!in, and..... t uo OCCUPAIKY will be made of any structure without the permission of the Building Division. I further eel'" . y t~at my/regi ation with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt t basi,'for/exe 9 is noted hereon, and t~at only subcontractors ~.~~p:ees~: a;~n_~:Pliance with ORS 701.055 will e ,us~ ?:~ /JJect. IlAl'iE(please print) Vf.A Vtu "/171.. SIGrIATURE_~' /4- ~ DATE , FOR OFFICE USEO~ I' Tyoe/Const. Units Sa. Ftg. rlafn Bedrooms Occy load Sq. Ft~. Access Stories Occy Group Sq. Ftg. Other Zone x Value Value Value Fire Zone Flood Plain x x TOTAL V ALUA TI ON BUILDIIIG PERflIT Charges an~ Surcharges Plan Ck. Comm/Ind 65%/Bldo Ppr Fee ------------ Plan Ck. R-es 30%/Bld. Per Fee Fence Systems Development Charae (1.5~) PLU'~BING PERMIT Charges and Surcharges ELECTRICAL PERr~IT Cha rges and Surcharges _15~~ "S DeAlO Sidewalk A/C Paving I Curb Cut I Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges TOTAL .'\D'~' - .- -:. ... . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. exam)'le- Lot 1. Block 3, 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examDl~- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater{electrical/or solar E. Square footage or valuation, etc. ----- 1. example- 1250 sq. foot house, SOD sq. foot garage 2. examjple- if new project, check-nfw - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. examele - 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 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . - PERMIT VALIDATION "d3'9Q tr,l \Dw (f}1) Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date