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HomeMy WebLinkAboutPermit Electrical 1989-11-28 ~- I INSPECTION LINE 726-3769 ~= "'= 1(4 'J-J rYla,;M'rrr.u)- legalOescription i 7~ D?,g&~-3 I '1L.- ~,-/DD Wo.J.f.L ~ ddi--- itnnll.. ~ffW{'C-- (tr~~,/ ) NOd r /YLfJiM tv'; TY SPR NGflElD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat l~ater Heater Range ValuE of Hork: . I NFDRlIATlDN LI No 726-3763 Sq, Ftg. Main ~q. Ftg. "Access. Sq. Ftg. Other Ilew Add Alter P.ep. -Fence Oemo Change/Use Other- - D() ~ - ~ \J\ 'P Job Address Owner Address Phone BuildinQ Permit Info: Oeser be Work(i.e.. Build Single Familv nesidence With Attached Gara~e~ --rj J'ViI,O, .Ill /J ./l hj (U.J-. ('// fJ..u ). vJ15Y Y-mt<.r mL JOt-, Cons truct i on lender '. . Address OESI~N TEAl1 (namel Phone (address 1 , (lies. no.) (exoiresl (Dhone no. * ~ Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (address' (l in.. no.' (pxnirp~' (nhoop on. , Pl umbi no ;If) .:b Genera 1 Electrical ~'echani ca 1 PlUlm 1 NG ELECTRICAL MECHANICAL NO. FEE JdjARGF Nn r~~ 'r~~Qr.~ NO HI=' rl-l~ SQ. FT. furnace/burner to BTU's Each single fixture Residence of. Relocated bui1din9 (new fix. additional) New circuits alts. or extensions Floor furnace and vent S. F. Residence 11 bath \ Duplex (1 bath) each Additional bath SERVICES Recessed wall <;I);U'P hp;lotpr ;lo,lri ....pnt Storm Sewer Of amps. Appliance vent s~oarate Stationary evap. cooler Vent fan wi th sin~:lle duct Vent system apart from heatina or A.C. Mechanical exhaust hood tlnd dud Wood stove/heater Sewer Temporary Construction Change in existing r~ll j dr_nc~ multifamily. comm. or Tndustri.11 Wa ter servi ce CO~1./INO. FEEDERS Install/alter/relocate dishib. feedPrs Of amps. ISSIJANCF OF PFR!IIT TOTAL CHARGES WHERE STATE l~W REQUIRES shall not be va1i1 until the TOTAL CHARGES TOTAL CHARGES , that tile Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division 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 oerformed 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 herein, and that UO OCCUPAIKY will be made of any structure without the permission of the Building Division. I further certify that my registration \'lith the Builder's Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. IWIE(please print) -:v k iR.i..l-cl- /-I.....c../cJ-,Ud..r SIGIIATURE A e;\ H.trjl'-f-l.~~r OATE_Ll!.'?I!tll FOP. OffICE USE DIlLY' I j Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories Units Occy load Occy Group Sq. Ftg. t1ain x Value Sq. Ftg. Access x Value Sq. Ftg. Other x Value TOTAL V AlUA TI ON -S~stems Deve10pment , C arge (1. 5~ . BU I lO I NG PERI-lIT Charges and Surcharges . Plan Ck. Conm/lnd ____________ ~/81da Per Fpp Plan Ck. lies 30X'B1dQ Per Fee Fence PlUI1BING PERMIT Charges and Surcharges ELECTRICAL PERlm Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges /5,00 ---6O'j{) ,16 O~o. .Sldewa 1 k A/C Pavin9 Curb Cut Total Comb. rermit TOTAL /67fJ I' - COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exa~le- heat/electrical ceil inn/or forced air Qas 2. examyle- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. examDle- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - if addition, check add, etc. F. Building pennit information: 1. examole - construct single family house with an attached garage 2. example. remodel existing garage into family room 3. exam~le. 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 TEAN AND CONTRACTORS To avoid design or construction de1uys. 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 8. 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 .0. 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 S i goa ture. 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. FDR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: -- ~ PERMIT VALIDATION v ~ tJ:;- /~...; L/5 Permit Cl erk IiAJ j O~ ~ Permit applicant exempt from registration with the Builder's Board because: Additianal Project Information: PLANS REVIEWED BY: name signature date