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Home My WebLink AboutPermit Electrical 1987-7-10 r I IrISPECTION LINE 726-3769 . CITY OF SPRINGFIELD corm I IIATI ON APPLICATION/PERMIT EIIERGY SDURCES: Heat ()~ ~ Heater Ranqe - INFORlIATIDN UNt 726-3753 Sq. Ftq. l'lain ~q. Ftg. Access. Sq. Ftq. Other Ilew Add A Her Rep. -Fence Demo Change/Use -Other- - 09 f5 ~ ~ ~ Owner Job Address ?OSo Ci!~r.~.J Legal Description ,\ fl1#rf (lS/alPr(fj3::253f U/dl1-I1. \ [("'~ ({,C&: _ t:..d. 'I+cW de Address 3L.-=s-;n (~t4J.PlM~J(PhoneIJ,4/) ~ l q ZJ Address DESIGN rEAI.r (name) Phone (address) ValUE of Hork:. -_. .,,- [ BuilriinQ Pernlit Info: Describe Work(i.e., Build Single Family Residence With Attached GaraQe) CU~ Y-wIJ ~-5 'ftJ t37tL ?'~;~ (' / ..A/.;..J (exo; res) (l1cs. no.) {ohane no. I Construction lender Primary Electrical '1Ll~ I /100 . "ll ~ I r; Structural f1echan i ca 1 CONTRACTORS (name) {address) (1 icC';.. nn.) (pxnirpc;,) (ohnnp nn, \ Genera 1 Plumbina Electrical I)V.J//J rJ II .J ~1echanical PLUIIBI NG ELECTRICAL MECHANICAL 110. FFF CHARGE Nn J:'J:'L...cHARG.E.. NO ~J:'~ .c.HARG.E. Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence II bath) Duplex (1 bath) each New circuits alts. or extensions F1 oor fu rnace and vent SERVICES Recessed wall So~rp hp~t~r ~nrl v~nt Storm Sewer Of amps. Appliance vent <;f'Oaratp Stationary evap. cooler Vent fan with sinole dtJ\-~, Vent system apart from heatino or A.C. Mechanical exhaust hnnd and dud Wood stove/heater Additional bath ~!ater service Temporary Constj"uction Change in existing rpc;, i dJ'~nr:~ multifamily, COI1111. or Tndustrial Sewer COI1l.1. /!ND. FEEDERS Install/alter/relocate dic;;t.rih_ f~~dprc;; M 10f I I I amps. ISSUANC, nF PFR!IlT TOTAL CHARGES TOTAL CHARGES WHERE STATE L,"~ REQUIRES that the Electrical work be done by an shall not be vali~ until the label has been signed by an Electrical TOTAL CHARGES Electrical Contractor, the electrical rortion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAtlINED 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 HO 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 only subcontractors and employees who are in comDliance with OP.S 701.055 ~l~ use~~s project. IWIE(please print) :ED HA-vcAC SIGIIATURE ~ #~ DATE 7-/0-91 Fon OFFICE USE orlL Y S~. Ftg. lIain Sq. Fta. Access Sq. Ftg. Other Zone Type/Const. Bed rooms Stories Units Occy load Occy Group x Value Value Value uj Fi re Zone x Flood Plain x TDT AL V ALUA TI ON BUILDIIIG PERflIT Plan Ck. Conm/! nd Charges anc ------------ 65%/Bl do Ppr Fpp Surcharges Plan Ck. Res 30%/Bldo Per Fee PLUI1BING PERMIT Fence Char.ges and ------------ Surcharges Demo ELECTRICAL PERI~IT !5 #'0 Sidewalk Cha rges and V\ .-------~7lJ Surcha rges A/C Paving IIECHANICAL PERMIT I Curb Cut Charges and ------------ Surcharges I ~.iLc. L b.( Systems Development Charoe (1.5~) ~Total Comb. Permit I /3116 .20 ITDTAL /5, tfS , . ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 1/ oj 4j 2. examole-Lot 1. Block 3, 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air qas 2. exa~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. 1. examole- 1250 sq. foot house, 500 sq, foot garage 2. exa~ple- 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. example - remodel existing garage into family room 3. exa~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 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 fu 11 schedu 1 es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES O. 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. t?F t&l(/ j---lj---t:J V. FOR OFFICE USE ONLY Permit Clerk w III . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date