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HomeMy WebLinkAboutPermit Electrical 1981-7-22 .---. 'D INSPECTION LINE 726-3769 ) CIlY o'F SPRINGFielD COMBINATION APPLICATION I PERMIT J INFORMATION LINE _ 726-3753 Job Addre" ENERGY SOURCES: Sq. FI.9. Main Heat ~""1.. Sq. Ftg. Acce... Water Heater Sq. Ftg. Other Range _New _Add,_Alter _Rep. I } ()?S Z t, I U I,Value of Work: ., _._Fence_Demo_~hange/.U,~e _ - _' . 7 " _Other A"1.6". Co? s:) J1 ' t: ,i?:! !i., 'f, L,<:... h n:Z '--; d C/e5} ytCy" c.. rf _. . p~ U//V/ j,~,' ic::L..J:.> .A.,.... I ,. ~. Building Permit Info: Describe Work (i.c. ., Build Single ,J Addre.. ? '7 pC?; A' (2.(2 (,Pli' .-=t:-If Phone -1'1 q C, i3J'Family Residence With' Attached G,orage) /~ O.3-~..p t/-:r. 9 T t.-( 01 .,' lLa s: ft( t.! .'l(ez <;.3 ~? 1(' :y(. /> v/w If" , Con1truc:tion lender I II) 16 ! 7() <.f IT' Sir. m legal Description Owner ? C>Q O<Q. Addre.. Phone , DESIGN TEAM I I I r I I (nome; . (address) (lics. no.)' (expires) (phone no.) Primary Structural Electrical ,,^echonicol CONTRACTORS (nome) (address) (Iics. no.) (expires; (ohone no.) G"n"ral Plumbinq Electrical /J1"L'I;5 C I .p ~ f-r I /' I~ . , :? UJ::2 I;; () /I' I 'J/ P [;. e, < 41/ f" U' 'Z.P - /7/ t"'.. dDq>,r<-IJ.b- - "'j. M"chonicol PLUMBING elECTRICAL MECHANICAL Residence of furnacel burner to l\TU's Appliance vent separate Stotionary evap. cooler Vent fan with single duct Vent sy.tem aport from 'heating or A.C. ., Mechanical exhau.t hood and duct FEE ! CHARGE j I I I './ I NO. t FEE CHARGE i NO. FEE i CHARGE NO. Eac;, ,ingle fixture R~locared building (n"w fix. additional) S.F. Residen,e (1 both) sq: ft. New circuits~ alterations or extensions SERVICES Duplex (1 bathl eo en Temporary Construction Addit;o",,1 both Amp.. Water service Sewer Wood .tove/ heater Stor,m Sewer FEEDERS L/ IE(/) Heat Pump Air handler to 10,000 CFM Air nandler over 10,000 CFM Amps. . I. TOTAL CHARGES TOTAL CHARGES ISSU-ANCEOF ~PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the E!ertrical Contracral, the electrical portioll of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREFULLY EXAMINED the compleied application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and all work performed .hall be done in accordance with the Ordinances of the City of Springfield and the Laws of the Stale of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Divi.ion. I further certify that my regi.trotion witl> the 8uilder'. Board is in full force and effect os required by ORS 701.055, that if eX,empt the basis for exemption is noted.' heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. 8asi. for Builder's Board exemption: r~ \ ~ NAME (plea.e print) t3'~':.Pf?, . (j-t :t.tohr, NATURE (/ f DATE FOR OFFICE USE ONLY Zone Fire Zone Flood Plain Type/ Canst Bedrooms <:.tori..... Unils Occy load nccy Group C'l. Ftg. M"in C;q; Ftg. Access Sq. Ftg. Other " '.'olue Value Value " x TOTAL V ALUA TlON BUilDING PERMIT Cnarg". and Surcharge. I /0.001 .i/Ol /6.0{) WI Plan Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Re. 30%/ Bldg Per Fee System. Development Cnarqe (1.5%) ~=5c.~ ~- I ~ PLUMBING PERMIT Charge. and Surcharge. Fence Demo Total Comb. P~rmit elECTRICAL PERMIT Charges and Surcharges Sidewalk Ale Pavina MECHANICAL PERMIT Charges and . Surcharges Curb Cut TOTAL c9-&,OO " Q,' _...:......., . ."",,"": ,:".;,...-_,:~~~:d~':~~~>~_~..;:;..,';';'..:'.,:.. -...._., .... _.. <i -'\ ____I ~', ) COMBINA nON APPLICATION/PERMIT (CAP) PERMIT V ALIDA TION I. Applica~ to furnish A. Job Address B. legal Description 1. examole-tax lot 1 AD, Lane County Map Re 2. examoie-Lot 1. Block 3, 2nd Addition to Spl C. Name, elc. or owner and construction lender D. Energy Sources 1. examole-heal /electrical ceiling/or rorced a 2. c)(amoie-water heaTer: electrical/or solar E. Square raolage or valuation, etc. 1. examole-1250 sq. foot house, 500 sq. foot S 2. examole-ir new project, check new-ir additj, add, etc. F. Building permit inrormation: 1. examolp.-construct single family house with garage - 2. examole-rerf10del existing garagE.- into fcmiil 3. e)(ample-convert single famiiy residence intc reSTaurant (change or use) G. Value or work as dcrined in Section 303 (0) of I Siructural Specialty Cede H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delay!', .Building Staff must be aole 10 contact appropriate persol design information or iob site corrections, elc. II. Abbreviated Plumbing, Mp.chonical & Electrical SchE A. Except where blcnk spaces occur in the descripti or the Mechanical and Electrical Schedules, the c need fill-in only the No. Boxes adiocentto the af item(s) to be installed B. Full Plumoing, Me<hanical. and Electrical Schedl. ore available at. the Building Division 1. To conserve space on the permit form the schE have been abbreviated 2. Ihhe itemis) to be installed ore not covered 0 ated schedule's you should consult the full scht C. BUILDING DIVISION STAFF WILL Fill OUT All FEE CHARGES ON THE SCHEDULES CITY Of SPRINGFIELD ,..:. ~f; City Hall Springfield, Oregon Department of Public Works OffiCIAL RECEIPT (~, No. B 5 6 9 4 9 ( Date r; - 2:2- 198/ - Rec'd FromS i ~ofrred hi- ~ ll~brctncl" -' Address:<0K q Jk'~~ 6 J.erO/l--<:;/ . t~'J .tf)42.. 0~,' Received For: ~g c .lo,m .(/-6 / S ()() . ftJO /; Jp.u/; tfft -- . (if) IlJJ/j)/rrJJ(/1Iiti /O.()O I a . lit) ~. ,uuidm.i ,..--, 6.D~ 52--2-? r /~~ r 1 >Y1;U AUTHORIZED S-IGNATURE SHELTON-TURNBULL PRINTERS. EUGENE, OR 97401 58511-8 c- ,-)PLlmlH~~ </90 { fJ J O~I"i~71 aD {P,(. ( .{J '\ \ Amount Received m. Applicant to sign and dote Whenever possible, the initial application will be use worksheet only. Where possible, Building Division SIc prepare a Iypewritten copy and return it to the appli the time the actual permit is issued for his signaturE.. ( ". - is, \.. BY IV. ( Fees and Charges } Plan check fees are due and payable at the time of tHt;- ":,.,pllcatlon, 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 Permit Clerk r PROJECT CONDITIONS .TO BE SATISFIED BEFORE OCCUPANCY: " Additional Project Information: PLANS REVIEWED BY: namE" ~ignatur(" ,.j,.,te :...; , p; .... ( ( ( ( ( ( ( ~. ( (' ( ",