HomeMy WebLinkAboutPermit Electrical 1981-7-22
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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?:!
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.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
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Sir.
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legal Description
Owner
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O<Q.
Addre..
Phone
, DESIGN TEAM
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(nome;
. (address)
(lics. no.)'
(expires)
(phone no.)
Primary
Structural
Electrical
,,^echonicol
CONTRACTORS
(nome)
(address)
(Iics. no.)
(expires;
(ohone no.)
G"n"ral
Plumbinq
Electrical
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C I .p ~ f-r I /'
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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
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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:
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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
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'.'olue
Value
Value
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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.~
~-
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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
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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
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City Hall
Springfield, Oregon
Department of Public Works
OffiCIAL RECEIPT
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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:
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AUTHORIZED S-IGNATURE
SHELTON-TURNBULL PRINTERS. EUGENE, OR 97401 58511-8
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{P,(.
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Amount Received
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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..
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BY
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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
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PROJECT CONDITIONS .TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY:
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