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HomeMy WebLinkAboutPermit Electrical 1990-1-16 --~:;-= 7"--~ -- -' Job Address '\ S8:\0 . ...:J\. cst l\ Q 0 :.t CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Range Valu€ of Hark: . ,/ INFO~~ATION LINe 726-3753 Sq. Ftg. l1.in ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Rep. -Fence Demo Change/Use Other- - .]INSPECTION LINE 726-3769 '... Legal Description Address DESIGN IEAr1 (1 ics. no.) (exoires1 r (ohone no.l owne~ ')~'(\.N\.t\ lli AJJrcss I '~-,........ 1-( \.. \ A .J. ~ 1\N, construc~de l, Phone BUllGinQ Penmit Info: Describe Work(i.e.. Build Single FamilY ~esidence With Attached GaraQe\ {name} Phone {address\ :'-0 h 0t L.-f~ )('("("\ctJ Primary Structural Electrical Mechanical CONTRACTORS (name\ (address' (1 ice;. no.) (pxnirpo;: \ (ohonp I1n \ General Plumbinq . Electrical B\)..\ h ~ f'S t:~d PLUJIBING ~ ~ N1~1 f.in ~ ?'70S ~S.fS-l!y;,t ('~:H:- ()4Q .Q.(.? 11Auiar) . - ", I " ELECTRICAL MECHANICAL "1echani ca 1 SQ. FT. , ..EEL .QJAR!iE JJQ...I I furnace/burner to BTU's cJJ Floor furnace <::,.1' I J.. and vent 'H.LLiJA1lliE. NO. I ' FEF -----lEach single fixture Relocated building (new fix. additional) cHARGE .1lll....' Residence of S.F. Residence (I bathl Duplex (1 bath) each ~ N~cu~ts alts. . o1\extenslons , ' ~ [SERVICES Recessed wall ~n~~p hp~tpr ~nrl vent Storm Sewer Of amps. Appliance vent seoarat.f' Stationary evap. cooler Vent fan wi th sinc-1e duct Vent system apart from hea t i no or A. C. Mechanical exhaust hnnd and duct Wood stove/heater Sewer Temporary Construction IChange in existing rps i r1encp Imultifamily. comm. or Tndll':;t.l";al Additional bath ~Iater service COMI." IIND. FEEDERS Install/alter/relocate d;drih. fppdpr<; Of amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the :. I ISSUANCr OF PFRIIIT TOTAL CHARGES d.-t:J . 'f.. C )TOTAL CHARGES that the Electrical work be done by an. Electrical Contractor. the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXMlINED the completed apl1 1 i ca t; on for permit. and do hereby certify tha tall i nformat i on 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 Spl"ingfield and the laws of the State of Oregon pertaining to the work described herein. and that fW OCCUPAHCY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and emnloyees who are in compliance with ORS 7Dl.055 will be used on this project. IWIE(please prin~ ~ ~ Units Occy load Occy Group SIGNATURE (! ~ ~. Fn~ OFFICE USE nllLY 7 . . Sq. Ftg. Hain Sq. Ft!J. Access Sq. Ftg. Other !?...e ~ ,oS DATE /-/'--1'0 Zone Fire Zone Flood Plain . Type/Const. Bedrooms Stories x x x Value Value Value TOTAL V ALUA Tl ON BUILDING PERMIT Plan Ck. ConrnlI nd Charges and ------------ 65%/Bl do PJ'r Fpp Surcharges Plan Ck. Res 30%/Bl do Per Fee PLU!1BING PERMIT Fence Charges and ------------ Surcharges D~mo ELECTRICAL PERI\lT _&cL~~) 'Sidewalk Charges and Surcharges ..1,1;'~ AlC Pavi ng /IECHAN I CAL PERMIT Curb Cut Charges and ------------ Surcharges syste.ms Development Charoe t1.5~)' " , ITotal Comb. Permit I TOTAL c!)3,lo3 . . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Appl icant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. Lane County Map Reference 1/ oj 43 2. example- 'Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name," etc. of owner and construction lender D. Energy Sources . 1. exa~le- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exa~le- if new project. check new - if addition, ehee k add. etc. F. Building permit information: 1. example - construct single family house with an attached garoge 2. example - remodel existing garage into family room 3. examyle - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 3D3 (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, Mechan;cal, and Electr;cal 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 b~ 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. /~/b -90 D-L:O /(jA ~ #/67flo V. FOR OFFICE USE ONLY Permit Clerk rlt~ ,/ , , . 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 . .