HomeMy WebLinkAboutPermit Electrical 1990-1-16
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Job Address
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
Range
Valu€ of Hark:
.
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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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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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
.
.