HomeMy WebLinkAboutPermit Electrical 1983-10-10
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CITY UF SPRIr<GFIELO
COIIBIilATION APPLICATION/PERMIT
SOUR~
ter
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INFORIIATlON u,,,
726-3753
Sq. Ftg. I-tain
~q. Ftg. Access. ",
Sq, Ftg, Other~
r~e\'" Add ter Rep.
nqe -Fen, erno Change/Use
Valu' of~l A ~ 0 r- -
BUilc;ina Permi{t Info: Describe Work(Le., Build Single
Family P-esidence With Attached Garaae)
.
I IrlSPEC110l1 LIIIE
726-3769
Job Address \ \ \1 (1r'\. tfu, c;A. ~,
Legal Description \, b ~?'S4 \l)<:;<ffi
"
~
~
Owner'\ ) \ (\ DUl.u \. \_~ r\ l N
Address \\ \"l a()(~ ~-=A \ Phone!\
con~~\~e~' I 0e-> ~
-
rJ
~ Q Q 01- i\
A. l1'iYL. (\lvt V 1 A)
(Dho~e no.)
{exoires}
4
Address
UtSHjN 11:.Af-1
lnameJ
Phone
(address)
(l1C5. no.l
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address 1
(1 ics. no.)
(exo;res)
(ohonp no.)
Genera 1
Pl umbi no
Electr;ca~~ ~~~ ~-I
f.lechanical
PLUIIBING
ELECTRICAL
r""o",' NO
MECHANICAL
SQ, FL
furnace/burner to
BTU's
n'~ I r~o.Rr,J:'
NO,
Each single fixture
FEE I r.H^RGE Nn
I
'"
Residence of
Relocated building I
(new fix. additional)
S.F. Residence
(1 bath 1
10uplex (1 bath) each
IAdditional bath
[~Iater service
jSewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
SOnce hPnter and vent
TOTAL CHARGES
I
I
I
I
I
I I
/.:;5.00
I Appl iance vent
sPD!lrate
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent sys tern apa rt from I
heatina or A.L
IMeChanical exhaust
hoorl and duct
Wood stove/heater
Temporary Construction
Change in existing
rpc; i d~nce
Imultifamily, camm. or
Inrlll"t.ri;1l
Storm Sewer
10f
ICOMH,/INO, FEEDERS
IInstall/alter/relocate I
dic;trih_ fppners
Of amps. I
amps.1
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
ISSUANCE OF PFR/1IT
TOTAL CHARGES
that tile Electrical work be done by an,"Electrical Contractor, the electrical portion of this pernit
label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFUllY EXM1WEO the completed apfllication 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 la\'/s of the State of Oregon pertaining to the work described herein. and that UO OCCUPAIKY 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 employees who are in compliance with ORS 701.055 will be used on this project.
IWIE(please print) (}J7/1A.<.:' "'/n~ SIGtlATURE ::reRtf'I/ mtJSE,k'
/ ( FOr. OFFICE USE o;~L y
Type/Const. Units Sq. Ftg. ria;n
Bedrooms Occy load Sq. Ftg. Access
Stories Occy Group Sq. Ftg. Other
OATE /':;-/0--83
Zone
Fire Zone
x
Value
x
Value
Flood Plain
x
Value
TOTAL VALUATION
BUILDIIlG PERIHT
Charges an~
Surcharges
Plan Ck, Comm/Ind
65%/Bl do Ppr Fpp
------------l5"f'an Ck. Res
30%lBldQ Per Fee
Fence
Systems Development
Charqe (1,5~) .
PLU'1BING PERMIT
Cha rges and
Surcha rges
O~mo
"- )LbJ;:)<t~
. to))
ELECTRIUL PERI~IT
Charges and
Surcharges
J5~C?~
.ld')
Sidewalk
A/C Paving
Total Comb. rermit
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAL
1~6C)
-, ,
.
.
COMB!NATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description ~
1. example- Tax Lot 100. Lane County Map Reference
II oj 43
2, exam~le- Lot 1, Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinqlor forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. ------
1. examDle- 1250 sq. foat house, 500 sq. foot garage
2. example- if new project, check:new - if addition,
check add. etc.
F. .Building permit information:
1. examole - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examPle - convert single famlly residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H, DESIGN TEM1 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 Plymbing, 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
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 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. ~ll other fees and charges are due and .
payable when the permit is issued.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
, ,
.
PERMIT VALIDATION
.,
Permi t
Cl;Jxi1
)
.
Permit applicant exempt from registration with the Builder's Board because:
.
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
I