HomeMy WebLinkAboutPermit Electrical 1987-6-10
~ I INSPECTION LINE
, 726-3769
.
CITY Uf SPRINGFIELD
COtIBIIIATION APPLICATION/PERMIT
.
INFORtlATION LINt
726-3753
Sq. Ftq. 1.lain
:q. !=tg. Access.
SQ. Ftq. Other
flew . Add A fter ~).ep.
--Fence Demo Change/Use
Other- -
Go
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Job Address
1<)' 70
c::"" c.J 7 #-
A/ <r
EilERGY SOURCES:
Heat
!'later Heater
Ranqe__~_
ValuE. of Hark:
"":::?.-'" .-......... ---
Legal Description
Address
~r f clA/?7L?S HWA'-.Rb S
?b-/<;, 7.c::> 5~ A' ~. ~_n'R~/
<;;z:}?//TC;r/€cc> ~.
/
Owner
Address
UESIGN TEAr.,
(name)
Phone
(address)
BulldinQ Permit Info: Describe Hork(Le.. Build Single
Family nes;dence 1.lith .d.ttached GaraQe)
h~TAL< ;t V//YCio .4J'}/.#-Cr~
~.j'7/}l:>~<>A-[R' r.7tcr'?7/%?A"//Y
~rfi;FE7- /Pb'Y3/'7e> A YW
(lies. ~o.) (eXnires:{) (Ph;' no.,
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Construction lender
Primary
Structural
El ectr; Cd 1
11echan; ca 1
CONTRACTORS Inamel
General E~<i-eNE :s4-"",,?:> --:I,e;:;/-i'A?I/E"C".
{address'
(l ic~. no.
(exo;res)
(ohonf> no.)
Plumbina
Electrical
/>.lechani ca 1
PLUJIBI NG
ELECTRICAL
MECHANICAL
NO.
FFF CHARGE NO
~~~ r~AQr.~ ~O
C"~~ r\.iAQr.~
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
SOArp hp~tp~ ~nrl vp~t
Storm Sewer
Of
amps.
App 1 i ance vent
c;eo?lrate
Stationary evap.
cooler
Vent fan wi th
c;inole duct
Vent system apart from
heatino o~ A.C.
Mechanical exhaust
hood ilnd duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res.i rle.nee
multifamily, comm. or
Tnrlllst~ial
~!ater service
Cor~f'I./lND. FEEDERS
Install/alter/relocate
rli,t~;h. fppoer,
Of
amps.
ISSUANCF OF PFR!HT
TOTAL CHARGES . TDTAL CHARGES TOTAL CHARGES
WHERE STATE L"l~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAtUNED the completed aprlication 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 Laws of the State of Oregon pertaining to the work described herein. and that 1W OCCUPArlCY 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.
HAr.1E{please print)
SIGt~ATURE
FOr. OFFICE USE OflL Y
DATE
Zone L L.
Fi re Zone
Flood Plain
Type/ Cons t.
Bedrooms
Stories
Units
Occy Load
Occy Group
So.
Ftg.
Ft<J.
Ftg.
r1ain x
Access x
Other 4if)lj-~. x
,-
Value
Value
Value
TOTAL VALUATION
2~"".-
Sq.
Sq.
PLU'1BING PERMIT
Char..ges and
Surcharges
, Plan Ck. CorrmlInd
65%/8100 PP~ Fee
------------ Plan Ck. Res
30%/Bl do Per Fee
Fence
~/I-.
Systems Development I
Charoe (1.5%)
BUILDING PERMIT
Charges anG
Surcharges
ELECTRICA.L PER!~IT
Charges and
Surcharges
Demo
___________J Sidewalk
A/C Pavi~<l~
-:g~ -So?>
Total Comb. rermit
I TOTAL
]#'37,5":>
J
!1ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
.
~ \
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100. Lane County Map Reference
11 U3 43
2. example- Lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources . .
1. example- heat/electrical ceilinq!or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (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, 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 OIVISION 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. ---
111. 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. All other fees and charges are due and
payable when the permit is issued.
,
-
i
V. FOR OFFICE USE ONLY
Permit Clerk
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 I ~~ ?c~~
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signature4~?....L_~. ?
',p' - ;'
date G-/~..g7
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