HomeMy WebLinkAboutPermit Electrical 1984-1-9
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II IrISPECTIOll L1IIE CITY OF SPRINGFIELD
'1726-3769 COMBIrIATIDN APPLICATION/PERMIT
Job Addresd t'Jfj a:vJh ( cA m.PtJ b ~~y SOURCES:
Legal DescriptiQn/fJA:q3 n~~.Ol9(y) . Hater ~r
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(name)
Phone
(address)
INFORlIATlON LINt
726-3753
Sq. Ftg. 1.lain
Ftg. Access.
Other
rlew A Alter Rep.
--Fence Demo Change/Use
ValuE of I-l~/k: ~ fJ.---- Other-
BU11c.lna p'etn M~: Descnbe Work{1,e., Build Single
Familv nesiden With Attached Garaoe\
, d p f'hu "Pl 0 \ fJo fI YVI dJ -kW
. .A:frJYnj) 1 . u.XV....u/l tf)',/ /)2/
!
~. ~.. Phone
f/L!0-7()lq,.-,
Address
DESIGll TEAI.I
(1 ics. no.)
(exoires)
,
(ohone no.l
Primary
Structural
Electrical
Mechanical
CONTRACTURS
(name)
(addr~5:sl
(l ics. no. \
(pxoires)
(ohone no. ,
General
Plumhino
I Electrical l
~lechanical
.lQJ..~O~
(~tn~~ ~ l\_\~~
PLUIlBlNG
ELECTRICAL
MECHANICAL
NO.
FEE" fHARr.f Nn
~FF r~~~r,F NO
FFF fl-M.Rr.j:
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
$.F. Residence
[] bath 1
Duplex (1 bath) each
Additional bath
New circuits a1ts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~cp hp~tp~ ~nrl vpnt
Sewer
ITempOrary Construction
I'Change in existing
res.; d_e_ncl?
Imultifamily, COIml. or
TndlJc:tri~l
Storm Sewer
Of
COffi1./IND. FEEDERS
Install/alter/relocate
distr;h. fppdl?rs
amps.
Appliance vent
seoarittp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
hell. t i no or A. C.
Mechanical exhaust
hood and duct
~Jater service
Wood stove/heater
Of
amps.
ISSUANCE OF PFR!llT
TOTAL CHARGES
WHEfiE STATE L~I-l REQU1RES
shall not be va1iJ until the
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an. 'Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
1 HAVE CAREFUllY EXN11NEO 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 performed 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 rw OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builderts
Board is in full force and effect as required by ons 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.
IIAI-IE(please print) ~\(::'.ve~ RIA 12.
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DATE
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Zone
Fire ZonE'
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Dccy Load
Dcc'y Group
SIGllATURE
Fon OFFICE USE DIlLY
Sq. Ftg. t1ain
Sq. Ftn. Access
Sq. Ftg. Other
x
x
x
Value
Value
Value
TOTAL VALUATION
BUILDING PERI.IIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65%/Blda Ppr Fpe
-- -- - -- -- - - - Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charge O.5~)
PLU'~BING PERMIT
Charges and
Surcha rges
D~mo
d 5 cJOSidewalk
- -, ~C5i:5--- A/C Paving
Curb Cut
1LUJtL
-dLO
ELECTRICAL PERI~IT
Charges and
Surcharges
Total Comb. Permit
'lECHAN I CAL PERMIT
Charges and
Surcharges
TOTAL
&19.00
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax Lot 100. Lane County Map Reference
17 03 43
2. examole- lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examRle- if new project. check-new - if addition,
check add. etc.
F. Building pennit information:
1. example ~ construct single family house with an
attached garage
2. examole - 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 DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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
signa ture.
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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Pennit
Cle&tfY)J
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Permit applicant exempt from registration with the Builder's Board because':
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date
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