HomeMy WebLinkAboutPermit Electrical 1990-2-20
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Job Address
EilERGY SOURCES:
Heat -.
-tL.. D:JIJ~I' Hater Heater
Ranl'Je
INFORHATlON lIN'
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
QtilE<7/onl Other- -
l3uil(linq" Permit Info: Describe Work(i..e.. Build Single
Fa.ll1ilv nesidence Hith JI..ttached Garaqe)
fLljVLDdU.- 01
$i-/-6.tJnD ,~
.
1 INSPECTION LINE
726-3769
.
-ZSO .N. AS,.
Legal Description /7 - fJ6~:;;3 t;; :3 'J.
CITY OF SPRINGFIE~D
CDrlBlljATlON APPLICATION/PERMIT
Construction lender
fut!, OJ;(; (P
Address
S"R2-<.""\ &F IU]~
2S\) N, A
Chit ,--r'Y ~,,^10a
!'!J('
Phone
Owner
Address
DESIGN IlAI-\
{name}
Phone
(address)
(1 ics. no.)
(exnires)
~!
00;"
~'.
(phone n'o. t
Primary
Sc", ,
Nh.
~ -r GAuAs
NI.!t
I (name)
J.A4,,<<-vJ '2-1E.. O;yv..,MfJZJ:A..M.--
Q.-~
A:5<; 0 0A-rY'-5
IN(...,
UJi:> S. ~(C-L..
72(. -07~
Structura 1
Electrical
Zau ::>,;-'\( l.oL-
$YeMA>
7 2-(, -07f'~
Mechanical
CONTRACTORS
(address'
(l ire:::. no.)
(pxni ff>S)
(ohone nn. )
J<f'1,7/<13
,
Genera 1
8c.s- W. 2ND
E:oCrfAJL OR--.
Plumbincr
Electrical ~~,.j ~CT/A.c.... 2::,135" ~.sofA.JU,T '1r'-I' f":JJ~97'-frrr... 2o'S:~G IP-(-C,x)
~lechanical
PLUI1BING
ELECTRICA~
MECHANICA~
NO.
FEF CHARGE Nn
~FF rHARr.FI Nn_
FFF rHARr.F
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
----I New circu~ts alts.
or extenslons
~ &>A f776/'3"&'-
ISERVICES
I
.ITempOrary Construction
Change in existing
rp~ i np,nrp
multifamily, comm. or
lnrluc;t.rial
<<'~
Floor furnace
and vent
S. F. Res i dence
(j bath)
IDuplex (1 bath) each
IAdditional bath
I~Jater service
I Sewer
Istorm Sewer
Recessed wall
Sb~CP hp~tpr ~nrl vpnt
Of
amps.
Appl iance vent
seoil ra tp
Stationary evap.
r:nnler
I Vent fan with
sinale duct
I Vent system apart from I
heatinq or A.C.
I Mechanical exhaust I
hood and duct ~
I ~Jood stove/heater I
I I
I I
I I
Of
amps.1
COI-\I-\./IND. FEEDERS
Install/alter/relocate
rlic;trih_ feedprc;
TOTA~ CHARGES TOTAL CHARGES
WHERE STATE L.\\~ REQUIRES that tlie Electrical work be done by an
shall not be valii until the label has been signed by an Electrical
ISSUANCF OF PFR!llT
.:;;r.;.>-SC> TOTA~ CHARGES
Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division
r HAVE~CAREFULLY EXN1INEO the completed apnlication_for ~ermit. a~d do he~eby cert.ifY_ tha~Jl in(o_rmat;~n_h~r~on is ~rue
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of th~ City
of Springfield and the Laws of the State of Oreryon pertaining to the work described herein, and that rlO OCCUPAHCY \'ii11 be made
of any structure without the permission of the Ouilding 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 ex p the basis for exemption is noted hereon, and tha~
~~YV\~K(\C?{m~~nl~nce w OP.S 701.05 ,.'-,-' ~e ~on~i;;io;;ct.
HAI.IE(please print) LA.rJMY ~(r Vr... ~'~...-vI_/ DATE Z -20- 10
CJ ~
sC']. ftg. f1ain x Value
Sq. FtQ. Access x Value
Sq. Ftg. 'lfher.4'..7.C",,/.....A ~lue 'YS;-~
-rV';W ~~li1 TOTA~ VA~UATlOrl
/7 ,. I.q ~a) I Systems Development I ,E /..L1
( U'. ~-..1 Charqe (1.5%) /Y,,/
'-. ------
Zone
cc
Tyoe/~st. ~-/~~ Units
Bedrooms Occy Load
Stories -;/ Occy Group _"'B-:::::<
Fi re Zone
Flood Plain
BUI~DIHG PER~IIT
Charges an~
Surcharges
, ~lanCk.
___~~~.q_ 65%/Bldo
Plan Ck.
/3.':::>3 30%/BldQ
I Fence
I Demo
____~.:_s.::~J Sidewalk
CommlInd
Ppr Fpp
Res
Per Fee
PLUI1BING PERMIT
Charges and
Surcha rges
E~[CTRICP.~ PERI~IT
Charges and
Surcharges
/ -/3
AIC Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTA~
';? <9 7/t;;
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
8. legal Description
1. example- Tax Lot 100, lane County Map Reference
II oj 43
2. example- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1.' example- heat/electrical ceilinqfor forced air qas
2: examole- waterheater/electrlcal!or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. fOQt 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. example - 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
.0. 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. 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
: -,'. ....., " t
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it ( 0'L2f3
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Permit
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
.
name~-1?"fuE' ;z::z.c~ ~)"")
signature
./7 /',~
/~__~/~date
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