HomeMy WebLinkAboutPermit Electrical 1987-6-10 (2)
I HISPECTION LINE
726-3769
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INFORIIATIO,~ L"t
726-37S3
Sq. Ftg. I.lain
~q. F'tg. Access.
Sq. Ftg. Other
~ew Add Alter ~ep.
-Fence Demo Change/Use
Other - -
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Job Address
1~70
<""'~.J7#
A/<r
CITY UF SPRINGFIElO
CO/IBlIlATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Ranlle
~
legal Description
owner7:".rf ,/.4?77~ E"hWA"-R7.:> 5
Address 76 /"" 7.c> 5~ A r <::;r. ~_nJR//
<F1?/h'c,r/€U;;> 4-?
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ValUE of Hark:
""::?~.--
BuilciinQ Permit Info:
Famil y l1es; dence Hith
Describe \~ork( i.e.. Build Single
Attached Garaqe)
Address
()t~HiN TtAr.,
lname)
Phone
(address)
~T.4L.<' jlk V/.h'69~7)/kC c/'7'7""
h / :P.z>?l t> A- C,,<;/ r?:l-cr"7;> . /'%;:>A'"//V
-ST~e-e? - /,.?"'OrY3/'7?>:::< 7'W
(lics.r1'o.) {exnires} (ohoneno.l
Construction lender
Primary
Structural
Electrical
~
!1echani ca 1
CONTRACTORS Inamel
General E~4i-eNE :s:4-.....n ~~/.?""J,oF"C.
(address)
(1 ;r:5. no.)
(pxoires)
(nhone nn_l
Plumbino
Electrical
~lechanical
PlUf.1BING
ELECTRICAL
MECHANICAl
Each single fixture
FEE CHARGE Nn I
I Residence of
SO. FT.
I New circuits alts.
or extensions
ISERVICES
I
~~~ rHAR~~ NO. i=i=i= rHAQ~~
furnace/burner to
BTU's
flO.
Relocated building
(new fix. additional)
S.F. Residence
f1 bath)
Duplex (1 bath) each
Floor furnace
and vent
Recessed wall
~o~rp hp~tp~ ~nrl ~P"t
~Iater servi ce
Iremporary Construction
IChange in existing
re) j d_ence
Imultifamily, comm. or
Tnrl!Jc;tr;t1l
IOf amps.1
ICOMM./INO. FEEOERS
IInstall/alter/relocate
rl;c;trih. fpprlprc;
Of amp~1
App 1; ance vent
c;eD~rate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnrl and dur:t
Additional bath
Sewer
Storm Sewer
Wood stove/heater
ISSUANCF OF PFRtllT
TOTAL CHARGES
-WHERE STATE l~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
TOTAl CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical rortion of this perr.lit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CARE FULL Y EXMllNED the comp 1 eted appl i cati on for permit, and do hereby certify tha t a 11 in format i on 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 Spr; ngfi e 1 d and the laws of the Sta te of Orel]on perta i ni ng to the work descri bed herei n, and tha t UC 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
IlAI.IE(please print)
Zone--.b./..
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
SIGNATURE
FO~ OFFICE USE OIILV
Sq. Ftg.
Sq. Ft9.
Sq. Ftg.
D~.TE
t1ain
x
Value
Value
Value ::?~""_-
TOTAL VALUATION
Access x
Other m}.'l~. x
, -,
BUILDING PERMIT
Charges and
Surcharges
, Plan Ck.
65%/Rldo
------------ Plan Ck.
30%/Bldo
I Fence
I Dlimo
I Sidewalk
A/C Pavi.%":l~
COrml/l nd
Per ~pe
R-es
Per Fee
AI.I1-.
'Systems Development '
Charoe (1.5%)
PLUMBING PERMIT
Cha l\ges and
Surcharges
ELECTRICAl PERI~IT
Charges and
Surcharges
-q"2 -Sc:>
Irotal Comb. Permit
MECHANICAl PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAl
#37- 5c:>
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I
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.ITY OF SPRINGFIELD
. City Han
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~
Springfield, Oregon
Department of Public Work.
OFFICIAL RECEIPT
No. B
Date rJone- /c;, 19..f'?.r
. . /
Rec'd From C # C:=?~c~C5 ., ~Ce::>
h'>; -W~/-'7':;P-- .
Address ~~~~~cb.~'?f" ,
68411
COMBINATION APPLICATION/PERMIT (CAP)
II.
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot lOa. lane County Map Reference
17 03 43
2. example- lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. 'Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qa~
2. examyle- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. example- 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 gar~ge
2. examPle - remodel existing garage into family rOOI
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.
Abbreviated P1umbing, 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 adjacen
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 schedule
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 ANO
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
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.
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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Received FO~ h~&"?c> 7~.,(" /,,~';::-" ;" _
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Amount Receiv.2 Jl-;;;: -5" c::>
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~ AUTHORlZEO S1GNA~AE'" ,- I
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r. . _ lIUs.\M.SS fORMS.lkC. 150113ol.2.$14'
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be de 1 i vered to the-
by his electrical
is ,not authorized
III.
IV.
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./ ~;,e,/t?i RFif.s:;::?
v -
Signature~~~ ~~
'F . ./
date 6-/t:P...&7
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