HomeMy WebLinkAboutPermit Electrical 1983-3-21
1 INSPECTION LINE,
726-3769
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INfORllATION liNt
726-3753
Sq. Ftq. f.lain
~q. Ftg. Access.
Sq, ft9, Other
New Add Alter Pep,
Range .. \~ Ofetnhecer_oemO_Change/Use
Value of Hark: N
Bullciina Permit Info; Oescnbe \1ork(1.e.. Build Single
Family ~esidence With Attached Garaae)
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Job Address ~5.s S, 'r!' Sf , I
Legal Oescription Vf7C J~'~f?=\l~~()F}2fX)1
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Owner /... ~S;
Address ::;L ')" S '
:3 F' .{' / C),
Construction lender
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W
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'o<l
Address
UI:.~lurl 11:.Ar~
(name)
\~. \()[~ ( )
Phone
(addressl (lies. no.) (exoires) (ohone no. J
Primary
Structural
PYe.~neq E: / e do r 9/ n /() ~c1c:r rnt1A'> t;(;J. -~-I I<<:!...
9-30-'l.? 7<fl-d't7:
nectrical
Meehan; ca 1
CONTRACTORS
(name)
(address I
(l iC'.". no.
(exo; rps)
(phone no.)
Genera 1
Plumbina
Electrical
~1echan; ca 1
PLUIIBI NG
ELECTRICAL
MECHANICAL
SQ, fT.
furnace/burner to
BTU's
fff CHARO, I
NO,
I ,ff CHARGE NO
~~~ rHAR~F NO.
Each single fixture
Residence of
I Relocated building
(new fix. additional)
lS.F. Residence
(1 bath)
IDuplex (1 bath) each
IAdditional bath
~Iater service
New circuits a1ts.
or extensions
I~,OO 1';,00
I
C{rrj 0 I
Floor furnace
and vent
ISERVICES
I
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
100
I.Go
I
I
I
I
I
I
amps, ~,O() I
tj10 I I
I I
I I
~ \ -~ ()
amps.
Appliance vent
seDaratE'
Stationary evap.
coo1er
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood ilnd durt
Sewer
ITempOrary Construction
Change in existing
rf':'j..l<!ence
multifamily, COIJ1J1. or
Industriill
Storm Sewer
Of
COMM,/IND, fEEDERS
Install/alter/relocate
dic;trib. fepders
IOf
I
I
I
Wood stove/heater
1<;'.(}lJ
, (,,()
ISSUANCE OF PfR'IIT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
TOTAL CHARGES
TOTAL CHARGES
that tile 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
I HAVE CAREFULLY EXN1INED the completed application 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 NO OCCUPAtKY 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~~11 be used on th~prOject.
IWIE(please print) /:::bPAL b I~ bicat=./JEL srr,a^TlR~J.-d I? ~ DATE..2/2/)83,
fOn OFfICE USE 'OaLY
Zone
Fire Zone
Flood Plain
Tyee/Canst,
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. t1ain
Sq. Ft9. Access
Sq, Ftg, Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILOING PER/lIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65X/Slda Ppr Fpe
------------ Plan Ck, Res
30%/Bldo Per Fee
Fence
Systems Development
Charqe (1.5%)
PLUI1BING PERMIT
Charges and
SurCharges
Demo
ELECTRICAL PERI~IT
Charges and
Surcharges
.2&C)O
- l. ~U
'Sidewalk
I A/C Paving
Curb Cut
Total Comb. Permit
11ECHANICAL PERMIT
Charges and
Surcharges
I TOTAL
~\,'2-0
"
rt
j
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax lot 100. Lane County Map Reference
Ii 03 43
2. example- Lot 1. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exam~le- 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 ANO 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, BUILOING 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. 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:
Permi t
.
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PERMIT VALIDATION /
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
1-
date
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255 SOUTH "A" STREET
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