HomeMy WebLinkAboutPermit Electrical 1989-11-21
Cf q 5 '- ~,)() If
, CITY Uf SPRINGFIE~P
COtIBINATION APPLlCATIONfPERMlT
EIIERGY SOURCES:
Heat
Hater Heater
Range
,
INFURl1ATION L1t1,
726-3753
Sq, Ftg. Haln
~q. Ftg. Access..
Sq, Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
'J INSPECTION LItlE
726-3769 .
Job Address
""I
I
legal De5cription
Owner~ \ \ (\(')\0. l) ~ ()\\'\f)rt f\ LY
^d::sq~S ~&A ~~:l1O~\2; \
cons~~~endh - -
valU'f\f IrtJ
BuihiinqlPermit Info:. Describe Workli~e.. Build Single
family Residence IHth Attached Garane)
l 0 Ivb. nli cQi- (1//1 (lj LI i:~
Address
OESIGN TEAl1
(name)
Phone
(address 1
flies. no.)
(exl)ire~l
fohone no.
Primary
Structural
Electrical
Mechanical
r.DNTRACTORS
(name I
(address \
nice:. no. I
(pxn; rpo;,l
(nhonp n".J
Genera 1
Plumbino
PLUlm ltlG
-~ )/ v'(()\r-.\ T{\cJ<Xt\0>
~.
ELECTRICAL
I
MECHANICAL
Electrical\.
Ul~
~1echanical
Each single fixture
I FH I rIlM~r.r ....rw I I ~H I rHMU::~ NO.
Residence of furnace/burner to
SQ, FT. . BTU's
~H rH!RGE..
Nil
Relocated building
(new fix. additional)
~ New circuits alts.
tV' or extensions
Q9,~.
Floor furnace
and vent
S.F. Residence
(1 bathl
Duplex (1 bath) 'each
Additional bath
SERVICES
Recessed wall
~n~cp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps,
Appliance vent
SPDarat@
Stationary evap.
cooler
Vent fan with
~in(lle duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnod i'nd du~t
Sewer
Temporary Construction
Change in existing
rpsirJe!ll::.r
multifamily. COrml. or
Jnrlu<;.trial
"later service
CU~1.fIND, FEEDERS
Install/alter/relocate
di<;.trih. feprlpr<;.
IOf
~Iood stove/heater.
amps.
TOTAL CHARGES
~jEnE STATE L~W REQUIRES
shall not be vali~ until the
ISSUANCE OF PFRrllT
TOT^1. CIl^RGES aJQ .5() TOTAL CHARGES
that the Electrical work be done by an, Electrical Contractor. the electrical portion of this
label has been si9ned by an Electrical Supervisor and returned to the Building Division
permit
I IlAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all infonnation hereon is true
and correct. and I further certify that any and all \'4ork performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of OrelJon flertaining to the work described herein. and that UO OCCUPAI~CY will be made
of any structure without the permission of the 13uilding Division. I further certify that my registration \-lith the Builder's
Board is in full force and effect as re~uired by OP-S 701.055. that if exempt the basis for exemption. is noted hereon. and that
only subcontractors and employees \'4ho are in compliance with OP.S 7111.055 will be used on this project.
IlAI-lE(please print) -,-; ....oLd /JIl"'SE/z' SIf,rlATURE~ c;l..>>-?~
FUP. OEFICE USE ;rLV 1
.-:t"
Sq. Ftg. f1ain ,x Value..?
Sq. Ft9. Access x Value
Sq, Ftg, Other x Value. ".
TOTAL VALUATION
Zone
Fire Zone
Flond Plain
Type/Canst.
Bedrooms
Stories
Units
Oi::cy Load
Occy Group
DATE 1(-.1.1-.9 '1
t
P~U!~BING PERMIT
Charges and
Surcharges
Plan Ck, Comm/lnd
65X/nldo Ppr Fpp
--------7""--- Plan Ck. Res
30X/BldQ Per Fee
Fence
Systems, Development
Charge tl.5~) ".
BUILOING PWIlT
Charges and
Surcharges
"
T
D~mo
",'1
;1
EL ECTR I CAL PERf\lT
Cha rges and
Surcharges
""':JY\ 'SO
-~Q----:::Y-7
(. 1 ,,~)'
Sidewalk
~, ,
A/C Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTA~
&3. w3
Curb Cut
"". ):.
;
I
I
!
"
I
J
.
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
~d
I (- J..B/i /f.3 0
J! -;2)- 69
-tt I ~40\
I. Applicant to furnish
A. Job Address
B. legal Description
1. examp1e~ Tax lot laO, l~ne County Map Hcfcrence
, II oj 43
2, exam~le- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1.' ,'examp1e- heat/electrical ceiling/or forced air Qas
2. . example~ waterneater/elcctrlcalJor solar
E. ,Squ~re 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 garage
2. examo1e - 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, OESIGN 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 Plumbing, Mechanical, & Electrica,l Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fi11.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 fonm 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 schedul es
C, BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
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.
II.
be delivered to the
by his electrical
is.not authorized
Ill.
IV.
r )',
Permit Clerk ~) ~
y. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,,'
I,'. t'
'..'
l'
."
Permit applicant exempt from registration with the Builder's Board because:
,,'1' .
Additional Project Information:
I
PLANS REVIEWED BY:
name
signature
date
.