HomeMy WebLinkAboutPermit Electrical 1989-11-21 (2)
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1 INSPECTION LIIIE
726-3769
TY SPR NG IELO
CDlIBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
I Range.
I valUr\f!trJ
J BUiloinqlpermH Info: Oeser,be Work(Le.. Build
IIFoi~s~:1ce N;J;tac~~;(,~~A;t~
INFORf1ATlON LI"t
726-3753
Sq. Ftq. 1.1a i n
~q. Ftg. Access.
Sq. Ftq. Other
flew Add Alter Pep.
--Fence Demo Change/Use
Other- -
I
JJ
...D
Job Address
q q ::s '- ~(') J.I.
Legal Description
Owner~ \ \ (\ f)~Q u ~ ~'\.O(\(\ W
Address q l\ ~ ~w xt-'. () Phone
con~~dh\- . 'l::llo- \c\ 'I \
Single
(JJ
I
I
Address
DESIGN lEAf,'
(name)
Phone
(address'
(1 ics. no.)
(exnires)
,
(phone no .-\
Primary
Structural
Electrical
Meehan; Cd 1
CONTRACTORS
(name 1
(address.'
(1 it":s_ no. 1
(pxoirpc;.\
(ohnn". nn \
hf'nera 1
PlumbiM
PLUIIBIIIG
,\..)1 <<0\7'\ ,\,\\()<AlU
~
ELECTRICAL
MECHANICAL
Electrical\.
Ul~
~1echan;cal
...@.
rFF rllf\RGF Nn
err r~~ Nn
H r r:1ARG.L
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
S.F. Residence
(1 bath)
Duplex (1 bath) 'each
Additional bath
SERVICES
~.~
I
Floor furnace
and vent
Relocated building
(new fix. additional)
~ New circuits alts.
C'J' or extensions
Recessed wall
Sn~rp hp~tpr ~n~ vpnt
Storm Sewer
Of
amps.
Appliance vent
SflOi\fi\te
Stationary evap.
cooler
Vent fan with
sin91e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hooc1 ilnd duct
Sewer
Temporary Construction
Change in existing
r!:!,c;J df!nc~
multifamily, camm. or
Inr1~J<;trial
~Ia ter servi ce
COMM./IND. FEEDERS
Install/alter/relocate
rl;strib. fppd~rs
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be valiJ until the
\ TOTAL CHARGES
that tile Electrical \...ork be done by an.
label has been signed by an Electrical
ISSUANCE OF PFR!1IT
oJQ . '50 -' TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXA~lIN[D 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 \'lark performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore<]on !1ertaining to the work described herein. and that NO OCCUPAIKY will be made
of any structure without the permission of the ~uilding Division. I further certify that my registration with the Builder's
~oard is in full force and effect as re~uired by ons 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and emr>loyees ",ho are in compliance with OP.S 7t11.055 will be used on this project.
SIGII^TURE~J <l ~v-
FO~ OffICE USE miL Y
Sq. Ftg. f1ain x
Sq. Ftq. Access x
Sq. Ftg. Other x
IW1E(please print) -r;..".o Ld
A1 cSe J2..
-- DATE I (-<!.I-.6' '1
Zone
Fi re Zone
Type/Const.
Bedrooms
Stories
Units
Occy load
9ccy Group
Value
Value
Value
Flood Plain
TOTAL VALUATION
PLUt1BING PERMIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65'.t1Rldo Ppr Fpp
--------I---"""'Plan Ck. Res
30%/BldQ Per Fee
Fence
[syste. rns Development '
Charqe tl.5~) "
BUILDING PERflIT
Charges and
Surcharges
Demo
ELECTR I CAL PERr~1T
Cha rges and
Surcharges
_QJ~-c~__
I. J ,-,'
Sidewalk
A/C Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
I c93. Lo3
.
Curb Cut
.
,
i....
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
11 oj 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. :exam~le- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrical/or solar
E. Squ~re footage or valuation, etc. -
1. 'examole- 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. example - 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
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.
J/ - c2J- 69
-it 1~40\
V. FOR OFFICE USE ONLY
Permit Clerk
~
Hw
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
signature
date
.