HomeMy WebLinkAboutPermit Electrical 1983-7-25
I INSPECTION LItlE
1726-3769
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Job Address J,VO? ~/lurn, 'A' .....l~<11-'
Legal Description 17-t:)3-U-<,/Z . <'~?&'O
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CllY Uf SPRINGFIELD
CotIBBIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
INFOR/1ATION llNt
726-3753
Sq. Ftg. i.lain S2.';:-.p
:q. Ftg. Access.
Sq. Ftg. Other
--1lewl(Add__Alter-c~ep.
Fence Demo Change/Use
Other -- --
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10-
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rf)
00
Owner
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Val..YJ of Hark:
"P> ) K, !J-O {)
. . Build;nq Permit Info: Describe Work(i-.e., Build Single
Phone)'!/. //Jf ?Familv Residence liith Attached Garaae'
ad~ - ":t:; /1 0 /) -f;. Wi.tU-'f
Address
1::1..1 j~ ~
, ConstrucLibn Lender
( .-VVL~
Address
DESIGN TEAll
(name)
Phone
(address)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
.!addrf'lss)
Art 2 rO
Genera 1
~o1- ~
Plumbino
Electrical
"lechanical
PLUilB BIG
ELECTRICAL
NO. '
, FEE 'CHARGE
Nn
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
y
New circuits alts.
or extensions
"'2 <:JR^"C!l~~
SERVICES
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rp,? j qpnr.p
multifamily. comm. or
TncllJc;trii'll
~Iater servi ce
Sewer
Storm Sewer
Of
amps.
COMi'l. /IND. FEEDERS
Install/alter/relocate
r1;c;tr;h, fpprlprc;
Of
amps.
TOTAL CHARGES
WHERE STATE L~li REQUIRES
shall not be valiJ until the
TOTAL CHARGES
that tile Electrical work be done by an. 'Electrical Contractor. the electrical rortio"uof this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
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 Derformed shall be done in accordance with the Ordinances of the City
of Springfiel~ 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 701.055 will be used on this project.
(('f,f) 17j..{~;Grl^TURE.. h~ /&/
h/
tlain' ~ 2-.f" F x
llAt-1E(please print)
L; II ,&- A/tA f1i[)
FOR OFFICE USE miL Y
Zone ~ tC.
Fire Zone
SoN
Uni ts
Occy Load 7"~C-
Occ'y Group <11- ""?
Type/Cons t. ~
Bedrooms
Stories
,
Flood Plain
BUILDING PERflIT
Charges an':
Surcharges
...-Ju ceo Plan Ck.
~ 7 . 65%181 do
------------ Plan Ck.
7. ~~ 30%lBldo
Conm/lnd
Ppr Fpp
Res
Per Fee
PLUtlBING PERMIT
Charges and
Surcha rges
Fence
D~mo
____,s:~~~_Sjdewalk
. 60 A/C Paving
Curb Cut
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
-- --..
~-----
,.,.,~
(l ics. no.)
(l ;r<:;. no.)
, FFI="
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/S,t>>
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1'5":00
f exn; res)
(ohone no.)
(pxn;rp<:;)
(ohonp no.'
9~3- :<777
MECHANICAL
NO
, FH
, r~ARr,F
furnace/burner to
BTU's
/
Floor furnace
and vent
Recessed wall
SOi'lrp hp~tpr ~nrl vpnt
App 1 i ance vent
S~Dari'ltp
Stationary evap.
rooler
Vent fan with
sinale duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hnnrl .:Inrl rlllrt
Wood stove/heater
I SSUANC, OF PFR/IIT
~
DATE 7~ 2.)/~.
Total Comb. rermit
/<'<. %
TOTAL
:; 7<'.%
..
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
1/ oj 43
2. example- lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examE'le- heat/electrical ceilinq/or forced air qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. examp.le- if new project. check-new - if addition,
cneck add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examE'le - remodel existing garage into family room
3. exa~le - 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 abb~eviated schedules you should consult the
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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
signa ture.
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.
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V. FOR OFFICE USE ONLY
I
ClertfJUJ()J
Permit
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appl icant exempt from reg'i5tration with the Builder,' 5 Board because:
Additional Project Information: !!?/J/c...7.?/~ ~A-)1f'D O..z=: ~~~t:.<;;;
G.lliifhl&77:EZ) ~hr ~b ~~ VA7?fi4kctF ;,"C'(::>r 4/'
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PLANS REVIEWED BY:
name~& f1:..~~
5ignatur~~~~~
p
date 7-/.~-g3