HomeMy WebLinkAboutPermit Electrical 1985-8-29
"6::0:3~
.
~
~ 85053'X
'1 INSPECTION LINE
726-3769
/5'1.05
Legal Description / I'J n-;;
.s~ H
.3 03::2
CIIY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
I EilERGY SOURCES:
Heat
tJ '7 tJtJ / Hater Heater
Owner. .."G OdV
Address :??-t'15('-' Spo...v-e..t..t L.nop
~ .Q..I-{- 2:u~o ./
I.J
Range
Valu€ of l'lark:
INFORr1ATION liNt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Rep.
--Fence Demo Change/Use
Dther- -
r
,(~
Ic~
)
Job Address
l+o tJ Co
~
Phone ( ! l/ I
0315"
Build;nq Permit Info: Describe Workli.e., Build Single
Familv nesidence With Attached Garaae)
~ .ftuo Cuuid;
\J
Construction lender
Address Phone
UESIGN TEAr~ (name) (address) (1 ics. no. ) (exoi res) (ohone no.,
Primary
Structural
El ectr; ca 1
Meehan; ca 1
CONTRACTORS (namel (address) (1 i r:s. no. , (pxnirpc;) (nhnnp nn ,
Genera 1
Plumbinq
Electrical ou.rY\.Q ), '\
f..1echan;cal
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE Nn
~~~ fHARGF NO.
FFF rHAR(.';F
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circu~ts alts. I I
or extenSlons ..-, Ie-
_/ .? C()
SERVICES I
Floor furnace
and vent
S.F. Residence
(1 h.thl
Duplex (1 bath) each
Recessed wall
~OnCP hPntpr nnd vpnt
Storm Sewer
Of
amps,
Appliance vent
seoa ra te
Stationarv evao.
cooler -' .
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood ilnd dud
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
re<;.i rtence
multifamily, comm. or
TnrtustriCll
~Iater servi ce
COMM./INO. FEEDERS
Install/alter/relocate
rtidrih. fppdprc:.
Of amp~
47,.., GV
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\\~ REQUIRES that the Electrical work be done by an.
shall not be valij until the label has been signed by an Electrical
15SUANC, OF PFR!IIT
I.e;, /:,1) TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Surervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed aprlication 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 riD OCCUPArKY 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 exemptiOZiS n ted hereon. and that
only subcontractors an: e:o:e:s Wh10 :: Nin C:~l iance with DP.S 7nJ.055..Wijf:i u:ed: t::; proj;t.
IWIE(please print) \ \'L.'~'-' Nt.) '= SIGNATURE )yy( J-aY\-I /1..At{) OATE,.5j'-.:2 ?z:f~ ~
FOr. OfFICE USE OIIL Y
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftg. t1ain
Sq. FtlJ. Access
Sq. Ftg. Other
x
tJ'""
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PER/lIT . Plan Ck. COITITI/l nd
Charges and ------------ 65%/Bldo p.pr Fpp
Surcharges Plan Ck, Res
3D%/Bldq Per Fee
PLUI~BING PERMIT Fence
Cha rges and ------------
Surcharges Demo
ELECTRICAL PERI~IT _____L~-'-9Q_ Sidewalk
Charges and
Surcharges ,(PO A/C Paving
11ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
'Systems. Development I
Charqe (1.5%) .
Total Comb. Permit
TOTAL
[5:-00
I
--'
.
.
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
11 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. example- heat/electrical ceilinqJor 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. exa~le- 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. examele - 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 abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. ~s noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .flot 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.
~ &!JJ(~
~/r'7-g)
\ PI ,.0
V. FOR DFFICE USE ONLY
Permit Clerk {?(7 ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project InfonTIation:
.
PLANS REVIEWED BY:
name
signature
date
I