HomeMy WebLinkAboutPermit Electrical 1988-3-11
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. INSPECTlOIl LINE
.726-3769
Job Address /7'2> r) -A'" J.- /
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legal Description
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A
CITY UF SPRINGFiE~D
, tOMBIrlATlON APPLlCATlON/PERMIT
· EIIERGY SOURCES:
Heat
Water Heater
Ranqe
Valu. of Work:
.
IftfORllATlON Llt1<
726-3753
Sq. Ftg. I,laln
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
Phone
Build Stngle
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Owner ..5?J/j,n" /7)- l-- ) d
Address v :/,~jv,. /J
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BUiloinQ Permit Info: Describe Workti.e.,
Familv nes;dence With Attached Garaae~
?cr? - 3:105 ~;.~(/ ~~>-
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Address
Ul:.:Sl[ir~ Il:.Al1
lname)
Phone
(address'
(11es. no.1
texnires\
.'-
fDhnne no.l
Construction lender
Primary
Structural
.tl4.(' S ~DU
Electrical
Mechanical
CUNTRAC IURS
(name!
(addresc:.'
--.--------m~ no. 1" .~i;~-ni~.i.-._.----( ~.~n:l
Genera 1
to..
1., , ,'"
Plumbino
Electrica~~/?~ ~ Ed.-c./:
/06 Yu/. ,-;)A.rl ~D-/Q'7 G-
;?y Jy.J- 7 If/q.Q.
~'echanical
PlUfIBING
ELECTRICAL
MECHANICAL
Each single fixture
I HF I r:HARGF m I I q~ I rHARGE. tin. I
Res i dence of furnace/burner to
SQ. FT. BTU's
':F ~ r:~!R.1
NO. \
Relocated building
(new fix. additional)
S.L Residence
n bath \
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions '.=>2;
c );).6.2
50
~
Floor furnace
and vent
SERVICES
Recessed wall
~n~cp hp~tpr ~n~ vpnt
I,
Storm Sewer
Of
amps.
Appliance vent
~eoa"'atp
Stationary evap.
cooler
Vent fan with
~in91p. duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond And duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp~ i qPJ'Ic('.
multifamily, comm. or
lndn:trhl
Water service
~)
C/
COMI'I.! INO. FEEDERS
lnstall/alter/relocate
dic;trib. feeders
amp.. I
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r.
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,y' \ \ \ .
Of
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TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be valf1 until the
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ISSUANCE OF PFRItIT
I HAVE CAREFULLY EXM11NEO the completed appltcation 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 Springfield and the laws of the State of Oregon pertaining to the work described herein. and that flO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builderls
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 7QI.055 will ~ used on this project.
IW1E(~leaSe print~~"-'~U2"Z; SIGMTU~E--C\/~/~~--=-
FOr. OFfiCE USE DriLY / r \'
Zone Type/Const. Units S~ flain \.c
'---'
Fire Zone Bedrooms Occy load Sq. Ftg. Access ~
Flood Plain Stories Occy Group Sq. Ftg. Other ,
oATE3- / / - ,f- y
Value
Value
Value
TOTAL VALUATION
BUilDING PWlIT
Charges and:
Surcharges
I Plan CIc. CorrmlInd
____________ .M!rBlda Per Fpp
Plan Ck. Res
30SlBlda Per Fee
fence
ISystems Development I
Charae tl.5~ .
l'
PlUflBING PERMIT
Charges and
Surcharges
Dome
_ _~.?-,s:::.Q.:"__:"$ldewalk
I . 13> AlC Paving
Total Comb.. Permit
ELECTRICAL PERIIIT
Charges and '\.
Surcharges v
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut.
TOTAL
~3,b3
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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
17 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced afr aas
2. examole- waterheater/electrica\/or SOlar
E. Square footage or valuation. etc. ------
I. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new.- if addition,
cneck add. etc.
F. Bunding permit informatton: .
1. examPle ~ construct single family house with an
attached garage
2. examole ~ 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 CaJ of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
01vision 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
8. 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. As noted on the CAP. the label must be delivered to the
electrical co~tractor for signature by his electrical
supervisor. The ~eneral contractor is.not authc~ized
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 ~ivision Staff
will prep~re 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.
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V. FOR OFFICE USE ONLY
Permit CI erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
Permit applicant exempt from registration with the Builder's Board because:
Additional. Project Information:
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PLANS REVIEWED BY:
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name
signature
date
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