HomeMy WebLinkAboutPermit Electrical 1989-10-23
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Legal Description \~-:SDO G::()\on
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CITY UF SPRINuflElO INFO~IATION liNE
COMBINATION APPlICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. Hain
Heat ~q. Ftg. Access.
llater Heater Sq. Ft9. Other .
lIew Add er Pep,
Range -Fence erno Change/Use
ValuE of H"{fi) 1 ~ Ot -
BUildi~qnmit Info: Deser be Workli.eo. Build Single
Familv nesldence With Attached Garaae\
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I INSPECTION LINE
726-3769
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Address
DES I GN TEAr1
{namel
Phone
(address 1
(lies. .no.1
(exnires)
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
.
(namel
(addrpss 1
C1 ics. no.1
(exnires)
(ohone no. )
Genera 1
Plumbino
Electrical\
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PLUI.1B 1 NG
ELECTRICAl
MECHANICAL
NO.
FEE CHARGE NO_
<FF rHAll!iE.Jl(l
:.E.L' .cJlARliE.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bathl each
Additional bath
SERVICES
Recessed wall
S~~rp hp~tpr ~nrl vpnt
Sewer
Temporary Construction
Change in existing
rps i d.fnr:p
multifamily. COI1JJl. or
Induc;,trial
( IOf ,,')/)()
ICO~1./INO. FEEDERS
l'Install/alter/relocate
didrih. fppdpr...
IOf
I
I
I
amps,
31.sc
Appl iance vent
c;,~oarate
Stationary evap.
cooler
Vent fan with
sinol~ duct
Vent system apart from I
hpat.ino or .Q r
MeChanical exhaust-
hood and dur:t
Water service
Storm Sewer
Wood stove/heater
amps.
TOTAL CHARGES TOTAl CHARGES
WHERE STATE L\l/ REQUIRES that the Electrical work be done by an.
shall not be vali1 until the label has been signed by an Electrical
I
I
I
<-3/).::6
ISSUANCF OF PFRP11T
TOTAL CHARGES
Electrical Contractor. the electrical rortion of this permit
Surervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 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 UO OCCUPAIKY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractor~ and employees who are in compliance with OPOS 7~1.055 will be used on this project.
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;;I~;" printlY _-0.'''614 ::r. ffl,,;$Ii" SIGUATUR( tf A',,-~d~.. ~ --- DATE /<>-,,3-6'7
/ . FOP. OFFICE USE OnLY /.C... ", j
Zone Tvpe/Const. Units 51'!. Ftg. Hain x Value
Fire Zone Bedrooms Oecy load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAl VAlUATlOU
BUILDING PWIIT I Plan Ck. COI11l1!1 nd
Charges and ------------ 65%/Bldo Pjlr Fpp
Surcharges Plan Ck. Res
30%/Bldo Per Fee
PLUl1B I NG PERM IT Fence
Charges and ------------
Surcharges O~RIO
ELECTRICAL PERIHT --Q1~~ 'Sidewalk
Cha rges and
Surcharges AlC Paving
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
ISyste.!:Is oevelopment I
CharQe (1. 5~
Total Comb. Permit
TOTAL
I
j 3Q. 8?S
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp]e- Tax lot 100. lane County Map Reference
17 03 43
2. exa~le- lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air QdS
2. exa~le- waterheater/electrlcal/or solar
E. Square 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. ete.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Sectlon 303 (a) of the
Structural Speclalty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Dlvision Staff must be able to contact appropriate
persons regarding deslgn informatlon or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanlcal, & Electrlcal 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 abbrevlated
2. If the item(s) to be installed are not covered on
the abbrevlated 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 hls electrlcal
supervisor. The general contractor is n2l authorlzed
to sign the electrical label.
III. Applicant to sign and date
Whenever posslble. the initial application will b~ 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 permlt is lssued for his
signa ture.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
applicatlon, and no plans will be processed until these
fees are pald. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Penni t
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
.
date