HomeMy WebLinkAboutPermit Electrical 1987-12-8
I INSFECTIO~.~INE
726-3769
Job Address "32(:; CEh"/~h-!Y/A":::: /c VD.
Legal Description 17"~'3"7.h.3'1~~zc:>c>
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Owner 6?R;'h~.Ff~P nS<"/c- ~ )&:~~.5
Address 5:2_5 /7///_/ ?"T 7J.~~e~?7~
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
\~ater Heater
Range
ValuE. of \-Iork:
INFORt1ATION llNt
726-3753
Sq. Ftq. r.lain
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Construction Lender
Buildinq Permit Info: Describe Work(i,e., Build Single
Family Residence With Attached Garage) ,
./.#5~~EX#AV57'/fa>?/ 1.&A/
'4~J/E / A/k~~'7~// 21.8';
, Address
DESIGN TEAr,1
(name)
Phone
(address)
(l ics. no.)
(exoires)
(ohone no. )
Primary
Structural
Electrical
Mechanical:7~/.?'#<A<e.c"/ ~,.?~~/ 26~ ~$ /5~'5r
CONTRACTORS (name)' (address) (lics. no.)
(exoires)
?2~-9/~"T
(ohone no. )
General
Plumbinq
Electrical
~lechanic'a17h1/.?>> ~6~ .r~r~~, 2'~? ~~ /~~ S"7:
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PLurm I NG ELECTRICAL
NO. FEE CHARGE NO.
Each single fixture Residence of
SQ. FT.
Relocated building New circuits alts.
(new fix. additional) or extensions
MECHANICAL
FFF rHARGF NO.
FFF rHARG
furnace/burner to
BTU's
F1 oor fu rnace
and vent
!TempOrary Construction
Change in existing
residence
multifamily, comm. or
Industrial
10f amps~
ICOMM./IND. FEEDERS I
Ilnstall/alter/relocate 1
distrih. feeders
10f amp~1 I I
Br-4 n./'1"/'7?/lr 4~1
~R"'~~ ~~ ;?~ I
. ~~ ZJ/$ ~, ',I ISSUANCE OF PFRtJIT
TOTAL CHARGES , TOTAL CHARGES I TOTAL CHARGES /1/'!H., ,/ ~5: ~
WHERE STATE LAI~ REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
S.F. Residence
(l bath)
Duplex (1 bath)
IAdditional bath
I~later service
I Sewer
Istorm Sewer
I
SERVICES
Recessed wa 11
Soace heater anrl vent
each
Apoliance vent
seoa ra te
I Stat i onary evap.
cooler
I Vent fa'n with
sinale duct
I Vent system apart
heating or A.C.
/ I Mechani ca 1 exhaust
hood and duct
I Hood stove/heater
I
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from
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I HAVE CAREFULLY EXAmNED the completed application for permit, and do hereby certify that all information hereon is true
land 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 oertaining to the work described herein, and that NO OCCUPANCY 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 exemp the basis m tion is noted hereon, and that
only subcontractors and employees 0 are in compliance with ORS 701.055 w 1 be used
Zone
Fire Zone
Fl ood P 1 a in
Type/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
S I GtlATURE
FOR OFFICE USE GrlLV
Sq. Ftg. r1a i n
Sq. Ftg. 'Access
Sq. Ftg. Other
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'lDATF/2 -8-8?
INAME(Please print)
J:~ ~
x
Value
Value
Value
x
x
TOTAL VALUATION
PLUMB ING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd -:2 ,e
____________ 65%/Blda Per Fee ./- 7.,.,
Plan Ck. Res
30%/Bldq Per Fee
------_____J Fence I
/ D@ffiO I
___________Jsidewalk I
I AlC Pavi ng I
~ _ _ Lf2: _e:~-'. _, Curb Cut .1
~75' I I
Systems, Development
Charge (1.5%) , ,
- BUILDING PER~1IT
Charges and
Surcharges
ELECTRICAL PERtHT
Charges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
I
I
I'
Tptal Comb. Permit
15:7S'
/'/, S-o
I TOTAL
I. Applicant to furnish
A. Job Address
B.Legal Description , ~, V'"
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
.'. , "Springfield Estates" .. ',:. " .,
C~ "Name, etc. 'of o~tier and'constructi~n'lenaer
D. ' En.er.gy Source~ '. .' ) "", , .~. \.' ,
1. example- heatielec'tri'cal ce{l inqlo~ forced 'air qas
2. example- waterheater/electricalior solar
E. Square footage or valuation, etc.
1. example- 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 garqge,jnto f~milyroom
.. 3. example - 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: A~br.eviated 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. -
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.
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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COMBINATION APPLICATION/PERMIT (CAP)
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FOR OFFICE USE ONLY
- PROJECT XO~DITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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P.ERMIT VALIDATJON
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Permit Clerk
Permi~ applicant exempt from,regi~tration with the Builder~s ~oard bec~use:
Additional Project Information:
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PLANS REVIEWED BY:
-~;~;L..,..)'1'#A .n~~Signature~
,
date /":Z $-87
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