HomeMy WebLinkAboutPermit Electrical 1982-2-2
] IhsPECTION LINE
726- 37 69
, Job Address 0 J 7 UJ.
Legal Description SAM L
....
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
· ENERGY SOURCES:
Heat
Hater Heater
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-
INFORI1ATION liNt
726-3753 "
Sq. Ftg. r'1a in
Sq. Ftg. Access.
Sq. Ftg. Other
Net'! Add Alter Rep.
-Fence Demo Change/Use
-Other- -
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Range
ValuE. of I-/ork:
Phone
BuilGinq Permit Info: Descr,be Work(i,e.. Build Single
Family Residence With Attached Garaqe) I
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1-'6 d- -7;)';}' 7
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j Construction Lender
, Address
DESIGN TEAt4
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(name)
Phone
(address)
(1 i cs. no.)
(expires)
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Cphone no.)
Primary
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i t1ertlanical
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(address)
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, (l'ics. no.) - (~xpiYes)-=- --'-(bhone-'nn,L - ii
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General
Plumbing
, Electrical
r~g~r~lli~2L_--;~-:~;;~~-~,,~c=,-==,-- -~---,- ,==,=, -_r~-:I~C~Ri C~:~_O~'~'~-- -~, -, -----.'-r"- " '--'~,,-= ,'.. ~~~(~::~~A!~-" r=-- [:
(~'NO~';':=;~:'- '=-~"----~--- -~C7Er~1- CHARGE"l'N(;~"T~:~~'~~~:::;' --, ,',< - , ',' ': ,1~'''Fttl8R*~ch~;:f~i;~:e;~~:__~~:I~' ::-~_ _:['1EF~CHAR(iF_~
::~~~~:':":: ::::' , Ii' - New -:~ r~Uit:~l::. FT .- --~-- ~,:.~. -- :.....aFI110~:v\:e'n0~'" 'W' '-.--- ::
(new fix. additional) I ~ or exi:eilsions !. i:
i-
I SERVICES -J'------- RecessedWall ";.,1
,__ ,_$Q.~u;.. heater and vel11_ _ _ _1,
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jTempOrary' Construction --, App1iar.::e ~t- ---,------- -~,;
separate .,
I IChange in existing Stationary evap. I
res i dence coo ') er ~
I Imu1tifamily, comm. or Vent fan with, J
Industrial sinole duct I
'I 10f I I Vent system apart from H
amps. heating or A.C.; u
I ICOMr"./IND. FEEDERS I I Mechanical exhaust . ~,'
hood and duct Ii
I 1~~~~~~~~a~;:~~~~locate I -' Hood stove/heater ~___ Ij,
: ~ ~l IOf ::I~=:=~:,I- __ - ___ __:~= I ,~
I I __ _ _,__--!_, __--' ~
,I I I ISsUANc.:....O~_~~!~ty _ .=..1
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES I U
WHERE STATE LAH REQUIRES that the E1ect'r;ca1 work be done by an 'Electrical Contractor, the electrical portion of th'is permit' t'
shan not be val i-1 until the label has been signed by an Electrical Supervisor and returned to the Building DiViSi1n " ~
I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all information her40n"T;;-iruen, ~
:and correct, and I further certify that any and all work performed shall be done in accordance with the'Ordinanceslof the City ~
10f Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAJ4CY ~i1l be made '
of any structure without the permission of the Building Division. I further certify that my registratiol. with thelBui1der's
Board is in full force and effect as required bY,ORs 701.055, that if exempt the basis for exemption is noted here~n, and that
,only subcontractors and employees who are in comoliance with ORS 701.055 will be used on this project. I
COfu.((~.M.'i.- " Fate coloAfTtALt.. ' /
NAr-1E(please print) 1A)/: '5 G uJJTE. \-- sIGNATURtv.J. ~~ DATFI,-;J.-8':l.
FOr. OFFICE U?E or~~L__ --.-to -----~~~..n--~==""~--, __c_ _~~~_.-=-~:-
,
- --,----'
s.F. Residence
(l bath)
Duplex (1 bath) each
Additiona'l bath
~Jater servi ce
Sewer
Storm Sewer
F'i re Zone
Fi,'):Jd Plain
Sq. Ftg.
Sq. Ftc).
Sq. Ftg.
Access
Other
x
Value
__Value
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-~'
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il
I
I
Zone v
_Type/Const.
Bedrooms
stori e,s
Units
Occy Load
Occy Group
~1a in
x___, .value
x
TOTAL VALUA'nON
BUILDING PE:.R~1IT
Charges and
sUi"charges
Plan Ck.
65%/Bldo
------------PTan Ck.
30%/Bldq
Fence
CommlInd
Per Fee
Res
Per Fee
Systems, Development
Cha rqe ('1 :5%)
PLur1B ING PERMIT
Cha rges and
Surcharges
DlJmo
_ ___ _ LQ,-OJj I Sidewalk
. tJ() I A/C Paving
___________-' Curb Cut
I
~
I
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ELE.CTRICfl,L PERrm
Cha rges and
Surcharges
ITotal Comb. Permit
I TOT"
~;.~
II ',~
MECHANICAL PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant'to furnish
A. Job Address
B. Legal Description
1. examp 1 e-' 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 owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq, foot garage
2. ' example- if new project, checknew - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - 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 (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. Abbreviat~d 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.
Lhd
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III.
IV.
V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
6-79Lff
IO,.,()O
~ 16
10, '-10
"-_-::'~
.
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Permit appl i cant exempt from regi strati on with the Buil der I s Board because: _
Additi ona 1 Project Infonnati on,:
'"''''
PLANS REVIEWED BY:
name
signature
(JA_~ -
date