HomeMy WebLinkAboutPermit Electrical 1990-1-29
Owner ~
Address
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES;
Heat
!~a ter Hea ter
Range
ValuE of Hork:
INFORI1ATION LINt:
726-3753
Sq. Ftg. r'1ain
Sq. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other-- --
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1 INSPECTION LINE
726-3769
. Job Address 54-:;}- :~ rf'MttA
: Lega 1 Descri pt i dn
Phone
Buildinq Permit Info; Describe Work(Le" Build Single
Family Residence With Attached Garaqe)
-
Construction Lender
Address
DESIGN TEAt~
(name)
Phone
(address)
(1 i cs ,no, )
(expires)
,.
(phone no.)
Primary
Structur.al,
~ '
Electrical
."" ,
, /1echani ciii-
CONTRACTORS
(name) .
(address)
(1 i cs. no,)
(expires)
(ohone no, 1
General
P1'umbi nq ,
.' Electric~J.i?aJ~.Y/Pl-1';hos ~(~lc--- 3nO Hea~ ~ ib--MClC
ID/c.,O
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~1echanical
PLUI.1BING
ELECTRICAL
MECHANICAL
, NO.
FEE CHARGE NO, I
I FFF I rHARGFl NO. I
I FFF I rHARGF I
Each single fixture
Residence of
SQ. FT.
furnace/burner to
InU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
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r
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I SERVICES
I
I Temporary
IChange in
residence
I mult ifamily,
Industrial
Construction
existing
Storm Sewer
Of
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amps.
Ib3'- I
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.1 I
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~~I
f
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vpnt I
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1
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I Vent system apart from I
heating or A.C.
I Mechanical exhaust I
hood and duct
I Hood stove/heater I
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I Recessed wall
Soace heatpr and
I
~Jater servi ce
I Sewer
comm, or
I App 1 i ance vent
seoarate
I Stationary evap,
cooler
'Vent fan with
sinole duct
~ .fOMf'1./I ND. FEEDERS
"Install/alter/relocate
distrib. feeders
10f amp~1
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TOTAL CHARGES I TOTAL CHARGES ~(o ~
WHERE STATE LAW REQUIRES that the Electrical work be done by an,Electrical
shall not be valiJ until the label has been signed by an Electrical Supervisor
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I ISSUANCE OF PFR~1IT
J TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Division
I HAVE CAREFULLY EXNlINED 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 performed 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 describe rein, and that NO OCCUPAr~cY will be made
of any structure without the permission of the Building Division. I further,C, ify 'hat . registration ~/ith the Builder's
Board is in full force and effect as required by ORS 701.055, th~t if exempt, h~ bas's f ~ption is noted h~reon, and that
only subcontractors and employees who are in compliance with ORS 701,055 w' 1 be us d s project,
Zone
Fire Zone
Flood Plain
TypeJ'Const~ -"
Bedrooms
Star; es
'Unit.s-' .
Occy Load
Occy Group
SIGNATURE
FO~ OFFICE USE Y
~~: ;~~: 'i:ss
Sq. Ftg. Other
DATE
~'7.BD
~
IW1E(please print) Thl ~ -pt:::Jmev
J
x
Value
Value
Value
..c ....,..,.x
x
TOTAL VALUATION
ELECTRICJl,L PERfHT
Charges aQ9
Surcha rges'
MECHANICAL PERMIT
Charges and
Surcharges
__B_~.5n
-y. \3
Plan Ck.
65%/Bldo
Plan Ck.
30%/Bldq
I Fence
,. D/jmo
'$idewal k
Comm/lnd
Per Fee
Res
Per Fee
/Systems. Development
Charge 0'.5%) ",
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BUILDING PER~lIT
Charges and
Surcharges
PLU/1BING PERMIT
Charges and
Surcharges
A/C Paving
I Curb Cut
-------:------,
ITotal Comb. Permit
1- <71_~
IIOTAL OV
.. I g..... I ';0 I .... ."." I . ~,I .
,
.
I.
COMBINATION APPLICATION/PERMIT (CAP)
Applicant to furnish
A. Job Address
B. Legal Description
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 owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilingjor forced air gas
2. example- waterheater/electrical/or solar
E. Squa re {ootage or. va 1 ua t ion, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-riew - ,if addition,
check add, etc.
F. Building permit information:
1. examRl~ - construct single family hou~e with an
attached garage
2. example - remodel existing garage into f~mily room
3. example - convert single family: r:esidence'o, 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 descriptio~
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
electrical contractor'for signature
supervisor. 'The general contractor
to sign the electrical label.
Appllcant to sign and date
Whenever possible, the initial application will be, used as
a worksheet only. Where possibl~, Building Division Staff
will prepare a type written copy and return it to the
applicqnt 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.
1.
be delivered to the
by his electrical
is ,not authorized
I I 1.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
cDcid C!t ct (LA
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Permit Clerk
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Perm'it appl i cant exempt 'from reg'i strati on with the Bui 1 der I s, Board because':
Additi ana 1 Project Informati on:. '.
PLANS REVIEWED BY:
name
signature
,
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