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HomeMy WebLinkAboutPermit Electrical 1990-1-29 Owner ~ Address . '- (I", A ,j _.::- ~W'MCV .. 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-- -- S) 3 C) ',~ 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 ~ - Ie ('2.:l .. ~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 I I I I I I I I I r I I I SERVICES I I Temporary IChange in residence I mult ifamily, Industrial Construction existing Storm Sewer Of I amps. Ib3'- I I I .1 I I I I I I ~~I f I I I I vpnt I I I 1 I I Vent system apart from I heating or A.C. I Mechanical exhaust I hood and duct I Hood stove/heater I I I I 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 I I I I I I I 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 I I I 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%) ", I I 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: (~ '. , PERMIT VALIDATION cDcid C!t ct (LA , - ~ i f '{)~~-qo I ... t:5~G6 't, \\ , Permit Clerk t:AVJD_) " '. 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 , ,- " '( " .~) ,,/.-:l>/;,:-:;j'tfe