HomeMy WebLinkAboutPermit Electrical 1981-5-13
INSPECTION LINE
726-3769
..
I t 0 f /l .n 11- € n Vl I /10 f} ,Q.J) I Y f1ENERGY SOURCES:
Job Address It? t ~ LA r U LlU..X...) LX--U ~t
II Z~ -,1\2 .-=J J ~A Water Heater
Legal Description L..J-..J ) __ I I U'::J LC')~ Range
Value of Work:
.
CITY Of SPRINGFielD
COMBINATION APPLICATION I PERMIT
INfORMATION LINE
726-3753
JJ.
Owner UJt D~ 11l1h).(~'4
Address~ (') ~ 1_ Pjol'e
()j)_OJp ~~ Ci4(O-1"37C
Construction lender LJ( j4-'Zi .
Sq. Fig,,~~i~
Sq. Ft~f :AcCess. '
Sq. fig, Other
_New _Add,_Alter _Rep.
_,_fence_Demo_Chonge/ Use
_Other
- -
Building Permit Info: Describe Work (i,e,.
FO~iliDVApC~9 Gorooe)
Build Single
~
CY
~
j
~DO
Addre"
Phone
DESIGN TEAM
(nome)
(address)
(lies, no.)
(expires)
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(nome)
(address)
(lies. no,)
(expires)
(::>hone no,)
General
Plumbinq
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO,
F"'
CHARGE I NO.
FEE 'CHARGE' NO.
fEE i CHARGE
Residence of
furnace/ burner to
PoTU's
Appliance vent
separate
Stationary .;vap,
cooier
Vent fan with
single duct
Vent sy.tem aport from
heating or A.C.
Mechanical exhaust
hood and duct
/
Each ~ingle fixture
Relocated building
(new fil<, additional)
S.F. R..iden~e
(1 both)
sq: ft.
New c:ircuits, alterations
or extensions
SERVICES
Duolex (1 both) each
Temporary Construction
Additional both
Amps.
Water service
Sewer
Wood stove/heater
Stor,m Sewer
fEEDERS
Heat Puma
Air handler to
10,000 CFM
Air handler over
10,000 CFM
Amp..
fSSUANCEOf ,PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE SlATE lAW REQUIRES that the Electrical work be done by the E!ertrical Contracto" the electrical portio.. of this permit shall not be valid until a
label has been signed by an Electrical Contractor ond attached to the electrical panel.
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon i. true and correct, and I further
,certify that any and 011 work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any .tructure without the permission of the Building Division. I further
certify thot my regi.tration with the Builder', Boord is in full force and effect 0 s required by ORS 701.055, that if eX!lmpt the ba.is for exemption is noted
heron, and that only subcontractor> and employees who ore in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Boord exemption:
NAME (plea.e print)
c;lGNATURE
FOR OFFICE USE ONLY
Zon4
Fire Zone
Flood Plain
Typel Canst
Bedrooms
~tories
Ilnils
(""> 'cy Load
Occy Group
c;q. Ftg. Main
c;q, Ftg. Access
Sq. Ftg. Other
DATE
'( Value
x Value
'( Value
TOTAL VALUATION
BUILDING PERMIT
Charge. and
Surcharges
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Pion Ck, Re.
30%/ B/dg Per Fee
PLUMBING PERMIT
Charge. and
Surcharge,
Fence
I ,
-1~ct 601<62-,
6-IB~~ (
I
I
I
System. Development
Charge (1,5%)
tlP l oJo.e1J "
2(4B
.lO
Demo
Total Comb. Permit
ELECTRICAL PERMIT
Charges and
Surcharge.
1-6,00
1.00
Sidewalk
MECHANICAL PERMIT
Charge. and
Surcharge.
Curb Cut
I
I
I TOTAL
l0. !'to
AI C Povino
COMBINATION APPlICA TION/P. (CAP)
'l. 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 Springfi~ld Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas,
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot garage
2. exampie-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 garag& into family room
3. example.convert single famiiy 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. Abbrevioted Plumbing, Mechanical & Electrical Sched~Jes
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 cons.erve space on the permit form the schedules
have been abbreviated
2. If the item(s} to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT All FEES AND
CHARGES ON THE SCHEDULES
III. 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 typewritten copy and return it to the applicant at
the time the actual permit is issued for his signaturE..
IV. 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-:
'Additional Project Information:
PLANS REVIEWED BY:
namp
<;ignatur..
. PERMIT V ALIDA liON
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Permit Clerlr
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iate