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HomeMy WebLinkAboutPermit Electrical 1984-12-10 I INSPECTION LINE 726-3769 . CIIY U~ SPRINGfIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Hork: . Job Address ~() ,--7;_ i1 . Lega 1 Oeser; pt; on Owner, ~ ~ lOl)~ ./j. Addres~ ~ <::; =3 'iJ. 7/ ~ .J;~" i)~ Construction Lender INFORllATlQff UNt 726-3753 Sq. Ftq. 1,Iain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Rep. --Fence Demo Change/Use -Other - - o ~ eX) CJ ~ OQ Phone"l/~~ BUilciinq Permit Info: Deser.be WorklLe.. Build Single r~ / Family nesidence With Attached Garaqe) a 7</f ..eJ!uh ,.p-, f/A./PJ ---- . ". - -,- Address UI:.S lliNII:.At" Phone (address) (1 ics. no.) (name) Primary Structural Electrical Mechanical CONTRACTORS faddres.s.\ (1 ies.. no.) (name I Genera 1 t Pl umb; no I Electrical :1-"JtI r.... Uc.k:tvH bR"O.RJ- , ~1echanical PLUI,IBING ELECTRICAL NO. FFF rHAlU~E Nn ~~~ r~ARr.~ NO Each single fixture Residence of SO. FT. Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (] bath I Duplex (1 bath) each SERVICES Additional bath Temporary Construction Change in existing rpS i dJ>nc:p multifamily. corrm. or Tndllc:trial I I I I I I I'ah I I Water service Sewer Storm Sewer Of amps. COMM./IND. FEEDERS Install/alter/relocate r1ic:trih. fppdPrc; Of amps. Pnp..pf) aa t'tJe. fexoires) (ohone no. J (pxoirpc;) (ohnop nn, ) MECHANICAL ~n. n-lll.IU~~ furnace/burner to BTUJ s Floor furnace and vent Recessed wall ~oac:p hpatpr and vpnt App 1 i ance vent seoarate Stationary evap. cooler Vent fan with c;ioole dur:t. Vent system apart from heatina or A.C. Mechanical exhaust hnod and dur.t Wood stove/heater ISSUANC, OF PFR!lIT TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be valiJ until the I TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical f}b , TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed apfllication for permit. and do hereby certify that all information hereon is true and 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 pertaining to the work described herein, and that rm OCCUPAtKY 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 exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. SIGNATURE ~drL~A FQR OrFICE USE DillY \J So. Ftg. t1ain x Sq. Ftg. Access x Sq. Ftg. Other x llAf.lE(p1ease print) '5dF <::;vGk~t!~,,> ZonE" Fire Zone Flood Plain Tvpe/Const. l3edrooms Stories Units Occy Load Occy Group BUILDING PERflIT Charges and Surcharges I Plan Ck. COI1111/lnd ____________ 65%/Bldo Per Fee Plan Ck. Res :1n~/Rlrln Per Fee Fence PLU!~BING PERMIT Charges and Surcharges Dttll10 ELECTRICAL PERI~IT Cha rges and Surcharges Sidewalk , a 0 A/C Paving Curb Cut MECHANICAL PERMIT Charges and Surcharges DATE /C:--/P-B'f Value Value Value TOTAL V ALUA TI O~I lSysterns Development I Charqe tJ.5~) , Total Comb. Permit I I TOTAL . C(O I 3~\)~70 . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100, Lane County Map Reference 1/ U3 43 2. example- lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrlCaJ/Or solar E. Square footage or valuation, etc. - 1. exam~le- 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 garage inta 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. Abbreviated 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. --- 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 type written 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. (2::tf:;.- ~ '3 9 31 fJ fJJ/rf'l V. FOR OFFICE USE ONLY Permi t Cl erk fJ d . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date . I