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
.
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