The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1985-5-3 I HISPECTlOIl L1I1E 726-3769 Job Address ,~~ legal Description CYl A ~"n 00 1"" CITY Uf SPRWGFIELD COMBIrlATlON APPLICATION/PERMIT E!lERGY SOURCES: Heat \~ater Heater . . owne~~ '-~, ~1J..j{)~~QOf) Addres-; r-' = ^'" A ~J.. , Phone ~ ~.) L 11 )_. 1. ~.... ~ "- ;:;;~.LQ l1 (UQ... '74!-. rRn J /) - - ( , Construct; n ~en'er Ranqe Va1u. o~~;I~ BuilGinQ Pe~it Info: Family nesiience With INFOR/IATlDN 1l,'C 726-3753 So. Ftq, 1,1. i n ~q. Ftg. Access. Sq, Ftg, Other rlew Add Alter Rep. -Fence Demo Change/Use Other- - I )) i~ (jJ It: (ohone no. \ Describe Work{i.eo. Build Single Attached Garaae) JI011) J ffJf)~(lU Address UI:.:::dlirl II:.Af~ (name) Phone (address) {lies. no.) f exo; res) Primary Structural Electrical l1echanical CONTRACTORS (name) (address) (1 ics. no.) (pxoirpc;) (ohnnp no. \ Genera 1 ~ Plumbina Electrical ~'echanical PLUIIB I NG ELECTRICAL MECHANICAL NO. FFF rHARr.E NO r:r:r: rIolARr,J:." Nn r:r:r: rj.j.ll.IH~j:' Each single fixture Residence of SQ, FT, furnace/burner to BTU's Relocated building (new fix. additional) S. F. Residence (1 bath) Ouplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~o~rp hp~tpr ~nrl vpnt Sewer lTemporary Construction IChange in existing rp~ i dJ'nr:p Imultifamily, comm. or Tnrlllc::t.rial IOf -:JD n amps, ICO~1,/INO, FEEOERS IInstall/alter/relocate rlic::t.rih_ fppdprc:: 10f amp~ ISex Appliance vent <;eoari'lt~ Stationary evao. coolpr ~ . Vent fan wi th sinale duct Vent system apart from hea t 1 no or A. C. Mechanical exhaust hnnrl ~nrl rturt Additional bath ~Iater service Storm Sewer Wood stove/heater TOTAL CHARGES WHERE STATE l~W 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 ISSUANCf OF PFR!IIT 15 Lt...J I TOTAL CHARGES Electrical Contractor. the electrical portion of this pe~it Supervisor and returned to the Building Division 1 HAVE CAREFULLY EXN1INED the completed application for permit, and do hereby certify that all information hereon is true and correct, and 1 further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Orel)on pertaining to the work described herein, and that fm OCCUPArlCY will be made of any structure without the permission of the Building Division. 1 further certify that my registration with the Builder's Board is in full force and effect as required by ons 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. 1lAf.IE(please p~) / Zone Fire Zone Flood Pl a i n JQ/hJ f mAlA VilL"u6 '~SIG~IAT~4Jc/G-, Q FO~ OFFIC US~//, / // Tyoe/Const. Units /~, Ftg, IIain W" Bedrooms Occy load Sq. Ftg. Access x Stories Occy Group Sq. Ftg. Other x DATE ,5 -0'~A::c Value Value Value TOTAL VALUATION BUILDING PER/lIT Charges anC: Surcharges I Plan Ck. COllll1/1nd ____________ 65%/Bldo Pj"r Fpp Plan Ck. Res 30%/Blda Per Ff!e Fence ISystems Development I Charqe (1.5~) PLU'~BING PERMIT Charges and Surcharges Demo I I I ELECTRICAL PERr~1T Cha rges and Surcharges --t=t'l~~T- Sidewalk Ale Paving ITotal Comb. rermit /IECHAN I CAL PERMIT Charges and Surcharges Curb Cut I I TOTAL \ S~(OO. . \I COMBINATION APPLICATION/PERMIT (CAP) I. Appl ieant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference 1/ 03 43 2. example. lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole. heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. examRle- if new project. check-new - if addition. check add. etc. F. Building permit information: 1. example - construct Single family house with an attached gar~ge 2. example - remodel existing garage into family room 3. examole - 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 TE~I 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 8. 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 OIVISION STAFF WILL FILL OUT All FEES ANO 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 worksneet 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. V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . "I I PERMIT VALIDATION ~ ~~ /D~o 0~VJry Permit ci~Wu Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date