HomeMy WebLinkAboutPermit Electrical 1990-4-20
04/20/90
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225 521 S-r-
J INSPECTION LINE &..A CITY OF SPRINGFIELD
726-3769 . , CmlBINAT10N APPLICATION/PERMIT
ENERGY SOURCES:
Job Address 1fiSO C x\.tp .ijll-.Flvn.~' _ Heat
Legal De5cription .\{~. (\~ a S~~TJ~CD l~ater Heater
Range
ValuE. of Hork:
lNFORI~ATION Lltlt
726-3753
Sq. Ftg. '.la in
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter.. Rep.
.-Fence DemoChange/Use
-Other -, -
Owner
-."-
~
o
g
5)
{y
Address
Waremart, Inc.
1650 Centennial Blvd.
Springfie'ld, OR.
Construction Lender.
97477
Phone 747-
5185
Buildinq Permit Info: Descr,be Work(i.e., Build Single
Family Residence With Attached Garaoel
8~ +- ('A J1 CAIill\)
Address
DESIGN TEAM
(name)
Phone
(address)
(l i cs. no. I
(expires)
(phone no.')
Primary
Structural
. ElectricaL;..
r1echani ca 1
CONTRACTORS
(name) .
(address)
(lics. no.)
(exoires)
(phone no.)
Genera 1
Plumbinq
Electrical
Beacon Electric
2585 Roosevelt Blvd.. Euqene
20-53C 10/01/90
461-0291
~lechani ca 1
PLurlB I NG
ELECTRICAL
MECHANICAL
NO. '
, FEE 'CHARGE NO.
I FFF 'r:HARGFI NO. I
I FFE I r:HARGF
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
each I
I,
New circuits alts. /
or extensio~s 2 ckts 1,/.12
I! . ":2...
,.\J
I I
22.5(
Floor .fu rnace
and vent
Relocated building
(new fix. additional~
IS. F. Resi dence
(l bath) .
I Duplex (1 bath)
IAdditional bath
I~Iater service
Sewer
SERVICES
Recessed wall
Soace heater and vent
/
Of
ICOMM./IND. FEEDERS
I Instal1/alter/relocate
distrib. feeders
IOf
I
I
I
amps.
Appliance vent
seoarate
Stationaryevap.
'cooler
Vent fan with
sinole duct
Vent system. apart
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
from
ITempOrary Construction
Change in existing
residence
multifamilY'lcomm. or
Industrial
Storm Sewer
amps.
I
I
I
I,
"
I ,I~}
1Y\?b. /'
c:72~ TOTAL CHARGES
Electrj61 Contractor, the electrical portion of
Supervisor and returned to the Building Division
I SSUANCF OF PFRrll T
TOTAL CHARGES . TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an
shall not be .vali,j until the label has been signed by an Electrical
thi s permit,
I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby .certif.y 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 Spri ngfi el d and the Laws of the State of Oregon pertaining to the work descri bed herei n ,and that NO OCCUPAIKY wi 11 be made
of any structure without the permission of the Building Division. 1. further certify that my reg.istration ~/ith 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 sUbcon~ractors and employees who are in compliance _~ith O~S 7.~l.055 win be .used. J tiS ~ro,ject.
IW1E(please print) GARY E. JOHNSEN SIGNATURE~ 1:~tJ~ D/m04/20/90
FOr. OFFICE USE arM / 1'/
Zone Type/Const. Units Sq. Firtltlain x Value
Fire Zone Bedrooms Occy Load Sq. ~. Access x Value
Flood Plain Stories . Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PER~1IT Plan Ck. Comm/Ind
Charges and ------------ 65%/Blda Per Fee
Surcharges Plan Ck. Res
30%/Bldq.Per Fee
PLur~BING PERMIT Fence
Charges.and ------------
Surcharges D~mo
ELECTRICAL PERtm &q~ Sidewalk
Cha rges and
Surcha rges Ale Paving
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges , I
Systems Development
Charge (1.5%) ..
I,
I
ITota1 Comb. Permit
I
ITOTAL
J).~I
. ,"'.',-
COMBINATION APPLICATION/PERMIT (CAP)
PERM IT, V All OAT ION
n.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. examp1e- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources ..'
1. example- heat/electrical cei1inq/or forced air qas
2. examp1e- waterheater/e1ectrica1ior solar
E. Square footage or valuation, etc.,
1. examp1e- 1250 sq. foot house, 500 sq. foot garage
2. examp1e- if new project, checknew - if addition,
check add, etc. .
F. Building permit information:
1. example - construct single family house with an
attached garage'
2. example - remodel existing'gara'ge'into 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.
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 o~ly the No. Boxes adjacent
to.the appropriate item(s) to be installed
B. Full Plumbing, Mechanica'l, and Electrical Schedules
are available at the Building Division
1. To 'conserve space on the permit form the schedules
have be~n.abbreviated.
~. If the item(s) to be installed. are not covered o~
the abbreviated schedules you should consult the
full schedu1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES i
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.. -
,n,pp.Hcant,-tois.;gn-and-date-- -,--., -- ----- >- .", - ',-
Whenever possible, the initial application will b~ used as
a worksheet only. Where possible, Building Division Staff
will prepare a type. written copy and return it to the
appl i cant at the time the actual permit is issued for hi s '
signature.
Fees and Charges
Pian check fees are due ~nd payable at the time of the
application, and nb plans will be processed until these
fees are paid. All other fees and, charges are due and
payable when the permit is issued.
.d( ~
. 4-~3rLi'O. .
. l(~~oi
III.
.
IV.
V. FOR OFFICE USE ONLY
CJer~{m)
Permit
'.
PROJECT .CONDITIONS TO BE SATISFIED BEFOR( OC.cUPA~ky:' .. -,
,
"
\
Permit applicant exempt from registration with the Builder's Board because:
)
Additional Project Information:
,.
, .
PLANS REVIEWED BY:
name
signature
'date
./
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