HomeMy WebLinkAboutPermit Electrical 1990-3-1
L1 INSPECTION LINE
. 726-3769
CITY OF SPRINGFIELO
Cm1BINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of Hork:
Job Address 1650 Centennial, Blvd. ;. S9~
Legal Description \ f\ TYt>~ ~?-A- ()~~( A,
Address'
.Waremart, Inc.
Owner.
-~
INFORl1ATION UNt
726-3753
Sq. Ftc). '.1ain
. ~q. Ftg. Access.
Sq. Ftc). Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
" .
()
PhonErj1 4 7 -
5185
Buildino Permit Info: Describe Work(Le., Build Single
Family nesidence With Attached Garaoe)
1650 Centennial Blv~_
Sprinqfield. OR.
Construction Lender
~"._Q ~ \Lt'~~~ ~~)s
\
Address
DESIGN TEAt1
Primary
Structural
E1edrical
.'.
Hechanica1
CONTRACTORS
General
. P1 umbino
g7477
-:
(name)
Phone
(address)
. (1 ics. no.)
(expires)
(ohone no. J
(name)
(address)
(] ics. no.)
(exoires)
(ohone no. )
~1echani ca 1
E1ectri.ca1 Beacon Electric 2585 Roosp-vp-JLRlw'l , F.llgpnp; OR CU41)?
ITempOrary Construction
IChange in existing
.res i dence
Imultifami1Y, comm. or .
Industrial
IOf amps~
ICOMM./IND~ FEEDERS I
Ilnsta11/a1ter/re1ocate I
distrib. ff'eders
10f amp~1
I I
I I
I I I I ISSUANCE OF pF.RrlIT
TOTAL CHARGES I TOTAL CHARGES 15.75 I TOTAL CHARGES
WHERE STATE L'\l~ REQUIRES that tile Electrical work be done by an. [lectrica1 Contractor, the electrical rortion of this permit
shall not be va1iJ until the label has been signed by an Electrical Supervisor and returned to the BuiJding Division
NO.
Each single fixture.
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath)
IAdditiona1 bath
I ~Ia ter servi ce
Jsewer
I Storm Sewer
I
I
I
I
I
I
PLUt.1B I NG
ELECTRICAL
20-53C'
MECHANICAL
FFF rH.AR(;F NO.
FFF fH,AIlr::F
FEE CHARGE NO.
Residence of
SQ. FT.
New circuits a1ts.
or extensions
~I
each I
I
I
I
I
I
I
I
I
I
I
ISERVICES
I
I
I
I
I
I
furnace/burner to
BTU's.
.75
I
Floor fu rnace
and vent
15.00
I I
I I
I I
II
II
I
I
I
I
I
I
I
Recessed wall
Soace heater and Vf'nt
App.1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sino1e duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood and duct
from
Wood stove/heater
I HAVE CAREFULLY EXNlINED the completed apr1ication for permit, and do hereby certify 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPAUCY w.ill be made
of any structure without the permission of.the Building Division. I further certify that my registration with the Builder's I
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 I..'
only subcontractors and employees who are in compliance with ORS ]01.055 ~Iill be used on is project.
UAt'1E(p1ease print) Gary E. Johnsen-
Dim 03/01/90
Zone
Fire Zone
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLU14BING PERMIT
Charges and.
.Surcharges
ELECTRICAL PERrm.
Charges and
Surcharges
MECHANICAL PERHIT
Charges and
Surcharges
SIGNATURE
FOR OFFICE USE ONLY
Sq. FzY11ain ~
Sq.. Ft9. Access.
Sq. Ftg. Other
Type/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
Plan Ck. Comm/Ind
____________ 65%/B1do Per Fee
Plan Ck. Res
30%/B1do Per Fee
___________-' Fence
. _ ID6mo
___t~.Cl.) I Sidewalk
. f)~ I A/C Pavi ng.
I Curb Cut
I
x
x
Value
Value
Value
x
TOTAL VALUATION
Isyste.ms Development I
Char~e (1.51,) ,
I
I
I
I
ITotal Comb. rermi~
I
I
I
I.\~.ro
TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. 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
Springfield Estates
C. Name, etc. of owner and construction lender,
D, Energy Sources . . . .
1.. ex~mple- heat/~lectrical ceiling/or foried air qas.
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 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~ exampl~ - construct single family house with an
attached garage
2. example - remodel existing garage 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 d~sign or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site .
corrections, etc..
11. Abbreviated Plumbing, Mechanical, &.Electrical Schedules
A. Except where blank spaces occur in the description
portion of ihe Mechanical and Electrical Schedules,
the applicant need fill-in onlY the No. Boxes adjacent
.to the appropriate item(s) to be in~talled
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 schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As ~oted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general' contractor is .nrit authorized
to sign the electrical label. ---
III. "Applicant to "sign"and date
Whe~ever possible, the initial application will be used as
a worksheet only. . Wher.e 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
signa ture.
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:
PERMIT.VALIDATION
'1'.
Permi t
A( ,
~ 0
\ \g \0 \
clerk~um
"
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
. date
-