HomeMy WebLinkAboutPermit Electrical 1989-8-9
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'I INSPECTi~N T;'.NE" .. ,0. , CITY OF SPRINGFIEl,D ' . ' (NFORMATION UNt
726-176'f. -' COMBINATION APPLICATION/PERMIT 726-3753
Job A~ress I (p 5D Cen+en~;;) ~~~~GY SOURCES:''''' ;~:.> ~~~: ~~~:ss. ';B
Legaj Description \ r) () 3ri-S?J4 t\-5100 Hater Heater Sqi{e~tgAd~th!~ter Rep. 0
/ - Range Fence~emo_Change/Use
. - , ValuE.3 ~rk: ~ Other ~
ow'nd\(\\\U: (\l~ ~(\l\(lclffi~f\t~ . ,0) ,00f)~ .~ -,. S'
Addressv'\.? ':J...{~.. (r~' y ~^~n.-\.- phan""'.oS BU110.WO P~~llt Info: De.scrlbe Work(1.e., BU11d Single II f'I
?;,:Q~~~Q \~~-'q~4X?-> r~\\ \FJrl~tH'~At*~~d~i\QmC\rtJ'
Construction Le~r J
~ \)~~ <1\)\'0\()\".X1 Q__;
(address) (lics: no.) (e~i~) , (phone no. I
S<=\ ~D\)4M-,€u.~ \O~;/\~l{)
Address
DESIGN TEAM (namel
Primary ~~\\~~~. J- \\~ r\~ u n~
Structural '
Phone
Electrical
Mechanical
CONTRACTORS- (name)
Genera 1 l~~ (\.. 9_\< j
. Plumbino ~ '~ )
(address)
(lies. no.)
(expires)
(ohone no. )
, "
Electrical .
~lechani~al ~ \'G~~ ~~ \t)l\~
PLUt1B I NG \j
ELECTRICAL
, I
CHARGF NO.
MECHANICAL
NO.
FEE CHARGE NO,
FE!:
'FF!: . CHARGF
SQ. FT.
I
furnace/burner to
~ .BTU's
,?~p///9/r-
t1 oar furnace -
and vent
Each single fixture
Residence of
(
Relocated building
(new fix. additional)
/1Iew cir~u~ts alts.
, or extehslons
a. .6'-;r? ,/J-;I.d~~
I"
SERVICES
Recessed wall
Soace heater and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Storm Sewer
Of
amps.
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wopd stove/heater
~later servi ce
Temparary Canstructian
Change in existing
residence
multifamily, camm. or
Industrial
'~-
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders'
Of
amps.
I SSUANCF OF PFRt1IT.
TOTAL CHARGES TOTAL CHARGES ';:?-;;;;?-SO TOTAL CHARGES ~/"?' ,/;s:. ~
, WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an-:Electrical Contractor, the electrical portion af this permit
sha,ll. no,t be vali'l.until the label has ~een signed by an E]ectric~l 'Supervisor and returned to. th.: Building Division
~ ~ ~ '.~~. . ,., '.. . I". \, _
I HAVE CAREFULLY EXmlINED the completed application for permit, and do hereby certify that all information hereon is true
and corr.ect, and I further certify that any and all work performed.shall be done in accordance with the Ordinances of the City
of' Spri'ng'fi e fd"<irid the Laws of' 'the state' of Oregon oertai'ning to the, work descri bed herei n, and tha'tNO OCCUPAHC'y. will be made
of any structure without the permission of the Building Division. I further certify that my registratian ~Iith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt,the .basis tor exemptian,is noted hereon, 'and that
only subtontractors and employees who are in compliance with,OR~ 7nl.05~ will be used on ~his ~roject:
BU'ILDING PER~1IT
Charges and
Surcharges
:\6 ?J<rl~1/fl1 f171 SIGN^TUR~J-0f~J ./;lAC:;
I FOR OFFICE USE or~Uf I I
Type/Const.::3~S?/3'Units Sq. F~. t1ain ' .x Value
Bedrooms ' Occy Loa~ Yo Sq. Ft~. Access x Value
Stories I Occy Group ??-2 Sq. Ftg. Other~/~P" x Value -;::;.c:;,vc.--~
I 4mC\. V TOTAL VALUATION
Plan Ck. CommjInd \QQ n.,. W 13~n..sstems Development <--~
65%/Bldo Per Fee () 0 ,Y\\ 0 r'1 ~'rqe (1.5%), . 7~O-
Plan Ck. Res "
30%/Bldq Per Fee
DATE
f(-;;' d .'t /"
,
NAME(please print)
Zone C~R
Fire Zone
Flood Plain
---~~~-~-
I~. /S-
PLU/~BING PERMIT
Charges and
Surcharges
Fence
Dt1mo
ELECTRICAL PERfHT
Charges and
Sur.cha.rge~
MECHANICAL PERMIT
Charges and
Surcharges
~ - _.~.~, 'Si'de.w~il k
- - --.....-=-- -,-~~-:::.--
____/.:b~_:~~_ Curb Cut
~/)'
TOTAL
.g36.5';3
,. - .~
~_-,~,c:~-l ,Cio251 '
...
?
- ......~
A/C Paving
Total Camb. Permit
~ 7~ ~~ /~'=-?>A"!~-C~ O/V?Yt:... ~~~
,~ ' "'- ~ -~ --~
A, ,I, ,
//'~~~~~~~ /
, I
--6'~- ~/T-~75
'-0,
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- Lqt 1. Block 3, 2nd Additian to '
Springfield Estates
C. Name, etc. of awner and construction lender
D. Energy Sources t
1. ',example- heat/electrical ceilingjor forced a~ir qas
2. example- waterheater/electrical/or solar
E. Square faotage ar valuation, etc.
1. example- 1250 sq. foot house, 500 sq. faot garage
2. example- if new project, check-new- if addition,
check add, etc.
F. Building permit infarmatian:
1. example - canstruct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - convert single family residence into.
restaurant (change af use)
G. Value af work as defined in Section 303 (a) af the
Structural Specialty Code I
H. DESIGN TEAM AND CONTRACTORS
To. avoid design ar constructian delays, Building
Divisian Staff must be able to contact appropriate
persans regarding design information or job site
corre~tians, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the descriptian
partian of the Mechanical and Electrical Schedules,
the applicant need fill-in anly the No. Baxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To canserve space on the permit form the schedules
have been abbreviated
2. If the item{s) to be installed are nat cover.ed on
the abbreviated schedules you shauld consult'- ui'e
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted an the CAP, the label must be delivered to the
electrical contractar far signature by his electrical
supervisor. The general cantractor is,not authori'zed
to sign tlie electrical label. ,- ,
II 1. App 1 i cant to. sign and date
Whenever passible, the initial application will be used as
a'worksheet only. Where, possible" Building Division Staff
wi'll prepa re ,a type wrHteD, copy' and return it to. the
applicant, at the time the actual permit is'~issued far hls'
signature., ,",' " ,
IV. Fees and Charges :', ,",: 'I,!,I."',
P,lan check fees are due/and payable"at',thel,time af the',
~pplication, and no. plans ~ill be processeg uptil these ,
fees 'are pa i d.' All other fees' and 'charges, are I due and '
payable when the permi.t is, issued. I: - , ,
V. FOR OF~ICE USE ONLY
PROJECT CONDHIClNS TO BE SATISITIED BEFORE OCCUPANCY:
" ._ .-. I
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, ~, .
....~
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PERMIT VALIDATION
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Pe~it c:erk (o/fljiu
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a V.?5~.Y.
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Permit, ?'ppl i cant e~empt from regi strati pn with ,th~ Buil der I s Board because:
Additional Project Informqtion:
, .
--
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,
PLANS REVIEWED BY:
I
I ,
name I-b&/TC ~
--- ,,'
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~#_"\ ..=.)..~..::. ;.".
r-t~erT, ~;gnature~, .~~,..~....date
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