HomeMy WebLinkAboutPermit Electrical 1990-3-2
CITY UF SPRINGFIElD
COMBINATION APPlICATION/PERMIT
EIIERGY SOURCES
Heat
Hater Heater
Ranqe
ValuE of Uork
/3 ",.IJ''''7 ?",...'i ~ 870'113
1NFOR/1ATION liNt I
726-3753
Sq Ftq Ilal n
~q Ftg Access
Sq Ftg Other
~ew Add Alter Pep
-Fence Demo Change/Use
-Other - -
I INSPECTION lINE
726-3769
Joh Address lOb' C;,,.r!e,/tv,d..l
Legal De~crlptlon
rot./.!
.
Owner
1?~11td ,iY"'....~6;', (-.oJ
ZJt; r n?,-AhJ.v,~d it.1",j
Phone
BUlhnna Pernllt Info Descr,be Work{l e . BUlld Slngle
Fa~lly ~esldence Wlth Attd\h~d G~raa~)
Address
7Yb-I,,'ffl..
Constructlon lender
Address
DESIGN TEAr~
(name)
Phone
(address 1
Pnmary
Structura 1
Electncal
f1echanlcal
CONTRACTORS
(namel
(address)
Genera 1
Plumb,na
(11C5 no)
(l,CS no)
.'
Sl
3
~
(eXOl res)
I
(Dhone no 1
(pxnl res)
(ohone no )
Electrlcal
~r"" 8~&^.~.
In I I~IJ-f I / 60 --.;>
'i 7 20 ~'" rs.t&f.W-j:tJ'" 22 - 'fA <=-
9 ? J&lJ<f2- '
TOTAl CHARGES TOTAl CHARGES CHARGES
WHERE STATE l \I~ REQUIRES that tile Electrlcal work be done by an [lectrlcal Contractor. the electrlcal rortlon of thlS rerl\l1t
shall not be vallJ untll the label has been slgned by an Electrlcal Supervlsor and returned to the BU11dlng Dlvlsl~n
I HAVE CAREFULLY EXAMINED tie completed appllcatlon for permlt, and do hereby certlfy that all lnformatlon hereon lS true
and correct, and I further certlfy that any and all work oerfonmed shall be done In accordance wlth the Ordlnances of the Clty
of Spnngfleld and the Laws of the State of Oregon oertalnlng to the work descnbed hereln, and that UO OCCUPAUCY wlll be made
of any structure wlthout the permlsslon of the OUlldlng 01V1S1on I further certlfy that my req1strat1on wlth the GUllder's
Ooard 1S 1n full force and effect as requlred by ORS 701 055, that lf exempt the basls for exempt10n lS noted hereon, and that
only subcontractors and employees who are 10 compllance wlth QPS 701 055 wl11 be used on thlS proJect
I~AtlE(please Prlnt)~~'::ITtt~vJ >0, SIr,NA~l' ,.,Q.o9.n "') ~ J..o>
FOr OI"F I CE USE DI~l Y
So Ftg rialn
Sq Ftg Access
Sq Ftg Other
~lechanl ca 1
PLUt1BI NG
ElECTRICAl
NO
HF r.W\Rr,F NO
Each slngle flxture
Resldence of
SQ FT
Relocated bU11dlng
(new flX add1tlonal)
~W Clrcu1ts alts
c::J..Ilor extenslons
I SERVICES
I
Is F Res 1 dence
(I bath)
10uPlex (1 bath)
IAddltlonal bath
Ha ter serVl ce
each
ITempOrary Constructlon
I ~~:_~3;JI~~ ex 1 st 1 ng
Imultlfamlly, conm or
Tndll~trltll
IOf amps I
I COMlI /I NO FEEDERS I
Install/alter/relocate I
dl~trlh. fppdpr~
Of ':M.~ - 60 0 amp..1
I r010
I
I
Sewer
Storm Sewer
Zone
Flre lone
Flood Plaln
Type/Canst
Bedrooms
Stones
Unl ts
Occy Load
Occy Group
BUIlDING PERIIIT
Charges and
Surcharges
I Plan Ck
____________ 65%/B1do
Plan Ck
30%lBl dQ
[ Fence
I D~mo
JQQ_c!:! __I Sidewalk
W (JC) I A/C Pavlng
I Curb Cut
I
COITVl\/I nd
Ppr Fpp
Res
Per Fee
PlUI~BING PERMIT
Charges and
Surcharges
ElECTRICAL PERtHT
Charges and
Surcha rges
MECHANICAl PERMIT
Charges and
Surcharges
~~~ rHARh~ NO
r!JQfL I
I I
I I
I I
I
,
I
1~5G:-J
&JJ:)I
I I I
I I _)1
l~.<Jl-I1 TOTAl
I()/ /11
MECHANICAl
~~~ rJlAB.G.[
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sntl~p hptltpr tlnd vpnt
ApDllance vent
seDflratp
I Statlonary evaD
cooler
I Vent fan Wl th
slnole duct
I Vent systefTl apart from I
heatlna or A C
I Mechanlcal exhaust
hood and duct
I \Jood stove/heater
I
I
I
ISSUANCF OF PFR'11T
DATE -:'t. /z / '1 (J
I I .
x
Value
Value
Val ue
x
x
TOTAl VAlUATION
ISystems Development
Charqe (1 5~)
ITotal Comb rermlt
I
I TOTAL
/{)6 aJ J<i
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
Appllcant to furnlsh
A Job Address
B Legal Descrlptlon
1 ~xample- Tax Lot 100. Lane County Map Reference
17 03 43
2 example- Lot I Block 3, 2nd Addltlon to
Springtleld Estates
C Name. etc of owner and constructlon lender
o Energy Sources
1 exam~le- heat/electrlcal celllnqlor forced alr qas
2 example- waterheater/electl ;cal/or solar
E Square footage or valuatlon, etc -----
I example- 1250 sq foot house. 500 sq foot garage
2 example- lTinew proJect. check-n€w - If addltl0n.
check add, etc
F BU11dlng permlt lnformatlon
1 example. construct slngle farnlly house wlth an
attached gar.'lge
2 example ~ remodel eXlstlng garage lnto famlly room
3 example - convert slngle farolly resldence lnto
restaurant (change of use)
G Value of work as deflned 10 Sectlon 303 (a) of the
Structural Speclalty Code
H DES I GN TEAr! ANO CONTRACTORS
To avold deslgn or constructlon delays. BU11dlng
Dlvlslon Staff must be able to (ontact arproprlate
persons regardlng deslgn lnforrndtlOn or Job slte
correctlons. etc
II Abbrevlated Plumblng. Mechan1cal. & Electrlcal Schedules
A Except where blank spaces occur In the descr1ptlon
portlon of the Mechanlcal and Electrlcal Schedules.
the appl1cant need f11l~ln only the No Boxes adjacent
to the approprlate ltem(s) to be lnstalled
B Full Plumblng. Mechanlcal, and Electr1cal Schedules
are avallable at the BUlld1ng D1vlslon
1 To conserve space on the permlt form the schedules
have been abbrevlated
2 If the ltem(s) to be lnstalled are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be del1vered to the
electrlcal contractor for slgnature by hlS electrlcal
superv1sor The general contractor 15 not authorlzed
to slgn the electrlcal label
III Appl1cant to slgn and date ,
Whenever pos51ble. the 101t1a1 appllcat10n w111 be used as
a worksheet only Where P05s1ble. BUlldlng 01v1510n Staff
w111 prepare a type wrltten copy and return 1t to the
apP]lcant at the tlme the actual perm1t lS lssued for h1s
slgnature
IV Fees and Charges
Plan check fees are due and payable at the tlme of the
appllcatlon. and no plans w111 be processed untll these
fees are pald All other fees and charges are due and
payable when the perm1t lS 1ssued
~.--3-qO
1
\ 6 CQ~ ~
V FOR OFFICE USE ONLY
Permlt Clerk
K1C(1)
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Perml t appllcant exemp,t from regl stratlOn wlth the BUll der: s Board because
Addltlonal ProJect lnformatlon
PLANS REVIEWED BY
name
slgnature
date
~