HomeMy WebLinkAboutPermit Electrical 1988-1-13
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Job Address
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
J
Range
ValuE of Hork:
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INFORl1ATION UNI:.
726-3753
Sq. Ftg, I.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other - -
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I INSPECTION LINE
726-3769
Legal Description
Owner'
Address
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:5 q tt 0' ~~;,fl Phone 720
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, BuilGinQ Permit Info: Describe Work(Le., Build Single
Familv ~esidence With Attached GaraQe)
&wivL .cu ~L~ /of)
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Construction Lender
Address
DESIGN TEAI4
(name)
Phone
(address)
(lies. no.)
(exoires)
(phone no. )
Primary
Structural
qLf.)13CJQO,
Electrical
,
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Mechanical
CONTRACTORS
(name)
(address)
(l ics. no.)
(expires)
(phone no.)
Genera 1
Electrical
rAYUA~ fitJ"L
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Plumbino
~1echani ca 1
PLUI,1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO
FFF rHARGF NO.
FFF, n-lARGF
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
....'..............
SERVICES
Recessed wa 11
Space heatpr and vpnt
Storm Sewer
Of
amps.
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
~Iater servi ce
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
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ISSUANCE OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L"l~ REQUIRES that the Electrical work be done by an-:Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and' returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application 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 NO OCCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with 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 subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
NAME(please print) ~ d u..)(, "c\ ~ I G-v.. ~ d r" ~I SIGN^TURE-U~ IV.
FOR OFFICE USE ONLY
Zone Type/Const. Units Sq. Ftg. 11ain
Fire Zone Bedrooms Occy Load Sq, Ftg. Access
Flood Plain Stori es Occy Group Sq. Ftg. Other
DATEdJ~/r(
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Per Fee
Plan Ck. Res
30%/Bl dQ Per Fee
Fence
Isystems. Development I
Charge (1.51) .
I
PLut4BING PERMIT
Charges and
Surcharges
D(tmo'
,.:'" ,', -~.....:.._, '.
ELECTRICAL PERI~IT
Charges and I j
Surcharges ....,
37rS1J ; Sidewalk
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/.6g
AIC Paving
I Curb Cut I
II~~ /OCf3C111(!
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Total Comb. Permit
I1ECHANICAL PERMIT
Charges and
Surcharges
~t.1
/,(}f)
I TOTAL
Vo, 3 g'
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
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
Sprlngfield Estates \
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinq/or forced 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. example - 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 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
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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
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 worksheet 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.
1 0 79-;).
1-( 3-~~
V. FOR OFFICE USE ONLY
Permit Cl erk
cG
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
,
PLANS REVIEWED BY:
"
name
signature
date