HomeMy WebLinkAboutPermit Electrical 1989-10-10
I INSPECTION LINE
1 726- 37 69
Job Address 3D W
Legal Oe~cript;on
..
~J 11 UIOh )
CITY OF SPRINGFIELD . INFDRlIATlDN LINt
COMBINATION APPLICATION/PERMIT '26-J753
EIIERGY SOURCES: Sq. Ftg. li.i n ,.
Heat ~q. Ftg. Access.
Water Heater Sq, Ftg. Other
lIew Add Alter Pep.
Range Fence_Demo_Change/Use
Valu, ~ rrr ) . _Other
BuilciinQ fennTt Info: I Deser be Work.{Le., Build Single
:a;7/;ir0})trted ~raoel
c9 (1) A(l jLLf .is
))
6
i$'
Owner fil+(I>~
Address gDn uJ Htl .LA i )/ 0 fA ?one
const~~~Q-) (~2f )
n
Address
DESIGN TEAl1
lnamel
Phone
(addressl
flies. no.)
{exoires}
(ohone no.
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address'
(lies.no.\
(exniresl
(OhOM no.l
General
Plumbina
Electrical
~ f.oor<t\\\'~322.~2ii ~~J 13.Q4()
, ,J\,~~ C\r\'lf)
PLUIIBING E~TRICAL
(Q/WjQO
~'echanical
MECHANICAL
NO.
FEE r.HARr.F Nn
<r r r"AB.li[ Jill
:E.L .ClJARlif.
SQ, FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
I\;r New circu~ts alts.
rJ. or extenSlons
,~~o
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
Sn~rp hp~tpr ~nd vp~t
Storm Sewer
Of
COW1./IND. FEEDERS
Install/alter/relocate
di~trih. fppdpr~
amps.
Appliance vent
<;.~oaratp
Stationary evap,
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
MeChanical exhaust
hood "od durt,
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp",c:i4r..nr:p,
multifamily, canlTl. or
TnrllJc;trial
~Iater service
Of
amps.
I SSUANCF nF PFRlU T
TOTAL CHARGES TOTAL CHARGES ~ .~~, TOTAL CHARGES
WHERE STATE L\\/ REQUIRES that tile Electrical work be done by an'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore90n pertaining to the work described herein, and that 110 OCClIPAIICY 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 wno ~re in compliance with OP.S 7nl.055 w~ used on t~is project.
IW1E(please print) ,~,Ar~,..,...rq SIGIIATlIRJ.<.P- A/ ~ DATvtJ'?'f!7..,/Y'
FOr. OFFICE USe DIlLY -
Sq. Ftg. 11ain
Sq. Ftc). Access
Sq, Ftg. Other
Zone
Fi re Zone
Tvpe/Const.
Bed rooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALlIATlON
PLlIt~BING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________.&2!/Bldo P.I'r rpp
Plan Ck. Res
30%/Blda Per Fee
Fence
Systems Development
Charpe (1.5~l
BUILOING PERfllT
Charges and
. Suq:harges
ELECTRICAL PERIHT
Charges and
Surcharges
c{).f-) "ED___
7~ (?)-
D~A1O
Sidewalk
A/C Paving
Curb Cut
LtJfj!f#Jfl. W~
'_fUJl:!J V
.. de; .60
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
41o,\~
e
.
. .
PERMIT VALIDATION
\Rb. \gllq ~C
~\DOCG~
..
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B, legal Description
I. example- Tax lot 100, lane County Map Reference
1/ 03 43
2. exam~le- lot I. Block 3, 2nd Addition to
Spr,ngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ce;li~Q/or forced air Qas
2. examyJe- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examDle- if new project. check new - if addition.
check add, etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 3D3 (a) of the
Structural Specialty Code
H. DESIGN TE~1 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
full schedules
C. BUILDING DIVISION STAFF WIll FIll DUT 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. ---
Ill. 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.
V, FOR OFFICE USE ONLY
Permit Cl erk
rJ{f}j
-\.....,.
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date