HomeMy WebLinkAboutPermit Electrical 1990-1-19
01119190
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERHIT
EIIERGY SOURCES:
Heat
7R.IlNSI7 S71l7IOt Hater Heater
Range __ _.-_-:
Value of Hork:
e:
INFDRl1AHON .lI~C
726-3753
Sq. Ftg. I~ain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
--Fence Demo Change/Use
Other -- --
~
--
~
I INSPECTION LINE
726-3769
6J.'I~U -
Job Address 'lGe-o Gaf.p.wrw
Legal De,cription L 7D (j1l7 E./tJ1l1j
Owner.
Address
LTD
P.O. Box 2710
Euqene 97402
BuilciinQ Permit Info: Oescrjbe Work(i~e., ~~ild Single
Phone687_55f 1 Familv nesidence Hith Attached Garaoe'
Construction Lender
I O~O iC"r
Address
DESIGN TEAI~
(name)
Phone
(addressl
(l ics:. no.l
(exoires)
(ohane no. J
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
faddrf'ss\
(lies. no.)
(exo;rl?s)
(ohane no. \
General
Plumbino
Electrical
Beacon Electric
2585 Roosevelt Blvd.. Euaene 97402 20-S1C 10/01/QO 4h1-0?Q1
~tE'('h.lni('~l
"... M'
PLUI,IBI NG
ELECTRICAL
MECHANICAL
--1l!h.
FFE CHARGE ND
,FF rHIlRliE. NO,
FFF rHIlRliE.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
1
New circuits alts.
or extensions
.75 15.00
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (I bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
COMI"./IND. FEEDERS
Install/alter/relocate
rl;~tr;n_ fppdpr~
amps.
Appliance vent
~eoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina 01'" A.C.
Mechanical exhaust
hood ilnd du~t
Water service
Temporary Construction
Change in existing
rt>c;.jQcncp
multifamily. comm. or
Tnduc;.trial
Sewer
Wood stove/heater
Of
amps.
I SSUANCF OF PFRIHT
TOTAL CHARGES TOTAL CHARGES 15 _ 75 ,TOTAL CHARGES
WHERE STATE L'li REQUIRES that the Electrical work be done by an, Electrical Contractor. the electrical portion of this permit
shall not be valiJ 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 oerformed 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 OCCUPAIICY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7n1.055 will be used on ~h~~ro~ect.
IWIE(please print) Gary E. Johnsen SIr.IIATURE~ - ~~ DATE 01/19/90
FOP. OFFICE USE DllLy I/'I
Sq. Ftg. ~ I
Sq. Ft~.pACCe~
Sq. Ftg. Other
Zone
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
TOTAL VALUATIOtl
Fi re Zone
x
Flood Plain
x
BUILDING PERIHT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________..ill/R1do Per Fpp
Plan Ck. R-es
30%lBldo Per Fee
Fence
Systems Development
CharQe (I.S~l '
PLU!~BING PERMIT
Charges and
Surcharges
0ljll10
'Sidewal k
------------
I A/C Paving
___________J Curb Cut
I
I
I
I
I
Total Comb. Permit
ELECTRICAL PERI11T
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
.
.
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; ,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. lane County Map Reference
11 oj 43
2. examole- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examole- 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. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exam~le - 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 1tem(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
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 b~ 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.
i-fr~4{)
~5g(f1
V. FOR OFFICE USE ONLY
Pennit
""M
'-./ I .
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Infonnation:
PLANS REVIEWED BY:
name
signature
date