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HomeMy WebLinkAboutPermit Electrical 1990-8-22 ---.~- 'IIrlSPECTlON LINE . 726-376g Job Address;J.;,bS f:7~.:t:J"r-- _ legal Description 1 '10p->~n (f)f::J:J(J6 owner(lM.lt.f'./ Aa9~&, ValUE Of~k\o.J Address\)^ihn ii' 0 [.l'/lf ~ Phone BU1]olno P~nni't Info: Descnbe Work(Le., Build Single ~'T III . Y '0 c- Far.nlv t'lesldenceHlth Attached Garaae\ ?A ~ \ '5\- ~4rlj VrrtlOJ.lrl, OC-- ~ l u()~, ~ ,), Construction lender t (l\ ...............V . INFDRI1ATlON LINt 726-3753 Sq. Ftq. 1.Iain ~q. Ftg. Access. Sq. Ftq. Other Ilew Add A Iter Rep. --Fence Demo Change/Use Other- - I-CJ . ~ 0"",./ ~ ~ I Address UI:.~llm II:.AH (namel Phone (address \ (1 ics. no.l (~xnirp,,\ (nhn"p no. ~ Primary Structural Electrical Mechanical CONTRACTORS (nam~) (address~ (li('<:;. no. (exoires' (ohone no.) General Plumbino_ ! ., h Electri:~ Mar /-U1/ f)S I I <' J/70 Hff.ICfJlM./ ~ 13~eI. /}o-/1Q('/ ID/11 (ttf-b/zl 614?);? . q I!<() jq?J ~fechanical ~ PlUllBING ELECTRICAL MECHANICAL NO. FF F CHIlR&L yn . ""LIJ:JiAIlG.l Nn ~~~ 1...c.I:iA.B.!iE Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) 11 ,_ New circuits alts. ~., or extensions 1~- Floor furnace and vent S.F. Residence I (1 bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~rp hp~tp~ ~nrl upnt rlater service ITemporary Construction IChange in existing resjd..e.ncl"" Imultifami1y, comm. or Tndll"trinl Appliance. vent Sl""oarate S-tationary evap. cooler Vent fan with sinole duct. I Vent system apart from I hp;atina or A.r.. I Mechanical exhaust hnnd nnd rlurt IWO~d stove/heater I I I I I I IOf amps.l I I CDMI,I. II NO. FEEDERS I I IInstall/alter/relocate I di"trih. fpprlprl;. I IOf amps.1 I I I I I I I I I I SSUANCf OF PFRllIT TOTAL CHARGES TOTAL CHARGES ~. ~ ,I TOTAL CHARGES WHERE STATE L.\H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I Sewer Istorm Sewer I I i 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 un OCCUPAIlCY 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 I::::(:~::::t::~:~:: ~~nz with :::11:::(/1 ur2/ :ject. DATE~ 'J FO~ OFFICE USE OIIIY If I I Units Sq. Ftg. t1aini x Value Occy load Sq. Ft!J. Access x Value Occy Group Sq. Ftg. Other x Value TOTAL VALUATION Fi re Zone Tvpe/Cons t~ Bedrooms Zone Flood Plain Stories BUilDING PERfIlT Charges and Surcharges Plan Ck. Comm/lnd 65%/Bldo Ppr Fpp ------------ Plan Ck. Res 30X/Bldo Per Fee Fence Systems Development Charoe (!.5~) Plur1BING PERMIT Charges and Surcharges D~RlO ElECTRICAL PERIHT Charges and Surcharges --C)~.:'Ej ') Sidewalk I . I ~ AIC Paving Curb Cut Total Comb. Permit 11ECHANICAl PERMIT Charges and Surcharges TOTAL Il3,lo3 . COMBINATION APPLICATION/PERMIT (CAP) :' " I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, la~e County Map Reference 17 oj 43 2. examp.le- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender O. Energy Sources - 1. example- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house, 500 sq. foot garage 2. exam~le- if new project. check new - if addition. check add. etc. F. Building permit information: 1. exampl~ - construct single family house with an attached garllge 2. example - remodel existing garage into family room 3. exa~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; &'Electr;cal 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: / ,/' // . , , PERMIT VALIDATION , ' 0~~ \ ?f3'J ~'6\S~ Permit Clerk cJ;7fiv Permit applicant exempt from registration with the Builder's Board because: 'Additional Project Information: PLANS REVIEWED BY: name signature date