HomeMy WebLinkAboutPermit Electrical 1990-8-22
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'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\
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Construction lender t (l\ ...............V
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INFDRI1ATlON LINt
726-3753
Sq. Ftq. 1.Iain
~q. Ftg. Access.
Sq. Ftq. Other
Ilew Add A Iter Rep.
--Fence Demo Change/Use
Other- -
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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
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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
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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
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COMBINATION APPLICATION/PERMIT (CAP)
:'
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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:
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PERMIT VALIDATION
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Permit Clerk
cJ;7fiv
Permit applicant exempt from registration with the Builder's Board because:
'Additional Project Information:
PLANS REVIEWED BY:
name
signature
date