HomeMy WebLinkAboutPermit Electrical 1985-3-29
Val~€ of Hork:
-,1$ 1500
BuilciinQ Penn'it Info: Describe \~ork(i-.e..
Familv nesidence With Attached Garaae)
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I IrISPECTlON LINE
726-3769
Job Address ~ 5 S El )j~o...vI
Legal Description [i A-ttM ~
I
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
Owner
w~~I~.
Ljli.( /LfJn~, [Jd.<6
~,Wl/
Phone
Address
Construction Lender
Address
Dc>!li" [EAIi
Phone
(address)
(name)
(lies. no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
{name}
(address)
(1 ics., 1"10,,)
Genera 1
Plumbino
~
INfORlIATlON ll~c
726-3753
So. Ftg. 1.Iain
~q. Ftg. Access.
So. Ftg. Other
New Add Alter ~ep.
--Fence Demo Change/Use
Other - --
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In
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Bui ld Single
(exnires1
I
{ohane no.}
(p1(t"Jir'Pc,'
(ol1nl'lp ru"l \
(~ee- mAU 'f,,'./e. \~
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Electrical
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. ,
-
~1echan;cal
PLUIIBING
,
r"'IRliE ..Jj(L
ELECTRICAL
..J!Q..,.
ff,
fHARGF
Each single fixture
...I!O..-!
I Res i dence of .
SQ. FT.
INew circuits alts.
or extensions
I SERVICES
I
",
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
I Duplex II bath)
IAdditional bath
1~later service
I Sewer
I Storm Sewer
each
MECHANICAL
,cc
rlJARliE
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl ~~nt
ITempOrary Construction I
IChange in existing I
rec;,idencp
Imult({amilY, corrrn. or I
lnduo;.trial
10f amps.l I
ICO~1./IND. FEEDERS I
I Install/alter/relocate I
rlic:tr-ih fpprlprc:
10f ~ amp~ I f~.DO
I I
I 4c/D I .(,0
I I I SSUANCf OF PFR!1lT
TOTAL CHARGES TOTAL CHARGES I~.&O ,I TOTAL CHARGES
WHERE STATE L\li REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical rortion 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 EXM1INED the completed aprlication 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 flQ OCCUPAI~CY 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 exemp-t the basis for exemption is noted hereon. and that
only subcontractors and employees,who.are in comoliance with ORS 701.055 Wi~l ~sed o~ this project.
IlAIlE(please print(J:);;vib~P. ~ JIJ SIf,IIATURE ./ ~
fO~ OrflCEUSE DIU,.,
Sq. Ftg. t1ain
Sq. Ft9. Access
Sq. Ftg. Other
Zone
Fire Zone
Flood Plain
Tvoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILOING PERNIT
Charges and
Surcharges
, Plan Ck. Conm/lnd
65%/Rldo Ppr Fpp
------------"'"Pian Ck. R'es
30%lBlda Per ,ee
Fence
PLU'~BlNG PERMIT
Charges and
Surcharges
D~mo
ELECTRICAL PERI~IT
Cha rges and
Surcharges
__L9!.QQ___J Sidewalk
, 1.00 I AIC Paving
I Curb Cut
I
11ECHANICAL PERMIT
Charges and
Surcharges
Appliance vent
c;eoa r:a tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and durt
I Hood stove/heater
I
I
I
DA~d-27-rf
x
Value
Value
Value
,x
x
TOTAL VALUATION
Systems Development
CharQe (1.5~)
I
I
I
ITotal Comb. rermit
I
I TOTAL
....-.....
J $. (00
r
.
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100. Lane County Map Reference
1/ U3 43
2. exa~le- Lot I. Block 3, 2nd Addition to
Spflngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examEle. heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- 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. 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 303 (al of the
Structural Specialty Code
H. DESIGN TEN1 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. BUILOING 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. ---
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.
~
9
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V. FOR OFFICE USE ONLY
Permit Clerk
~
1
P~JEC~ CONDITI~S ~O BE ~ATISFIED BEFORE OCCUPANCY~ ~~~
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Permit applicant exempt f~omt?egistration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date