HomeMy WebLinkAboutPermit Electrical 1981-9-24
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CITY OF SPRINGFIELD .
COMBIIIATlON APPLICATION/PERMIT
EilERGY SOURCES:
Snrinllfield Heat
!~ater Heater
Range
ValuE of Hark:
INFORlIATlON UNt
726-3753
Sq. Ftg. "lain
~q. ftg. Access.
Sq. Ftg. Other
Ilew Add Alter P.ep.
-Fence Demo Change/Use
Other- -
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1 INSPECTION L1IIE
726-3769
Job Address 1860 Laura Street
Legal Oe$cr;pt;on
Owner Internatio'nal Business Fonns
Addn;,; P.O. Box 1361
Phone
Builriina Penmit Info: Descr,be Workl;~e" Build Single
Familv Residence Hith JI..ttached Garaae1
Eugene, Oregon
Construction Lender
97440
Address
DESIGN TEAl,'
(name)
Phone
(address)
(lies. no.l
(expires)
(ohane no.
Primary
fA
1.t
Structura 1
Electrical
Hechanical
CONTRACTORS
(namel
{address}
(1 ics. no.)
(~)[nirps1
(ohonp nn_ 1
Genera 1
PlumbinQ
Electrical !;"nf.ie..1i1 F.1W.l'i" r.o. P.O. Box 276'1 EnlYpnp Q.2Zlll2 20_1r.
6/"10/82
686-8612
~'echan; ca 1
PLUlIBIIIG
ELECTRICAL
MECHANICAL
NO.
FFF CH~ .1'n.
FFE rH~ ..llil...-.
FFE rHARliE
Each single fixture
Residence of
SQ. FT.'
furnace/burner to
BTU',
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
4% ,tate Surcharge
SERVICES
1 I Main Service 65.0( 65.0~,
!remporary Construction
IChange in existing
l"Ps..i d_pnrp
Imultifamily, COI1111. or
Tndll<:.trial
10f
ICO~1./IND. FEEDERS
IInstall/alter/relocate I I
1 di~trih_ fppdpf<:.
IOf 400 amps.130.0q30.0Cl
Of ,100 Amps 110.dq20.0C
I I
I I. 4.6C ' ISSUANCE OF PFRIIIT
119.6d TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
Recessed wall
Soar.p hpil.t~ vpnt
Storm Sewer
amps.
Appliance vent
spoa ra tp
Stationary evap.
cooler
Vent fan wi th
sinol!=! duct
Vent system apart
heating or A.C.
Mechanical exhaust
hnnd '" nd rillr t
from
~later service
Sewer
Wood stove/heater
2
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali1 until the
I TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
I HAVE CAREFULLY EXN1INED 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 Spr; n9fi e 1 d and the Laws of the Sta te of Oregon perta i n i n9 to the. work descri bed herei n. and that flO OCCUPArKY 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 OP.S 701.055 will be used on this project.
NA}'IE(please print) Robert E. Scofield
SIGIIATURE 1fl..L.# L //
DATE-2ill/Sl
Zone
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Dcc'y Group
FOr. OFF I CE USE DIlL Y
Sf]. Ftg. t1ain
Sq. Ft9. Access
Sq. Ftg. Other
p
x
,
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERflIT
Charges an':
Surcharges
, Plan Ck. Conmllnd
65%/BldCl Ppr Fpp
------------ Plan Ck. Res
30%/Bl do Per Fee
Isystems Development
Charoe (J.5~)
I
I
I
I
PLU!1BING PERMIT
Charges and
Surcha rges
Fence
------------1
DfIlllO
I'Sidewalk
I A/C 'Paving
!Total Comb. Permit
ELECTRICAL PERlllT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAL
I'Y
.
,
I
COMBINATION APPLICATION/PERMIT (CAP)
m
l. Applicant to furnish
A. Job Address
B, Legal Description
1. ~xample- Tax Lot 100, lane County Map Reference
II 03 43
2. exam~le- Lot l. ,Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources I
1. exam~le- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or va:luation, etc. -
1. examole- 1250 sq, foot house, 500 sq. foot garage
2. examole- if new project. check-new - if addition,
check add, etc. I
F. Building permit information:
1. . example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. example - 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 TEAI'I 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 s~aces occur in the description
portion of the Mechan'ical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanlcal, and Electrical Schedules
are available at the Building Division
1. To conserve spacelon 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 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 ~ill 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 ON,Y
.'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
J&r' l\ Q' nt-
5 t; 846
Md-.5( 1981
d~
Permit Cl erk
I
Permit applicant 'exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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