HomeMy WebLinkAboutPermit Electrical 1982-7-28
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J IrISPECTlON LINE.
726-3769
- Job Address ,..;2/G
Legal De5cription
.
CITY Uf SPRINGFIELD
COIIBIIIATION APPLlCATION/PERMIT
E!IERGY SOURCES:
Heat
(,later Heater
Range
ValuE of Hark:
.
INFORlIATlON LlNt
726-3753
Sq. Ftg. I-lain
~q. Ftg, Access.
Sq. Ft9. Other
r~e\'" Add Alter Rep.
--Fence Demo Change/Use
-Other- -
~ St-..
r~()od lJ.J.A.1. P I 0 nriu.atJUJ/)
Address :)j ( Q '""YY'ltu fl
c0P+:1c-L
Construction lender LJ
Owner
Phone
Build;na Pernlit Info: Describe Work(i~e., Build Single
Family nesidence With Attached Garaae)
Address
Ut~lliN ftAr-'
(name)
Phone
(address 1
~""-~
~O/L)
(~ni res)
(l ics. no.)
(ohone
Primary
. II Structura 1
Electrical
Mechanical
CONTRACTORS
tname)
(address)
(lir:e:, no,) (pxo;res)
X
lf~
,... "
Genera 1
Plumbina
Electrical
ritv-mif-frrn
fJO(1J. 9fl. &'i 7l:A
r ..J..J D-,.0-y 0 ,
u
I
~lechan; ca 1
PLUIIBIrIG
ELECTRICAL
MECHANICAL
NO.1
I FE'F I r.HARr.E Nn I
I ~~~ I rI-lA~~~ NO, I
I 1='1=1=' 'rs.lA~~~:
Eac~ single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
IS.F. Residence
(] bath)
IDuPlex (1 bath) each
[Additional bath
1~later service
I Sewer
lstorm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~r:p hPntpr nnrl vpnt
Of
amps.1
Appliance vent
spoarilte
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A,C.
Mechanical exhaust
hnnrl ilnd rlur:t.
Temporary Construction
Change in existing
rp~ j 4e.nr-",
multifamily, comm. or
lnrlllo;,triill
COffi~./IND. FEEDERS
Install/alter/relocate
rli<:.trih fpprlpr"
Wood stove/heater
Of
amps.[
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,'I~ REQUIRES that the Electrical work be done by an'
shall not be valij until the label has been signed by an Electrical
ISSUANCE OF PFRlm
I TOTAL CHARGES
Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apr1ication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed 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 OCCUPAUCY 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 7Ql.055 will be used on this project.
WAr.IE (p 1 ea se
print/f,AJ1YI d..f;,M ['1.<prT~/c:' S[GIIATUREWJ~..:[ ""Iif.M~~AT;; -b2..8: 8'~._
FO~ OFF I CE USE OIJL Y - I
Sq. Ftg. r1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
Tvpe/Const.
Bedrooms
Units
Occy Load
Occy Group
Zone
Fire Zone
Flood Plain
Stories
TOTAL VALUATlorl
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%1Rlrl(l Per Fpp
------------""Pian Ck. Res
30%lBl da Per Fee
Fence
Systems Development
Charae (].5~)
PLUMBING PERMIT
Charges and
Surcharges
D~mo
ELECTRICAL PERI~IT
Charges and
Surcharges
/IECHANJ CAL PERMIT
Charges and
Surcharges
_ _ _ _ -LQ,-Ofj
. ~/O
I-Sidewalk
[ A/C Paving
I Curb Cut
____________1
Total Comb. Permit
/O,;;D _~
TOTAL
.
,
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. lane County Map Reference
11 oj 43
2. example- Lot 1. Block 3, 2nd Addition to
>prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/~lectrical ceiling/or forced air aas
2. examyJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 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. example - 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 (a) of the
Structural Specialty Code
H. DESIGN TEN! 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
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 penmit 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:
.
;9
'1
""--.
PERMIT VALIDATION
"
~qL/71
Permit Clerk
(1~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
;~
date
....."".-,.-
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...-...............-.
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!I~/Y\ I LT (:)1'-1
(Name or firm - please print)
APPLICATION
E"-er/fl , C.
OEPARHlElIT OF 'PUBLIC WORKS
: BUILDING DIVISION
CITY.OF SPRINGFIELD
FOR }b)CTRICAL INSTALLATIOrl LABELS
'10 (1,,//0 K E ( Ie. F~ fJ lqJ/-f-. I-A Il/F
(flailing address) (City or town) (Zip code) (Coun:y)
, .
P.-20
REV. 12-77
346 l.lain Street
Sprincfield, Ol.coon
. 97~7i
D
HOHE m~itER'S - I hereby certify that I am the owner of the property described below, at which location I
propose to make an electrical installation for my own use and this property-'s not being
constructed for sale, lease or rent.
ELECTRICAL COIITRACTOR - Enclosed find S / Q cl Cl. for
/
(rlumber I
IS THIS BEING SUBI1JTTED TO COVER ONE ELECTRICAL JOB?
Label
electrical installation labels.
~
No.
'.RESI DErmAL
Residence wiring less than 1000 sq. ft..................@ S 15.00
Residence wiring less than 2000 sq. ft..................@ S 25.00
Residence wiring over 2000 sq, ft.......................@ $ 35.00
Electric heat installation in existing residence,.......@ $ 10.00
~ YES fro
rlo. Amount Recei ved
S'
S
S
~
S
~
S
S
S
S
S
S
SERVICES
Temporary Construction Service,........... .'.........,...@ S 10.00
Service change only in an existing residence.......,.,..@ S 10.00
Multifamily ~/ith Central Service,commercial or Industrial:
Service not over 100 amperes.....,..,.....,.............@ S 15.00
Service over IOU amperes but not more than 200 amperes..@ $ 25.00
Service over 200 amperes but not more than 400 amperes. ,@ $ 35.00
Service over 400 amperes but not more than 600 amperes..@ 5 50.00
Service over 600 amperes...........,....................0 S 65.00
Service over 600 volts..................................@ $150.00
CO:~:.IERCIAL AlID .HIDUSTRIAL FEEDERS
Installation of Alterations or Relocation of Distribution feeders:
Not more than 100 amperes.........."...............,...@ S 10.00
Over 100 amperes but not'more than 200 amperes..........@ S 15.00
Over 200 amperes but not more than 400 amperes..........@ S 25,00
Over 400 amperes........................................@ $ 30.00
Feeder over 600 volts...................................@ $ 40.00
S
S
S'
S
S
MI SCELLAlIEOUS
A 510.00 label shall apply for the following installations:
A. Each trailer or mobile home space...................@ $ 10.00
B. Each supply for mobile home..........................@ S 10.00
C. Each farm building other than residence..........,..@ $ 10.00
D. Each irrigation pump................,.......,.......@ $ 10.00
E. Each el~ctric sigrl or outline lighting,...........,.@ 5 10.0n
F. Each residential swirll11ing pool.......;..............@ $ 10.00
TOTAL
SUBTOTAL
ADD SURCIIARGE: 4~ of Subtotal
DTAl
S
s
S
S
~
S
S J6 00
S
S Ai)
S
S /() .r-u
BRA!iCIi C I RCU ITS
-1
One new circuit; alteration or extension................@ $ 10.00
Two or more new circuits; alterations or extension......@ $ 15.00
H011E OWflER - The actual installation will be made by me
or by
(Name and address)
who is a member of my family. Relationship:
(Home OWner's Authorlled Signature)
Cfjzp~c;.~J~
Electrical Contractor
~gnat~ of S'}IlI<rvisor) /
o -L. 7 I, U b'- '..,0 - 8 ~
fectrlca 1 L lcense tlumber '<