HomeMy WebLinkAboutPermit Electrical 1985-1-14
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IINSPECTION LINE CITY Uf SPRINGFIELD INFORllATION LINt
726-3769 COMBINATION APPLlCATlON/PERMIT 726-3753
Job Address~15 run J f) ~~.). ~~;~GY SOURCES: ~~: ~~~: ~~~:ss: CP
Legal Dmription \.. (")'3 :<-..c" "'''2- OS ,C() !~ater Heater Sqile~tgAd~th~~ter Rep. i>J;
- - . I Range Fence_Oemo_Change/Use (j
~:::~~nOYl/ JlX1 00 ~lJ 0 (~Qf11 g n~ ~:df::~;t In~cribe~:::~~.e., Build Single ir-
rL< ,...., I f J "I ) Family nesidence Hith Attached Garaoel /C)
~l/}(ttH}J.Ij (C.)(J; \_~_p c9+ o.jf)(111J1-3(2
con~t~+on Le~d~ I
Address
Ut"IiN ilAI1
(name)
Phone
(address)
(lics. no.)
(exDires) (ohone no.'
Primary
M
,~
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
f1i("~_ nn.)
(p~nirpe;.\ (nhn~p nn \
Genera 1
Plumbina
Electricao.JL.,A. Q l'o.Qi.et~
~lechanical ()
PLUf.lBING
\4l~ C'ioJ) (J.l nlLe~) Jr.;rrtrO .
"ii74/1" . f')pQ~
I MECHANICAL "-,
ELECTRICAL
NO.
FEF rHARr;F Nn.
Each single fixture
Residence of
CCF I rHARGF l-.I:ll!..-
~~~ rL.tARG.E.
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
SnnCP hPntpr ~nrl vent
Storm Sewer
Of
amps.1
Appl lance vent
sena ra te
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from [
hea t i nq or A. C.
Mechanical exhaust
hnnd and duct
Sewer
Temporary Construction
Change in existing
rP:i ; rJ..f'J1f"'P
multifamily, comm. or
Inrlllc;trl<ll
Water service
COffi~./IND. FEEDERS
Install/alter/relocate
dio;,trih_ fpprlpro;,
Wood stove/heater
Of
amps.1
I SSUANCr OF PFR!IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'l~ REQUIRES that the Electrical work be done by an."Electrical Contractor, the electrical portion of this permit
shall not be val;~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that rm OCCUPAtKY 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 ORS 701.055 will be used on this project.
UAI.IE(please
pr~LIE-qc:,eT Ii. I?IEqE../!.r
/ \ .~ FO~'OFFICE
SIGIl^TuG-klIl~/
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USE OIlL Y
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. r1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION
Shstems Development
C aroe (1.5~) '.
BUILDING PER~IIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Rldo P~r Fp~
------------ Plan Ck. Res
30%/Blda Per Fee
Fence
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERf:IT
Charges and
Surcharges
/IECHAN I CAL PERMIT
Charges and
Surcharges
_-16-f?2__
. (O()
Domo
'Sidewalk
A/C Paving
I Curb Cut
I
Total Comb. Permit
~
TOTAL
/5. Loa
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100, 'lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Additi?n to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam'ple- heat/electrical cei1inq/or forced air Qas
2. example- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examyle- 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 (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 jab 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. ---
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.
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V. FOR OFFICE USE ONLY
clerk~1ff)J
Permit
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the'Bu;lder's Board because:'
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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