HomeMy WebLinkAboutPermit Electrical 1983-8-5
I INSPECTION LINE
726-376g
Job Address Z4D 11 ft7 fJ
,
CITY UF SPRINGFIELO
COMBlilATION APPLlCATION/PERMrT
EIIERGY SOORCES:
Heat
l~ater Heater
Range
ValuE of Hork:
7'/
Legal Description
Owner 01-
Address 1.-40
17f2G
J.1l17fJ
Phone
7'r
,
INFORllATION UNt
726-3753
Sq. Ftq. flain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
Other- -
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BUllriino Permit Info: Describe Work(i.e.) Build Single
Familv nesidence With Att ed Garaoel
Construction lender
Address
UtSlGl1 TEAll
(name)
Phone
(address)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
Genera 1
..
Plumbina
~Q..l^--'
flies. no.)
f1i~c;.. nn.)
<;T!rt4?w;J e t...-r:af?1c. ZI!;tJ /lItI~ t;::tJ6aI[
Electrical
Hechanical
PLUIIBING
ELECTRICAL
-1!Q.,.1
lEaCh Single fixture
I Relocated building
(new fix. additional)
Is.F. Residence
(I bath)
IOuplex (1 bath) each
IAdditional bath
I ~Iater serv; ce
I Sewer
I Storm Sewer
I
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I
I
I
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I FE'F I rHARr.E
NO I
Residence of
SQ. FT.
New circuits alts.
or exten"s; Dns
SERVICES
Temporary Construction
Change in existing
rp}jdrnr.p
multifamily, COIllT1. or
Tnduc;trirl.l
Of
amps,
COMfI./INO. FEEDERS
I Install/alter/relocate
dic;trih. fppdprc;
IOf amps.
I
I
I
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L"I REQUIRES that the Electrical work be done by an.
shall not be vali1 until the label has been signed by an Electrical
I ~~~ I r'1ARG.E. NO I
10--
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'U?, 190
(exoiresl
(ohone no.l)
*
(exoirps) (ohnnp nn.)
20--/<17(; ~/'$I'(!;
4tl/-n~
MECHANICAL.
,
I ~~~
I rl-l'1B.G..E.
1/
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~r.p hPntpr nnd vpnt
App 1 i ance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood tlnd dur:t
Wood stove/heater
from
I SSUANCE OF PFR'lIT
Electrical Contractor, the electrical portion of this pe~;t
Supervisor and returned to the Building Division
TOTAL CHARGES
I HAVE CAREFULLY EXNIINEO 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 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 OCCUPAIKY 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 exem the basis for exem ion is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 w 11 be used on thi . roject.
1lAf.IE(please print)~I'tfJf?8Z- J. :;W/.,eTl:?,JSIGllATUR
FOr. OFFICE USE 'OIlLY
Sq. Ftg. l1ain
Sq. Ft~. Access
Sq. Ftg. Other
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
BOILOING PERfIlT
Charges anc
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Per Fee
Plan Ck. Res
30%/BldQ Per Fee
Fence
------------, Demo
~ f'\ c::lC) I Sidewalk
~<;4' ) A/C Paving
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:JT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
<""
omt-s--S3
/I
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
CharQe (1.5~) '.
I
I
I
Total Comb. Permit
J
I TOTAL
C!)O, t(sD
,
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
J. Applicant 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
springtield Estates. . ,
C. Name. etc. of owner and construction lender
D. Energy So~rces' r
1. example- heat/electrical ceilinQ/or forced air Qas
2. examele- waterheater/electr;cal/or solar
E. Square footage or valuation. etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cnee k add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exam~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, & 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. BOILOING 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.
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V. FOR OFFICE USE ONLY
. l....
Clernf(j)~
Permit
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the .Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date