HomeMy WebLinkAboutPermit Electrical 1988-10-28
INSPECTION LINE
726-3769
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
t4ater Heater
Range
Valu€ of Work:
.
INFOR/IATIDN lINl
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A I ter Pep.
-Fence Demo Change/Use
Other - -
~
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-....::.
Job Address ~G-('... $1-. ~h-.erOV<2."'-r~
Legal Description Wd (~ R,~ - ;).O-l-h stY=!_
(<.v,r.~h'wl\ no,,) ~'Ir.w- AJ^. 105;).0
'- . -l /"
Owner '.QrQ'{f" .5~ HI~"; 7Jiv;!>,,,,,,
Address ;AI LlI G. I ~./-/., sr.
G~ ()~ Q7L/-og
Construction Lender
Phone'8'.-JlJ, BuilriinQ Pennit Info: Describe Work.(Le., Build Single
~ ~ /~/I Familv Residence With Attached Garaael
Ath" CI.,.<LJL GcdCrp.u
I
)JiWJ -['mal" &...;"Q
~Ch, 'A' ~
-S<z.y v I;~
0>\
-
Address
UlSIGN TEAI~
(name)
Phone
(address)
Mechanical
CONTRACTORS
(name)
{address}
;
(lies. no.) {exoiresl (ohane no. )
.
/ALlf". tl00 '*
J .
r...
t).
(1;c<;..no.) (exoire<;.' (1)~(lnP !'In \
Primary
Structura 1
Electrical
General
~o. 130li l:J.toi'c'K SoJ'bl- UG.-IP 10'675: .:J..-<l-'ir?
9730'1
399-7009
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO.
Each Single fixture
FEE rHARr.F Nn I I <<< I rI-lAR~1=' fin I I 1='~1=' I rl-lAru:1='
Residence of furnace/burner to
SQ. FT. BTU's
New circuits alts. Floor furnace
or extensions and vent
..:l SERVICES /ooA ;ld,~ <f.5.5!!. Recessed wall
Snru"p hp,'ltpl" ;'Inri ....pnt
Relocated building
(new fix. additional)
S.F. Residence
(l bath]
Duplex (1 bath) each
Additional bath
Storm Sewer
Of
amps.
I
I
I
I
I
I
I ;; ::l5
I
#1./7.),'5'
I Appliance v~---
SPOilri\tp
I Stationary evap.
cooler
I Vent fan with
s;nole duct
I Vent system apart from I
hp<lti.,q or A.C.
Mechanical exhaust
hood and rllJrt
Sewer
Temporary Construction
Change in existing
rp$.;r1J'Jl("P
multifamily, camm. or
tnrllJc:.trial
~Jater service
COMM./IND. FEEDERS
Install/alter/relocate
r1ic:.trih. fpprlprc:
Wood stove/heater
I
I
I
I
I
VIe,
Of
amps.
.5'70 &<....J.t:Wf}
ISSUANCE OF PFR!\IT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an.-Electrical Contractor, the electrical portion of this perTilit
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 ;s 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 NO 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 ORS 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.
NAt.IE(please print)
R'l t,k ,(
BLAl\JS~~tJ SIGNATURE fi.;Af ~DATE IO-2&-~
FOr. OFFICE USE OIIL Y
Sq. Ftg. tIain
Sq. FtO. Access
Sq. Ftg. Other
,.
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
Plan Ck.
____________ .,ill/RIde
Plan Ck.
30%IBldo
I Fence
I D~mo
Lf5.0'll I'S1dewalk
_Uh_ ..:)~~51 AIC Paving
I Curb Cut
I
..'
Conrn!lnd
Pj"r Fpp
Res
Per Fee
Systems Development
Charpe ('). 5~) .
PLUI~BING PERMIT '.'
Charges and..-".
Surcharges
ELECTRICAL PERmT
Charges and \,;\
Surcharges
I
ITotal Comb. Permit
I
I TOTAL
L( 7, ~5'--1
MECHANICAL PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
,PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
II oj 43
2. example- Lot 1. Block 3. 2nd Addition to
Springfield Estates
C: Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examflle- waterheaterjelectrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examyle- if new project, check-new - if addition,
check add, etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garlJge
2. examole - remodel existing garage into family room
3. exa~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
fu 11 schedu 1 es
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. ---
III. 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.
I'~~~~
\ 0 r 2--~ - ~
V. FOR OFFICE USE ONLY
Permit Cl erk
C12-/
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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