HomeMy WebLinkAboutPermit Electrical 1990-5-29
~
I INSPECTION UN.
726-3769
Job Address 2800 Ga teway
Legal Description Gatewav r~all
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
Range
Valu, of Hork:
.\
INFORlIATION liNe
726-3753
Sq. Ftg. I"ain
~q, Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Pep,
-Fence Demo Change/Use
Dther- -
I-CJ
8
---
10.)
IJ
Shoooi no C~ntl'r
Owner' Emporium Inc.
Address 86776 t1cVey Hwy
Eugene, OR 97405
Construction lender
Bui1(iinQ Permit Info: Describe Work{Le., Build Single
Phon1146-9611 Family nesidence IHth Mtached GaraQel
Retail store @ Gateway Mall furnish and
install landscape & canopy lighting
Address
UDIGN II:.Ar~
(namel
Phone
(address}
(lies. no.-)
(exniresl
{ohane no..
Primary
Structura 1
El ectri ca 1
fiechanical
CONTRACTORS
(name)
(address'
11 ics. nn.'
(pxnlrpc;;'
(n~nnp nl" ,
Genera 1
Plumbino
Electrical L.R. Brabham, Inc., 10-0 West "Q" Street, Sprinqfield, OR 97477 20-87C 10/1/90747663;'
~'echanical
PLUJ.1BING
ELECTRICAL
MECHANICAL
NO.
FEF CH~.I'n
~~~ r~~ NO
J:' ~ I=" I JJiARG.E..
SQ. FT,
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
x
New circuits alts.
or extensions
22.50
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sna~p hp~tpr and vpnt
Storm Sewer
Of
amps.
Appliance vent
~"n~rtltp
SLitionary evap.
rr\O 1 pr
Vent fan with
~inale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and dud
Wood stove/heater
Sewer
Temporary Construction
Change in existing
r,,'S 1 d~PJ1rp
multifamily. COITrn. or
Tnt1uc:tritll
~Ja ter servi ce
CO~1./IND, FEEDERS
Install/alter/relocate
dic:trih. f"pdprc:
Of
amps.
TOTAL CHARGES
. WHERE STATE L,w REQUIRES
shall not be vali1 until the
Surcharge 5%
TOTAL CHARGES
1 .13 ISSUANCF OF PFR!UT'
23.63 TOTAL CHARGES
that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
1 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 nerformed 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 UO 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 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 7nl.055 will be used on this project.
IWIE(p1ease print) Larry R. Brabham SIGII^TURF.'I.. ~
FOP. OfF I CE USE OIIL y 1'/
Zone Type/Const. Units Sq. Ftg, Hain
Fire Zone Bedrooms Occy Load Sq. Ft!]. Access
Flood Plain Stories Occy Group Sq, Ftg. Other
AJf,' A.j~_. DATE 5/29/90
x
x
Value
Value
Value
x
TOT^L VALUATlOII
BUILDING PER~UT Plan Ck. Conm!lnd
Charges and ------------ 6S%/Blda Pj'r Fpp
Surcharges Plan Ck. Res
30%/Blda Per Fee
PLUI1BING PERMIT Fence
Charges and ------------
Surcha rges D~o
j- -
ELECTRICAL' PERI:IT -~-:~-- 'Sidewalk
Cha rges and
Surcharges A/C Paving
IIECIIANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charae (I.S~ '
Total Comb. Permit
TOTAL
:c931~
III
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
17 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. example- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrical/or ~
E. Square footage or valuation, etc.
1. example- 1250 sq, foot house, 5DO sq. foot garage
2. example- if new project. check-new - if addition,
check add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garllge
2. example ~ remodel existing garage into family room
3. example - convert single family residence into
res taurant (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 delJYs, 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 DUT ALL FEES AND
CHARGES DN 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.
V. FOR DFFICE OSE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
5- 30 -CfO
#- (7200
Permit Clerk ~~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
~
)
..