HomeMy WebLinkAboutPermit Electrical 1990-4-6
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IIilSPECTlON LINE
726-3769
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CITY OF SPRINGFIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
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INFORllATlON LINE
726-3753
SQ. Ftg. I,'ain
~q. Ftg. Access.
SQ. Ftg. Other
Hew Add Alter Rep.
-Fence Demo Change/Use
---:-Other- -
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Job Address. 2800 Gatewav Blvu Sorirjofif>lri
Legal Description \f]{) ::\Q{~()() tJ-:J..3CD
Ran!1e
Valu, of I'/ork:
Owner' General, Growth'.of California
. . .u,.,. ~-#. _
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I
Buihiinq Permit Info: Describe Work( Le..
Famn'/ nesidence Hi th Attached (jaraQe)
Build Single
Extend power &
Emoorium Slab.
telephone conduits under
Address
DESIGN lEAI1
(name)
Phone
(address'
flies. no.)
(exoires)
{ohone no. I
Primary
Structural
Electrical
t1echani ca 1
CONTRACTORS
(namel
(address\
(1 ics.no. 1
(exoiresl
(ohane no. \
Genera 1
Plumbino
Electrical
L. R. Brabham. Inr.
In-~ WP~t Q ~tr~~t ~nIingfield. OR 97477 7~7-6h3A
#20-87e exp 10/01/90
~1echanical
PLUI,IBI NG
ELECTRICAL
MECHANICAL
No
FFF r"~ yo
F' , J:IJARliE.-'l(l
:TI- J:IJARliE.
SQ. FT.
furnace/burner to
BTlI's
Each Single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 'bath) ,
Duplex (1 bath; each
Additional bath
SERVICES
Recessed wall
So~cP hp~tpr ~nrl vpnt
Storm Sewer
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dur.t
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rps.i Q~nq'
multifamily, camm. or
TnrllJc:.t.rial
Water service
"
Of
COMI1./IND. FEEDERS
Install/alter/relocate
r1ic:trih_ fpprlprc;.
Of
amps.
TOTAL CHARGES
~iERE STATE L~W REQUIRES
shall not be valiJ until the
I SSUANCF OF PFRtII T
TOTAL CHARGES I, TOTAL CHARGES
that tile Electrical work be done by an. Electrical Contractor. the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 Drec,:lOn pertaining to the work described herein, and that UO OCCUPArlCY will be made
of any structure without the permission of the Buildina Division. I further certify thnt my re!1istration ",/ith 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 complia~ce with ORS 7nl.055 will be used on this project.
S IGIIATU~ 1~ 4. C\M..'"1;:-
IWIE(please print)
Tim I nnt7
DATE 1'li/q(J
Zone
Fi re Zone
Flood Plain
Type/Con,t.
Bedrooms
Stories
Units
Occy Load
Dcc.v Group
FOr. OFFICE USE DIlLY
S<1. Ftg. f1ain
Sq. Ft!J. Access
Sq. Ftg. Other
'--J
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ .,ill/Bldo P.er Fee
Plan Ck, Res
30%/Bldo Per Fee
Fence
Systems Development
Charqe (1.5~) ,
PLUI~BING PERMIT
Cha rges and
$urcha rges
D~mo'
ELECTRICAL PERIHT
Cha rges and
Surcharges
jl MECHAN I CAL PERMIT
Charges and
Surcharges
~..:0.Q___ 'Sidewalk
I. k.~ A/C Pavin9
Curb Cut
Total Comb. rermit
TOTAL
16{8. G:3
'.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A: Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County ~lap Reference
17 oj 43
2. ~xam~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exalT!Ple- heat/electrical ceiling/or forced air qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. examDle- 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 garoge
2. exam~le - remodel existing garage into family room
3. example - 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 TEN1 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. I f the item( s) to be ins ta 11 ed a re 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
O. 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 OFFICE OSE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
"
-. ..
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/6 7'
~~
\ -)'-0 -qO
Pennit Clerk
d~
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Permit applicant exempt from registration with the Builder's Board because:'
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date