HomeMy WebLinkAboutPermit Electrical 1990-2-14
Job Address
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I.. CITY OF SPRINGFIELD . INFORlIATlDN UNt
COMBINATION APPLICATION/PERMIT . 726-3753
{'-:f\-r::- E!IERGY SOURCES: ...-/ Sq. Ftg. I"ain
\. .LU 0, I 'Q'11 Iv ileat _______ ~q. ~tg. Access.
(. \ \R'I~te, rHea Sq. Ftg, Other
flew Add Alter Rep.
--Fence Demo Change/Use
ValuE ofr)olh ") ~er--
Builtiina Pe~lft Info: Describe Work(i.eo. Build Single
Familv nesidence Uith Attached Garaae).
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jINSPECTlON LINE
1726-3769
Legal Description
Owner T\\t\\')\Q [)) Vrl.- 14(0-
::~E" W0%'l' W.t71J7
Address
DES I GN TEAI1
(name)
Phone
"(a"ddress)--'
(1 ics. no.)
(exoiresl
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(1 ;('<;, n(\~)
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(.Qhnn". nn. \
Genera 1
Pl umbi no
ElectricaN.R. Brabham, Inc., 10-D West "Q" Street, Spf1d., OR 97477 20-87C 10-1-90 747-6638
~1echan;cal
PLUIIBI NG
ELECTRICAL
FEE rHARGF Nn ~J:'r: r"ARliE. NO
Residence of
SQ. FT.
\ New circuits alts. rD!1S)
or extensions
SERVICES
MECHANICAL
NO,
r:E.L .QJARlil
Each single fixture
furnace/burner to
BTU's
Relocated building
(new fix. additional)
Floor furnace
and vent
$.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Recessed wall
~nnrp hp~tpr ~nrl ~pnt
Sewer
11 0\s~@L~cOh,a. ARt=)~
. 1'" '
Temporary Construction
Change in existing
ree;. i qr.rlCP
multifamily, camm. or
Industrial
Storm Sewer
Of
amps.
Appliance- vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
Water service
COffi1./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of amps.
~~ \':),W
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
c5y(..),.~
ISSUANCE OF PFR!lIT.
TOTAL CHARGES
that the 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 EXAMINEO 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 oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAHCY 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.
'i ~- L Af\lT'2.. SIGrIATURE~ ~ti Q,'S DATE 2.J lL.j J '1D
llAJ.1E(please i>rint) _ I \ M
FOR OfFICE USE DIlLY i:.S
Zone Type/Canst. Units Sq. Ftg. riain x Value I
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sg. Ftg. Other x Value
TOTAL VALUATION
BUILDING PER~IIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr F~e
------------ Plan Ck. R-es
30%/Bldo Per Fee
Fence
Systems Development
Charqe (1.5~)
PLU'1BING PERMIT
Charges and
Surcharges
,
D~mo
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
_dHd .W
(lo .t~
Sidewalk
AIC Paving
Total Comb. Permit
TOTAL
I
i 33<(;,~
Curb Cut
J
,.
COMBINATION APPLICATION/PERMIT (CAP)
. "-- . . ,---- - - .
I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
17 03 43
2. example- lot 1. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction" lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 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 garage
2. example - 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 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permi t
.
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PERMIT VALIDATION'
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Permit applicant exempt from registration with the Builder's Board because:
Additional Pro~ect Information:
PLANS REVIEWED BY:
name
signature
date