HomeMy WebLinkAboutPermit Electrical 1989-9-27
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jINSPECTION LINE
726-3769
Job Address < :.J.{ ) OC '
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CITY Uf SPRINllI'IEIIIr -. INFORlIATION LINE
COMBINATION APPLICATION/PERMIT 726-3753
ENERGY SOURCES: Sq. Ftg. 1.lain
Heat ~q. Ftg. Access.
Hater Heater Sq. Ftg. Other
New Add Alter Rep.
Range__ _~. _,,__~__.----=-- -Fence Demo Change/Use
ValuE of fl{'rk/t11 Other--
BUll(iinQ ~~l1ltit-InfO: Oeser be Work(l.e., Build Single
Familv nesidehce With Attached Garaqe)
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legal Description
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Owner ~ry;, C\ '0. <::...., "_ \
Address rn',?[') (::]nt O!4., l}!:te
~f)'l rt '1lf-) <-1~
construct;~der )
,
11J5T1Hd _ ~/-r!~C&Jr<:!
Address
DESI6N TEAI1
(namel
Phone
(addressl
(lies. no.)
(exniresl
(ohone no.l
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(addr~s.s.l
(l ics. no. I
(I?xnires)
(ohane no. I
Genera 1
Plumbina
Electrical ,96i\JtJYJRt/<.
'I "z.~ /3AI('/o(.1 Jtrll RD 'fF142.o-l'\3 cd
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fo.l(l'ch3nica 1
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PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FFF CHARGE NO
FFF CHI\llliE -1'0
FFF .!JJABli.E.
Each single fixture
Residence of
furnace/burner to
BTlI's
Relocated buildin9
(new fix. additional)
4.
SQ. FT.
New CirCUitS~1t e "'.'1 .:;C>
or extenSl0ns ti t1{P"
. ,Mh
SERVICES
Floor furnace
and vent
S.F. Residence
II bath)
Ouplex (1 bath) each
Additional bath
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
COffi1./INO. FEEOERS
Install/alter/relocate
d;<;trib. fppdprc;.
amps.1
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re!j j qe.nrp
multifamily, C01Tlll. or
Industrial
Water service
Of
amps.
,\
TOTAL CHARGES
WIIEnE STATE L.\l~ REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that the Electrical work be done bv an.
label has been signed by an Electrical
ISSUANCF OF PFRlIIT
~. ~ TOTAL CHARGES
Electrical C~ntractor. the electrical portion of this permit
Supervisor and returned to the Ouilding Division
I 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 oerformed shall be done in accordance with the Ordinances of the City
of Spri n9fi e 1 d and the Laws of the Sta te of Oregon perta i ni n9 to the work descri bed here; n, and tha t rw OCCUPAIKY wi 11 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 701.055 will be used on this project.
Units
Occy Load
Occ.y Group
S It;IIATURE
FOr. OFFICE USE DIlLY
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
~
DATE#
x Value
x Value
x Value
TOTAL VALUATlOtl
llAI-lE(please print)
J r:: ~Te.(^,
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
t1a;n
Access
Other
BUILDING PWIIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Pflr Fee
Plan Ck. Res
30%/BldQ Per Fee
Fence
'Systems Development
Charoe (1.5~) '---..
.....
PLU'1BINGPERMIT
Charges and '....
Surcharges ...
---
/'
ELECTRICAL PERIHT
Cha rges and
Surcharges
Oemo
'Sldewa 1 k
'1ECHANICAL PERMIT
Charges and
Surcharges
A/C Pavin9
____________, Curb Cut
I
Total Comb. Permit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
!II.
I. Applicant to furnish
A. Job Address . ~ '.......'" '
B. legal Description '. "
I. example- Tax Lot 100. Lane County Map Referenc~
11 03 43
2. example- Lot 1. Block 3. 2nd Addition to
spnngtield Estates ,,' "
C. Name, etc. of owner and'construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air QdS
2. exall!Ple- waterheater/electrical/or solar ,
E. Square footage or valuation, etc. I
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if additi~n.
I . check add. ete.
F. Building pennit information: i.
1. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examyJe - 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 TEAfl AND CONTRACTORS
To avoid design or construction delays. Building
Division.Staff must be able ~orcontact 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 \, I
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult t~e
full schedules
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 authori2ed
_ .to....."ign the electrical label. - ,
Applicant to sign and date _._-__-r.;.~..:
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 1s 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
P,rnit Cl~ q 1i/!1
PROJECT CONDITIONS TO BE SAHSFIED ,BEFORE OCCUPAricy:
~ . ."
. .'
Pennit applicant exempt from r'egistration with the Builder,is Board because:
Additional Project Information:
PLANS REVIEWED BY:
-.
name
signature
date