HomeMy WebLinkAboutPermit Electrical 1988-4-18 (2)
Job Address"'- A. I
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Legal Description '<:( '16 ~ L.cn.-,;,
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Owner /v\ ':l~ ~o b.s U
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I INSPECTION 'LiN'E
726-3769
Address
Construc~ Lender
~-- .
Add~--.
U~luN flAM (name)
Primary -'
S~rIu;al
EAal
Mechanical
CONTRACTORS
General
~
'"Plumolnb...
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enamel
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Electrical ~ .Ah.I(t,~
~l L~1t
~an;c'rr
PLUMBING ~
'7FF nMRr,F
Rel ated building
(new ix. add;tional)~
S,F, Ii idence /
(] bath
Duplex ( bath) ~ch
Additional bat~
Water
NO,I
Sewer
Storm Seier
/
/
/
/
\-\v,
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be val;~ until the
Zone
Fi re Zone
Flood Plain
BUILDING PERfIIT
Charges and
Surcharges
PLU!~BING PERMIT
Charges and
Surcharges
ELECTRICAL PER!HT
Cha rges and \ }.
Surcharges .....,
MECHANICAL PERMIT
Charges and
Surcharges
-~
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INFORllATION UN"
726-3753
Sq, Ftg, !,Iain
~q. Ftg. Access.
Sq, Ftg, Other
!Iew Add Alter Pep,
--Fence Demo Change/Use
-Other - -
,
1
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00
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CITY U, SPRINGFIELD
COMBItlATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
Valu, of Hark:
Phone
BUildino Permit Info: Descr be Hork(i,e,. Build Single
Familv ~esidence With Attached Garaae)
t::,..,. _: -: -/ ~,,-.t...~
,q/./: l. k?U~
~
Phone
(address)
(exoiresl
(ohone no.'
flies. no.)
~US- I Sl.OO
vl/I'b
(addres5 )
(1 iC5. no.)
(pxoi rpc;)
(ohonp no, ,
~ ....-< -'-< ... .....r
. ,
3<'1.2~
(J 0"- d:, "-4
q ..,010 r
(.-""c.
to,I_f'1 <;,1..2.
:l!A-II?... ~
.
Temporary Construction
Change in existing
l"P~ j n..E:nrp
multifamily, comm. or
Tnrludria1
MECHANICAL /
I rl-l~ _1Il[1 I II ~~~
" furnace/burner t~ ,j
\ BTlJS
oar furnace /
an vent
Rece ed wall!
Sn,cp p'tPJ1,nrl vpnt
Appliance ent
seoarat~
Stationam vap.
roolpl" r
Vent f7 wi th
sinole uct
Vent sy tern ap rt from
h~atin or A.C.
MechanIcal exha t
hond ahd duct
Wood jtove/heater
/
/
/
/ ISSUANCE
TOTAL CHARGES
I r'JARG.E.
ELECTRICAL
Nn I >>>
Residence of
SQ, FT.
New circuits alts.
)<, or extensions u,~
-
.. SERVICES
Of
amps.
COMI.I./lND, FEEDERS
Install/alter/relocate
n;c:trik fppdprc;
Of
amps.
le Electrical work be done by an' 'Electrical Contractor, the electrical portion of this pemit
s been signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
I HAVE CAREFULLY EXA~1INED 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 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 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 comoliance with ORS 7nl.055 will be used on thi~ject.
HAt,IE(please print) M"Q..'\-".j) <y ,..;_t_~ . __ ,u_,_ SIf,!IATURE ??1~J tI~ DATE 11--/3',)-1-'
FO~ OFFICE USE mil Y
Sq. Ftg. riain
Sq. Ftg. Access
Sq, Ftg, Other
x
x
TOTAL VALUATION
Plan Ck. Comm/Ind
65%/B1 do Ppr Fpp
------------ Plan Ck, R"es
30%/Bldo Per Fee
Fence
Demo
<;;(;;t" ~ I Sidewalk
----/~-1-3---1 A/C Paving
I Curb Cut
------------
I
Systems Development
Charoe (l,5~) ,
{;;/Cc:. ~c./
I *" I~/ le..-
I
I
,';<D
ITotal Comb. Permit
I
I TOTAL
,
;( 3. '63
.--.
-,.;:.-- ,
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- .;.....-
.
COMBINATION APPLICATION/PERMIT (CAP)
"
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2, example- Lot 1, Block 3, 2nd Addition to
,prlngtield Estates '.
C. Name, etc. of owner and construction lender
O. Energy Sources _'
1. exam~le- heat/electrical ceilin~/or forced air Qas
2. exa~le- waterheater/electrlcal/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. examele - construct single family house with an
attached gan~ge
2. examele - remodel existing garage into family room
3. examele - 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
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 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:
1
.
PERMIT VALIDATION
'rl*
<0>-e.t'- II 3 ~ t/-
,->,
Permit Clerk
a,G?~
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Permit applicant.exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
date