HomeMy WebLinkAboutPermit Electrical 1990-6-26
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jlNSPECTION LINE
726-37,,9
,
CITY llF SPRINt;FH:U:
COMBINATION APPlICATIOo/PERMIT
.
Job Address
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E!lERGY SOURCES:
Hent
Hater Heat?r
Range__:....--_-=- ...n
Va 1 U~ (of l'lurk:
Legal De~cr;pt;on
Owner, ?/O Ii Jf.bd
Address ~J!J/)I rlLus~ Ln,
f/{jJ\(MvY H7 J I
INFORllATION lH,"
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftq. Other
flew Add A 1ter Pep.
-Fence Demo Change/Use
Other- -
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V
0-
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Phon 'llH )-/) l..BuihlinQ Pennit Info: Describe Work.{Le.~ Build Single
f'-l'1 r":::J,-( ~mily Jl.es'!dence Hith Attached Garaae)
Construction Lender.
- l e,<..;>
t:::- '
Address
I OI:.~l{jN H.Af~
Phone
{addressl
(lies. no.)
(name)
Primary
Structural
E1ectricalt! /lg.rL~~AJ AL;. fj/I72";~
Mechanical
CONTRACTORS
f -. ~ -. - J 1,_"7~~
...~~pN' 7/=:1 ~,~ :
nh,-2"",20-Zt2t..-
(l ies. no_)
(name)
(address)
Genera 1
Plumbino
Electrical
~1echani ca 1
PLurlBI NG
ELECTRICAL
NO.
FEF r.HARGE" NO
FFC ~ NO
Each single fixture
Residence of
SQ. FT.
Relocated building -
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(J bath \
Duplex (1 bath) each
Additional bath
SERVICES
J Temporary Construction 15:'*
Change in existing
r~<;ideJ1ce
multifamily, COIl1t1. or
Tnrluc;;trial
/ Of hPL> amps. 7S.-
CO~1./IND. FEEDERS
Install/a1ter/relocate
di~trib. feedprc;;
"2 Of 7-::i?5 amps.~~
I '2~ -ps
Water service
Sewer
Storm Sewer
(exoires1
(ohane no.)
-" - ~<""- ~/
//)-1- '10
(exoire~1 (ohone no.)
MECHANICAL
1=1=1=' nlAB.G.E..
furnace/burner to
BTUt s
Floor furnace
and vent
Recessed wall
~na~p hpatpr ann vpnt
Appliance. vent
~eDarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnnrl and nuct
Wood stove/heater
ISSUANCE OF PFR!1IT
TOTAL CHARGES TOTAL CHARGES ~:;.?~~ TOTAL CHARGES
, WHERE STATE L\H REQUIRES that the Electrical work be done by an, 'Electrical Contractor, the electrical portion of this pemit
shall not be vali1 until the label has ~een signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED ,he 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPAr~CY 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 ORS 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.
IlArIE(p1ease print) YIr~p8Z- ']. ;,/1't1't.efl>IJ SIGrIATUREA~~ 2-1J.rS DATE 1,-1-(. -<;0
/ , FOr. OrFICE USE OIll Y
Type/Const. Units So. Ftg.
Bedrooms Occy Load Sq. Ftg.
Stories Occy Group Sq. Ftg.
Zone
t1ain
Access
Other
Fi re Zone
Flood Plain
BUIlOING PERfllT Plan Ck. ConmlI nd
Charges and ------------ 65%1Bldo PPr Fpp
Surcharges Plan Ck. R"es
30%lBI do Per Fee
PlUf~BING PERMIT Fence
Charges and ------------
Surcharges Demo
ELECTRICAL PERlHT 1.8..7-S~ 'Sidewa1k
Charges and --- --=------
Surcharges ?-fS AIC Paving
MECHANICAL PERMIT, Curb Cut
~ Charges and ------------
Surcharges
1
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
CharQe (1.5~) ,
!otal Comb. Permit
I
:TOTAl
I /::J6.&8
.
-
, ,
I. I II ~B ..
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. lane County Map Reference
II uj 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
.1. example. heat/electrical ceilinq/or forced air Qa5
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examjple- if new project. check-new - if addition,
cneCk add, etc.
F. Building permit infonmation:
1. examole - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exa~le - 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. ---
Ill. 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. '
\ I'
115/t)
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl i cant exempt from regi strati on wi th the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
..:
date