HomeMy WebLinkAboutPermit Electrical 1990-7-3
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INFORllATlON liNt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other- -
J]
.i)
-
t}J
~
Address
Phone
BuilriinQ Pernlit Info: Describe Work(i.e.. Build Single
Familv nesidence With Attached Garaoel
j:; lef',
Construction Lender
Address
Dt:>rGII TEAI1
(name)
Phone
(address)
(lics.no.l
(exoirflS\
{nl'loop no. I
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name) ~
(address)
(l its. no.)
(p~l)irp,,\
(l1hnnp no. \
Genera 1
Plumbina
Electrical.
c..e,.c/ ~ 1'L-TZiN
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;23d, W ~tl- ~ ~
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;;;. '{ -~S-c.
lo/q(J
41..r -0/0/ &S"""'
~'echanical"
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PLUI1BING
ELECTRICAL
MECHANICAL
NO.
FEE" rHI\Rr.F NO
~~L..t.l:iAB.G.E. "NO_
I=~J:' f'1ARG.E..
Each Single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
~Iater service
SERVICES
lomcA(\(t{YlPL -
Temporary Construction
Change in existing
res) rtencp
multifamily, COrml. or
Inrluc;trial
Recessed wall
~n~rp np~tpr ~nrl vpnt
lSG:
Storm Sewer
Of
amps.
App 1 i ance. vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
nnnn ~nrl /'illrt
Sewer
COffi1./INO. FEEOERS
Install/alter/relocate
di<;trill. J!~r,
Of )J {-.l::--, amps.
Wood stove/heater
e)
1I~.3)
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'l~ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
'! 'Uo, gz
ISSUANCE OF PFR!lIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information hereon ;s 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 tlO OCCUPAUCY 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 OP.S 7nl.055 will be used on this project.
SIf,IIATURE ~~tJi~ ~
Ke """th U t1 ~ ~d to..,
OATE 1-3-<tQ
IlAfolE(please print)
FO~ OFFICE
USE OHLY
Sq. Ftg. r1ain
Sq. Ft9. Access
Sq. Ftg. Other
x
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
,
Value
Value
Value
TOTAL VALUATION
BUILOING PERflIT Pl an Ck. Conmflnd
Charges an~ ------------ 65%1Bldo Per Fep
Surcharges Plan Ck. Res
30%lBldo Per Fee
PLur1BING PERMIT Fence
Charges and ------------
Surcha rges D6R10
ELECTRICAL PERI:IT _nl~~-,~ Sidewalk
Cha rges and
Surcharges .~A A/C Paving
11ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charoe (1.5~)
Total Comb. rermit
TOTAL
(q{p (3 a
.
.
.
- .
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. exampl~- Tax lot 100, lane County Map Reference
17 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin~/or forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project, check:ruew - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - 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 TEM1 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
8. 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=-= - - - u
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 penmit is issued for his
signa ture.
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. '
r;~t3-qo
#(r')W2-
Permit Clerk
<"'"
V. FOR OFFICE USE ONLY
/X;J)
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from regi strati on with the Builder's Board because':
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date