HomeMy WebLinkAboutPermit Electrical 1998-6-4
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I INSPECTION LINE CITY OF SPRINGFIELD
726-3769 . CDMBIilATION APPLICATION/PERMIT
Job Address 3d3o . (oj ct.lO...4JAvj~ ~~;~GY SDUR(ES:
legal Description ~ Water Heater
Range
ValuE of Hark:
."
INFOR/lATIDN UNL
726-3753
Sq. Ftg. I,'ain
~q; Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter pep.
-Fence Demo Change/Use
Other - -
~.
.N
-
L
Owner' j(......... +u..ciu....- .cl-~.1l
U
ct. ~Gk
Address
Phone
Bul1Glna Pernlit Info: Describe Work{i.e.~
Familv nes;dence With Attached Garaae)
T~,^^.p '71hr,
Build Single
Construction lender
Address
DESIGN TEAr~
(name)
Phone
(address)
flies. no.'
(exo;res)
(ohone no. J
Primary
Structural
!+-
00-).""'"
Electrical
-,
Mechanical
CONTRACTORS
(name)
(address)
11 lcS. no.'
(pxo;rpc;,)
(ohMP no.)
General
Plumb;na
Electrical
f-I--~I'-T&N
Et..,sl,
f.<J, 8v,/')<:J i?
~'
)..t../..{,&"L
iO/90
4~-'I'I~
~1echanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
FEE CHARr.F Nn
':E.L.ldlARliE. NO
~~L .cHAEUiE.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts. .
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
~n~~p hp~tpr ~nrl vpnt
J
Temporary Construction
Change in existing
re<>.i d_e..nce
multifamily, comm. or
Tnrlll"tri~l
.,.... .
15'- 7<::)
Appl iance' vent
o;.eoarate
Stationaryevap.
cooler
Vent fan with
o;.inole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnnr! and r!ur:t
Wa ter servi ce
Sewer
Storm Sewer
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
rlid.rih. fppr!prt>
Wood stove/heater
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,'lj REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
ISSUANCf OF PFR!1IT
/ ,C:; 2E- 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 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 NO OCCUPAIKY 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 comoliance with ORS 7n1.055 will be used on this nroject.
NAr.IE(please print) ()~_ at,,- ~~ ......\ \to,,", SIGIIATURE '--t\ ~ \~ ~
FO~ OFFICE USE DilLY
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
DmG- a.- ~e,
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occ'y Group
x
Value
Value
Value
Fire Zone
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERMIT
Charges anc
Surcharges
Plan Ck. Comm/Ind
65~/Bldo P~r Fpe
Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
CharQe (J.5~)
PLU'~8ING PERMIT
Charges and
Surcha rges
D~mo
ELECTRICAL PERI~IT
Charges and
Surcharges
_ JS ,no
:-7S
Sidewalk
A/C Paving
To~al Comb. rermit
MECHANICAL PERHIT
Charges and
Surcharges
Curb Cut
,
TOTAL
,
~IS'/S
.
-
.
.
~
oJ
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
17 03 43
2. examEle- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
"I. example- heat/electrical ceilin9/or forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, SOD 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. 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 3D3 (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 SCHEOULES
. O. 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.
O~
,
~
, .
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date