HomeMy WebLinkAboutPermit Electrical 1990-1-10
ValUE O(\.'i(\ ')
Buihi;nQ PEt"nTit Info: Describe Work(Le. t Build Single
Familv nesidence I.lith AttachBcl l1araoel
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CO~1./IND. FEEDERS
Install/alter/relocate
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Of . amp~~
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AnO c04m.n
) D tfPn1Jl QtiJ.JVluIl1J /6.00
TOTAL@ARGES () < ~CfY7. 00 TOTAL CIIARGES
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] INSPECTION LINE . CITY OF SPRINGFIELD
726-3769 CmlBINATION APPLICATION/PERMIT
Job Addres~ '-~~~ \ ~ h rr'rO Q \ "('~ l. ^) ~~;~GY SOURCES:
L~9~ Omription /'7()3:JR{}() {)()qrYi C\ l'/ater lIeater
:)trtLJ. ,-;)( ;(,/1./1) t!DnUll.M.dIJ'b. Q" Range
O:ner \'\\0 t \Q~ \\\r'\\ 0 ~ ,
Address~CJ~\ &, ~~ . Phone
\(Q~r\l ~00) (~-k. l\\ncYJ8.
Construction lender. . (\
.
Address'
DESIGN TEAr1
Phone
{address'
(lies. no,)
(name)
Primary .'
Structura 1
Electrical
f1echanical
CONTRACTORS
'{namel
(address'
(l ics. no.'
Genera 1
Plumb;nq
Electrical
R IS f"[)pf'1fl Lc.J
~lechanical
PLUIIBI NG
ELECTRICAL
NO.
FEF r11ARr,E ,n
n'1= rHAR(.;F NO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
~ New circuits a1ts.
r.J ' 'or extensions
JJSC
. I
S.F. Residence
(] bath \
Duplex (I bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
r~sirjenc.p
multifamily, comm. or
1~~4\tirl
I opvr-fV (') . amps.
11~1
~ater service
Sewer
Storm Sewer
n
, t''\
TOTAL CHARGES
WHERE STATE L'I/ REQUIRES that tile Electrical work be done by an..Electrical
shall not be va1iJ until the label has been signed by an Electrical Supervisor
J.
INFOR/lATION L1Nl
726-3753
Sq. Ftg. '.lain
~q. Ftg. Access.
Sq. Ft9. Other
Ilew Add A Iter P.ep.
-Fence Demo Change/Use
-Other- -
(exnires)
- (ohone no.
(pxnir~~1
(nhon~ no.'
t1L.{~1 ~C!J)'-
MECHANICAL
I ~~'F" n"4IU:~
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
So~c.P hp~tpr ~nrl vpnt
Appliance vent
seoa ra t.~
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood and dud
from
Wood stove/heater
ISSUANCF OF PFR!11T
Contractor, the electrical portion of this permit
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 rw OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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
:'1-\ :ub~~N1~mIOye w 0 are i Pl~O~S 701.055 \.fill be used on this project.
~int) Jt~SIr,IIATU'RE DATE /--/6-70
FOr. OfFICE USE DIlLY
S~. Ftg. t1ain
Sq. Ftl]. Access
Sq. Ftg. Other
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Units
Occy load
Occy Group
Stories
BUILDING PERfl1T
Charges an~
Surcharges
Plan Ck. Comm/Ind
____________ ~/Blda P~r Fee
Plan Ck. R'es
30t/Blde Per Fee
Fence
PLU'IBING PERMIT
Charges and
Surcharges
D~mo
ELECTRICAL PERmT
Cha rges and
Surcharges ~
MECHANICAL PERMIT
Charges and
Surcharges
01B~W
Sidewalk
A/C Paving
Curb Cut
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charee (1.5%) .
Tot~l Comb. rermit
TOTAL
4 \ r'/.5~
r
-
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 63 43
2. exa~le- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. examole- 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. example - construct single family house with an
attached gar~ge
2. examole - remodel existing garage into family room
3. examole - 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 TEN! AriD 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 itern(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 SATISFIE~ BEFORE OCCUPANCY:
~
.
..
,
I
PERMIT VALIDATION
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{ (3 715:
Permi t
Cl.,e:f(DQ)
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
,
date