HomeMy WebLinkAboutPermit Electrical 1989-12-6
Owner. /f(;Jtr-S ~ (I L
Address ')-~ VI +I- i l/fDI? Or! lie,
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TY F SPR NGFIELO
COMBINATION. APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Nater Heater
Range
ValuE of Hork:
Sq.
~q.
jINSPECTION LINE
726-3769
Address
Ut~ tliN I tAf1
Phone
(address'
Bull(;lnq Permit Info: DescribeWork(Le..
Family R.esidence Hith Attached Garaqe'
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Build Single
Phone
(name)
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{ex:S~~(YL U {~no~ no-.~
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Construction lender.
Primary
Structura 1
Electrical
t1echanical
CONTRACTORS
(name)
{address \
(1 ics. no. \
(pxoires)
(ohane no. \
Genera 1
Plumbino
Electrical
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/61J1CJ 2--
~ z. 7~~5J7
~lechanical
PLUIIBI NG
NO. FEF CII!JJlGL Jl(l
Each Single fixture
Relocated building
(new fix. additIonal)
S.F. Residence
(1 bath)
Dup 1 ex (l ba th) each
Additional bath
~Ia ter service
Sewer
Storm Sewer --'
ELECTRICAL
MECHANICAL
SQ. FT.
cr~J:ll8.r.r No
'=t:'t:' n1'iR.GL
Residence of
furnace/burner to
BTlI's
New circuits alts.
or extensions
Floor furnace'
and vent
SERVICES
Recessed wall
So~rp hp~tpr ~no vpnt
15100
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
het1ti....o or AC.
Mechanical exhaust
hood t1nd dud
Chan e .n existing
res] en e
multiltmily, comm. or
Tnouc;trial
Of
amps.
COMI.I./IND. FEEDERS
Install/alter/relocate
rli~trih. fppdpr~
Wood stove/heater
Of
amps.!
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
. TOTAL CHARGES
that tile Electrical work be done by an. Electrical
label has been signed by an Electrical Supervisor
ISSUANCF OF PFR!1IT
/ t;,(fA TOTAL CIIARGES
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 nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore(]on 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 thilt my registration \'lith 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 OP.S 7nl.055 will be used on this project.
.Su..rVVi ~ ljuhi d"..", hl A
IWIE(please print) JeSS... L. 111"".......... J., SIGIIATURE.~ /" ~~
FO~ OFFICE USE ~Y
~
S~. Ftn. IlaIn
Sq. Ft/]. Access
S~. Ftg. Other
DATE
/~ -& -,f'Jl
x
Value
Val ue
Value
Zone
Type/Cons t.
Bedrooms
S tori es
Units
Oeey Load
Occy Group
x
Fi re Zone
Flood Plain
x
TOTAL VALUATION
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________~/Bldo Ppr FpF'
Plan Ck. Res
30%IBldQ Per Fee
Fence
Systems Development
Charoe (1,51) .
PLU!iBING PERMIT
Charges and
Surcharges
D~mo
__Lfi,-QQ___sldewalk
,7'-
J A/C Pavi ng
Total Comb. rermit
ELECTRICAL PERIIIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
I fi, '1;;-
Curb Cut
.
.
.
~
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
]1 oj 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates .
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceiling/or forced air oas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add I ete.
F. Building pennit information:
1. examyle - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyle - 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 TEN4 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.
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.
Applicant to Sign and date
Whenever possible, the initial application will b~ 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.
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.
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IV.
V. FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder'S .Board because:
Addi ti ona 1 Project Infonnati on:
.
PLANS REVIEWED BY:
name
signature
date