HomeMy WebLinkAboutPermit Electrical 1990-5-11
Job Address ::SLl 27 (-;trl--e lAlO ',\
, Legal Description 1'1 b"3 Z 22 f) J
s.....f-
-01 L.j DD
CITY Uf SPRINGFIELD
CDMBIIIATIDN APPLICATION/PERMIT
E!IERGY SOURCES:
Meat
t~ater Heater
.
I NFORllATION .l' Nl
726-37,3 '
Sq. Ftg. ','ain'
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
"1 INSPECTION LINE
726-3769
.
Owner --::::r'K's
Address 101 () tWs..f ? b I () ,5ou1l^
':Sa)+- !'C/,Iu!';fu J IA+qJ
Construct;Qn lender d
9/)/-
Phonea'"7Jj..JJ--~~ulldlnQ Pennit Info: Oeser be \~ork(;,.e"
-/ /1 -':l'2IfJamilY Residence Hith Attached Garaoe-l
-2'4/1 -
Build Single
~
\)
C>
IQ
--J
Range
Valu€ of Hark:
Address
DES I GN TEAl,'
(name)
Phone
(address}
(l;es. no.)
(exn;res)
(chane no. '
Primary
Structural
Electrical
C'l~iiiful Cle,tn L
?kit/) !-to. (Ii) W lLd '
.2JJ7/~
2/r2/'1 f
,~
Ir/if 7 -12C( 2.
Mechanical
CONTRACTORS
(name)
(address 1
(1 ice;_ 00_'
{exnir",,,\
(nnnl"lp nn
General
Plumbina
Electrical
~lechan;cal
PLUI,'B I NG
ELECTRICAL
MECHANICAL
NO.
FFF 'rHARGE ."
~~c 'r~A~r.~ NO
~!:,C r~ADr.~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building -
(new fix. additional)
New circuits alts.
or extendnn<:...~
?2- fJ 2lJh
Floor furnace
and vent
S.F. Residence
(j bath I
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp ~p~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance' vent
seDaratp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
hea t i nq or A. C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
rp<;jdence
multifamily~ comm. or
Tnrlu<;trial
Water service
CD~~./IND. FEEDERS
Install/alter/relocate
di!;trib. fpprlprs
Wood stove/heater
Of
amps.
TOTAL CHARGES \ TOTAL CHARGES
, WHERE STATE L.\l~ REQUIRES that the Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
I ISSUANC, OF PFR!HT
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 thJt all information hereon is true
and correct, and I further certify that any and all work performed 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 HO OCCUPArKY 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.
20)(05
IWIE(please print) ~ff/"'PL>J tJ6-ff"EV'
.
SIG:IATUR~~
FOr. OfFICE USE D:lL Y
DATE5-1/ -90
x
Value
Value
Value
,I
Zone
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Group
SCl. Ftg. t1ain
'5q, Ftc]. Access
Sq. Ftg, Other
x
x
TOTAL VALDATION
BUILDING PERflIT
Charges anc
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
------------ Plan Ck, Res
30%lBldQ Per Fee
Fence
Systems Development '
CharQe (1.5~) ,
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICAL PER!~IT
Charges and
Surcharges
D6A10
2z.-.5D Sidewalk
----TI3---- A/C Paving
Total Comb. Permit
MECHANICAL PERMIT,
Charges and
Surcharges
Curb Cut
TOTAL
23,~3
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Oescription
l. exam~le- Tax lot 100, lane County Map Reference
17 OJ 4J
2. examole- lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examyle- waterheater/efectrlcal/or ~
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, etc.
F. Building pennit information: ,
l. example - construct single family house with an
attached garage
2. exa~le - remodel existing garage into family room
3. examJPle - 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. ---
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 SATISFIED BEFORE OCCUPANCY:
"'.
..
'.
I..,
PERMIT VALIDATION
6-II-CZU
~efJAt~s
Permit Clerk ~/JJ+-L
Permit applicant exempt from registration with the Builder's Board b~cause:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date