HomeMy WebLinkAboutPermit Electrical 1985-3-28
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"J ItISPECTIOIl L1IlE
726-3769
Job Address
.qq;) 1
Owner V 4xJ...I
Address(lt-ur ~;'J
;jj;J1 ;JJi1illlJJA
Construction lender I
CITY OF SPRINGFIELD
~ COMBliIATION APPLICATION/PERMIT
/-j, ~;zy I EilERGY SOURCES:
'0. W Heat
!~ater Heater
Ranqe
INfORllATION L1~"
726-3753
Sq. Ftq. 1,Ia1n
~q, Ftg. Access.
Sq. Ftg. Other
Ilew Add A lter ~ep.
-Fence Demo Change/Use
Other- -
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~
~
<0
~
~.
legal Oe~cription
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flf~~::~-
{)7f177
ValUE of ['Jark:
Builo;nq Permit Info: Descrlbe Work{i.e., Build Single
Familv nesidence With Attached Garaael
"A;;;/>'f (2:/1 A.//./).JJ/)A/-U~
.fJ J #2 'L-f"d!P' .
~
Address
Ut; Hill 1 tAI1
(name)
Phone
{address)
(lies. no.)
{exoiresl
I
(ohane no.)
Primary
Structura 1
Electrical
11echanical
CONTRACTORS
(name)
(address)
(1ir:5.00..)
(plCoirpsl
(ohnnp nn")
Genera 1
Plumbina _' A ~
Electrical (i!;JjI i JI}/il
~1echani ca 1
PLUf.lBI NG
~t/- ::j(PGo ;}JVI) PI CuflhtJ
, .. OP. {J 7C/O /
ELECTRICAL ,
FEE" . rHA!u:;E NO ~H n-l~ NO
{;?7- /d.fid:
MECHANICAL
...JiQ.."
I=J=I= r
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
(] bath]
Duplex (1 bath)
SERVICES
___1-
Recessed wall
Snare heater and
I
vef'lt
each
Additional bath
ITemporary Construction
IChange in existing
rp1'_i qrnrp
Imultifamily, corrrn. or
Tnnuc;,trial
I Appl iance vent
seoarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hnnri <tnd du/"t
1l1~~~ stove/heater
I
/60;J- I
II
I
I TOTAL CHARGES
Electrical Contractor, the electrical portion of this penmit
Supervisor and returned to the Building Division
amps.1
I ~Iater service
I Sewer
IStorm Sewer
IOf
ICOffi1./IND. FEEDERS
Install/alter/relocate I
rlic;,trin fpprlpr<;.
Of I~ . amps. I
:~&IMd/t1,Ar'
I I
TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\I~ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
J
I
I
I
I
I-I
I SSUANC, OF PFR!llT
I HAVE CAREFULLY EXNlINED the completed apf1lication for permit, and do hereby certify that 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 NO OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s
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 7Ql,Q55 will be used on this project.
SIGrlATU~ C1::2~
FOR OFFICE USE DilLY
Sq. Ftg. t1ain x
Sq. Ftq. Access x
Sq. Ftg. Other x
DATE....?-?6'-d:'Sj
Value
Value
Value
rlAl'iE(please print) p/fJ..p,U _\ t/cf-I-..E R-
Zone
Fire Zone
Flood Plain
Tyoe/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Gro~p
TOTAL VALUATION
BUILDING PERHIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________ 65%/B1dC'l P.er Fpp
Plan Ck. Res
30%)Bldo Per Fee
I Fence I
------------
, 10_ I
/0 f)-U I Sidewalk I
--------Lj(j-I A/C Paving I
------------ ;J;;~ ~,;;I3 <;9 ~
Syste~s Development
Charqe (1. 5~)
PLUI~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
I
ITotal Comb. Permit
r1ECHANICAL PERMIT
Charges and
Surcharges
I qO
ITOTAL /6 -
,.YD
/ 6 c..---
~
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
17 03 43
2. example- lot 1, Block 3, 2nd Addition to
Sprlngtield [states
C. Name. etc. of owner and construction lender
O. Energy Sources
1, examole- heat/electrical ceilina{or forced air Qas
2. examfile- waterheater/electricalfor solar
E. Square footage or valuation, etc.
l. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition.
check add, etc.
F. Building pennit information:
1, examole - 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 TEAfl 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 adjaeent
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. ---
111. 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
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
PERMIT VALIDATION
12-4 bLfL/ij/}
I) '7;0JAi
4)7/
Permit Cl erk
Permit applicant exempt from registration ,with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
]
date