HomeMy WebLinkAboutPermit Electrical 1990-4-3
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IINSPECTION LINE CITY HF SPRINGFIELD
726-3769 COHBIIiATlON APPLICATiON/PERMIT
Job Address ~ -Y.&''7-' ~~I.h?'N4-- c:::;,...~l ~~;~GY SOURCES:
Legal De<cription 12-63-22 ~ ~ /T"~ I Hater Heater
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\ ValUE of Hork:
9~--
Build;na Permit Info: Descr,be Work(i~e., Build Single
Familv R,esidence Hith Attached Garaoe)
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Phone 1/1".r~/~~..4--)';i?'P-~ .
(address) - -,. (1i(e nn,' - (exoir~~'
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INFORlIATION liNt ,I
726-3753
Sq. Ftq. 1,Iain
~q. Ftg. Access.
Sq. Ftq. Other
flew Add Alter Rep.
--Fence Demo Change/Use
-Other - -
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Owner'
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Address
Phone
Construction Lender
Address
Ot~jGN TtAH
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addresc;,)
(1 ire;. no.)
(pxoirp<d
(ohol1P nn )
Genera 1
Plumbino
Electrical/{ Y/ F"cC;C-C.7.
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PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARr,F NO
~~~ r~AQr.~ NO
t:"t:"t:" rUAQt':.t:"
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
(/
New circuits alts.
or 'extl;Dsi9ns
LP.N~ L//-?c":"r,7
SERVICES
1$:"=
Floor fu rnace
and vent
S.F. Residence
II bathl
Duplex (1 bath) each
Additional bath
Recessed wall
~nnrp hp~tpr ~nrl vpnt
Storm Sewer
Of.
amps.
App 1 i ance' vent
e;.eoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud.
Hood stove/heater
Sewer
Temporary Construction
Change in existing
rps i dp':nr.p
multifamily, COrml. or
Industrial
~Iater service
CO~1,/IND. FEEDERS
Install/alter/relocate
r1ic;t.rih_ fpprlprc;
Of
amps.
,
-'. ...
ISSUANcr OF PFR!1lT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l~ REQUIRES that tile Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
/-~
,5-
Electrical Contractor, the electrical portion of this permit
Su~ervisor and returned to the Building Division
TOTAL CHARGES
I HAVE CAREFUllY EXN1INED 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 Ore~on pertaining to the work described herein, and that 110 OCCUPAIlCY 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 7nl.055 will be used on this Rroject.
IlAIIE(please print) G p~~",,~ LJ jo "'.... ~ SICIMTURE ~/./ W L
v FO~ OFFICE usE' QiILY / U
Type/Const. Units Sq. Ftg. riain
Bedrooms Occy load Sq. Ft~. Access
Stories Occy Group Sq. Ftg. Other
om/h Ae)
; I
Zone
Fire Zone
x
Value
Val ue
Value
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERflIT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65%/Bldo P~r Fpp
------------ Plan Ck. Res
30%lBl de Per Fee
Fence
Systems Development
Charqe (1.5~)
PLUt1BING PERMIT
Charges and
Surcharges
D~mo
__L~::~__ Sidewalk
_ 7:;;- A/C Pav.ing
Total Comb. Permit
ELECTRICAL PERI:lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I
TOTAL
J /s:?,;,~
Curb Cut
.
I
II
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference
1/ D3 43
2. exam~le- Lot I. Block 3, 2nd Addition to
>prlngfield Estates
C, Name, etc. of owner and construction lender
D. Energy-Sources ' '\'.
'1. exam~le- heat/electrical ceilinq/or forced air Qas
2. example-~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. etc.
F. Building permit information:
1. exam~le - construct single family house with an
a ttached garage
2, example - remodel existing garage into family room
3. exam~le - 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 P'lumbing. 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
8. 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 eovered 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:
,
,
.
II
...
.
PERMIT VALIDATION
#lb~~9.
!77~
all';? 5;8
.
7'- 5'';7<9
Permit Clerk~~/.
.
Permit applicant exempt from registration with the Build~r's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date