HomeMy WebLinkAboutPermit Electrical 1989-10-19
- ~ .~ -- --.....- ~.~ f'
I INSPECTION LINE
726-376g
Job Address ,1'1,,on() (-j{)fO /J }J~_
Legal Description I rID 3::J;:J.:Jn()~ntD
~ CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES: //
Heat ./
Hater I
/.
'-'
INFOR/1ATION LINE
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Acces
Sq. Ftg. 0 r
!lew Alter Pep.
--Fe Demo Change/Use
ValUE of H~kl -;) . -. er- -
Builliino PermIt ~fO: Descr,be Hork\ i.. e.. Build Single
Familv neside~ce With ^ttached Garaoe'
.
J
Primary
lname!
=l\, ~
, .
Phone
(address'
o Vn rt . PQ_~~. t: ~
., Pi ffl Y ,~fYll ) 'pj:,)f i
- (lies. nO': 1 - (exoires) .....-- (I)hon~ no.
JJ
~
,\)
~
r:;::::;
Owner lf5:'fY\ f mJLV 'j
Address f'\f\( n ,p 11 ~~'l'~
(-l-qi fU)' ,~~ ql4n \
Construction L~n~r . J
Phone
Address
DES I uN TEM
- )
ji
I
. --
Structura 1
Electrical
f1echanical
CONTRACTORS
(name)
(address'
(l ice;. no. \
(~xo;rec;)
(I)honp no. \
Genera 1
'.
Plumbino
Electrical
" 1 n \ ~ 'So f 0 0 r1ll1 r )
,
~1echanical
PLUIIBI NG
ELECTRICAL
MECHANICAL
-1J!l.
FFF rH~ JjO
~~~ r~~.~
H~ r~
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
SERVICES
(~.s:J
I
Floor furnace
and vent
Relocated building
(new fix. additional)
1\ ~\ $iW circu~ts alts.
...:..J..; 1 or extenslons
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
Recessed wall
Sn~cp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps..
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
sin9le duct
Vent system apart from
hp.t\tino r>r A.C.
Mechanical exhaust
hood t\nd dud
Sewer
Temporary Construction
Change in existing
r~!:..idpJICfi"_
multifamily, conm. or
Indu<:.tr;al
~Iater service
COMI.I./lND. FEEDERS
Install/alter/relocate
rli<:.trih_ f"prlprc:.
Wood stove/heater
Of
amps.
I
rO& .SO I TOTAL
ISSUANCF OF PFRI1IT
I HAVE CAREFULLY EXmlINED the completed aprlication 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 Oregon pertaining to the work described herein, and that IW OCCUPAIKY will be made
of any structure without the permission of the Building Div;sion. 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 SUb~~\~;~nd efuti\a~~sn~{~~>>used nhiS prOie..ct.
~se print)" q SIGIIATURE ,~h ~ DATE
FOP. OfFICE USE O~LY' . -,
Sq. Ftg. f1ain
Sq. Fta. Access
Sq. Ftg. Other'
Stories
Units
Occy load
Occy Group
x
Value
Value
Value
Zone
Fire Zone
Tvpe/Const.
Bedrooms
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERflIT
Charges ant:
Surcharges
. Plan Ck. COIl111/lnd
____________~/Bldo PJ'r Fpp
Plan Ck. Res
30%/Blda Per Fee
Fence
Systems Development
Charae (1.51-) .
PLUI1BING PERMIT
Cha rges and
Surcha rges
D~mo
_Cl&'_~_nS1dewalk
Ii l ~ A/C Paving
Curb Cut
Total Comb. Permit
ELECTRICAL PERllIT
Cha rges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
I
d?>.(o <-
u _ _ _ U L.
C""'S,,:"",~ -...-:;-."~,
. .
COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100, Lane County Map Reference
17 03 43
2. ~xa~le- Lot I. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and constructlon lender
D. Energy Sources
1. examyle- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. 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:
1. example - construct single family house with an
attached garage
2. example - 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 TEAll AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding des ign 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 si9n the electrical label.
III. 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.
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
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~"\',n
,.
"
rim
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
"
date
..... .
)
~