HomeMy WebLinkAboutPermit Electrical 1988-10-14
I INSPECTION lINE
726-3769
CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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legal Oescription 7/fy / n 7' 2!IJO. Ilater Heater
Ran~e
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Owner' Tlll1A./ d- "USAN 11:: LIMr.J..I .
Add ,/, I ,,/ h _.j!uil<iinQ Pennit Info: Describe NorK(Le..
ress ...,.07-./ 1\/6 t f.(~JIIE<I P onr.:5,'(;/?t;. r.hmil v ~esidence Nith Attached Garaoe I
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Construction Lender
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INFOR/IATlON LINt
726-3753
Sq. Ftg. I.tain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Fence_Demo _Change/Use
_Dther
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Build Single -SJ
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Job Address
Address
Ut~lliN TEAf1
(name)
Phone
(address)
flies.no.1
Cexniresl
Primary
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Structura 1
Electrical
Mechanical
CONTRACTORS
(namel
(address 1
(lieS.M.l
(pxnirps)
(ohnnp nn.)
General
Plumbina
Electrical
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1='1='1=' r':fARG.E. _NO_
&81 -.:2/0<.../
~lechan;cal
PlUI.IBING
ELECTRICAL
MECHANICAL
NO.
FEE rHARr,F Nn
Each single fixture
Residence of
~(")OO SQ. FT.
'..EEL ..cJJAIlllE.
::
Relocated building
(new fix. additional)
New circuits alts.
or extensions
1:)'C9'Y' /YJOre-
SERVICES
;:;jl
31~
;1~~:
furnace/burner to
BTU. s
"
'I
Floor furnace
and vent
S.F. Residence
(j bat.h 1
Duplex (1 bath) each
Additional bath
Recessed wall
~nMrp hpJUpr nnrl vpnt
~Int~r .~erviCI=!
ITemporary Construction
Change in existing
. rp~ j (j~rtl"p
multifamily, camm. or
Tnr1'Ic,trinl
Storm Sewer
Of
COMl.1./IND. FEEDERS
amps.
Appliance vent
"f1naratp
Stationary evap.
cooler -..
Vent fan with
sinole dur:t
Vent system apart from I
heat;na or A.C.
Mechanical exhaust
hond and durt
Wood stove/heater
Sewer
\"~.c1
I Install/alter/relocate
dic:.trih. fpprlprc;.
10f
I
I
I
amps.
I SSUANCE OF PFR!1lT
TOTAL CHARGES
. WHERE STATE L.\ll REQUIRES
shall not be vali~ until the
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor 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 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 UO OCCUPAr,CY 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 cornplian~e with ORS 701.055 will be used on this project.
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SIGIIATURE ~LO~)'~.lJ."L
OATE
/o/;~/rt
FO~ OFFICE USE OIll Y
Zone Tvpe/Const. Units Sq. Ftg. riain
Fire Zone Bedrooms Occy load Sq. Ft9. Access
Flood Plain Stories Dccy Group Sq. Ftg. Other
x
x
Value
Value
Value
x
TOTAL V AlUA TI ON
BUILDING PERI-tIT
Charges and
Surcharges
Plan CK. Corrm/lnd
65t/Bldo P~r Fpe
------------ Plan Ck. Res
- 30%181 do Per Fee
Systems. Development
Char~e tl.5~) .
D~o .
I
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I
Plm~BING PERMIT
Charges arid......-
Surcharges.
-'
Fence
<.
ELECTRICAL PER!~IT
Charges and .. \
Surcharges 1",\
MECHANICAL PERMIT
Charges and
Surcharges
bo . cYD l'sidewalK
-------3~~-ol A/C Paving
I Curb Cut
I
Irotal Comb. Permit
I
I TOTAL
~ '3.00
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
11 oj 4J .
2. examele- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilina/or forced air qas
2. examole- waterheater/electrica(Jor 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 pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exa~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. OESIGN 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
O. 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.
1 I l. Appl icant to sign and ail fed -
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.
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V. FOR OFFICE USE ONLY'
0(./
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
Permi t appl i cant exempt from regi'strati on with the Buil der I s Board because:
Additional Project Information:
'.
PlANS REVIEWED BY:
. name
signature
date