HomeMy WebLinkAboutPermit Electrical 1982-11-2
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Job Address
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CITY UF SPRINGFIElD INFDRlIATlDN l.INt
COMBIIIATlON APPliCATION/PERMIT 726-3753
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I Hater Heater ---- Sq. Ftg. Other
- flew Add' A Iter Rep.
Range -Fence;.:'"" Demo Change/Use
Valu, of llork)uA ;' Otller- -
BuilriinQ Permibfinfo: Descrlbe Work(i.e.. Build Single
Familv Residence With Attached Garaoe)
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I IrISPECTlOfl 1I11E.
726-3769
legal Description
ownerhtu l ~ 0 ..... ( \(\ 1 U l \1 U\ tJ." ./l
Add~~~ n~~,~,.~P~41~~~
Constructlon '8der ' L9.Jlt Q1\r\
, I.. 0 \lo 1'"'f ) ~D\~
Address
Ut~lliN H.AH
lname)
Phone
(addressl
(lics.no.)
{exoiresl
(phOM no.
Primary
Structura 1
Electrical
I~echan;cal
CONTRACTORS
(name)
(address)
(1 ;('0;;. no.'
(exoiresl
(nhone no.)
Genera 1
Plumbina
Electrical
~lechanical
PlllllBIrIG
ElECTRICAl
FF",.JJ:HARIiE.! NO
MECHANICAl
NO.
FEE CHARGE NO
:EL .cHARliE.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
'/ I' New ci rcuits a lts.
o'2.e~e~t "R. \'O("e....
ISERVICES
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Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Recessed wall
~n~~p hp~tpr ~nrl vpnt
~Iater service
ITemporary Construction
[Change in existing
rp~.i drJl~p
[multifamily, comm. or
Inrlustrial
[Of amps.1
[COI~'I./lND. FEEDERS I
I~~;;~~~~a~~:~~~:locate I
IOf
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Appliance vent
spoaratp
Stationary evap.
coolpr
Vent fan with
sinole duct
Vent system apart from [
heatino or A.C.
Mechanical exhaust
hoorl and rluct
Wood stove/heater
Additional bath
Sewer
Storm Sewer
amps.
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IS.c)O
ISSUANCE OF PFRI1IT
I HAVE CAREFULLY EXM1INED 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 Oregon pertaining to the work described herein. and that HO OCCUPAllCY 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.
IW.IE(please print) (sQ\\eJ A c.u..,<-h'~ SIGIIATURE h;,lu.--
EOr. OfFICE USE Olll Yr "-
Zone '--'
Tvoe/Const. Units Sq. Ftg. 11ain
Fire Zone Bedrooms Occy load Sq. Ftg. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
J 0Lt_a;'c,
OATE II -..:L-~:l.-.
x
Value
Value
Value
x
x
TOTAl VAlUATION
BUIlDING PER~IIT
Charges anc
Surcharges
Plan Ck. Comm/lnd
65%/~ldQ P~r Fpp
------------ Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charoe O.5~)
PlUllBING PERMIT
Charges and
Surcharges
D~mo
_ I;:i._C?g ___S1dewalk
, Coe) A/C Paving
Total Comb. Permit
ElECTR I CAl PERlm
Cha rges and
Surcha rges
11ECHAN I CAl PERMIT
Charges and
Surcharges
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax lot 100, lane County Map Reference
II Uj 43
2. exam~le- lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceiling/or forced air qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
I. examole- 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
attached 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 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:
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PERMIT VALIDATION
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Permi t
clerd1f1U
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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