HomeMy WebLinkAboutPermit Electrical 1990-8-27
I INSPECTION LINE
726- 37 6g
..
Job Address 102- ~ . ffi Jl Dn} ) f(!J
Legal Description \ I 1 ()O(-\t:}()CJ Cf-J.6l1)
CITY OF SPRINGFIELD . INFOR/lAnON LINE
COMBINATION APPLICATION/PERMIT 726.3753
EIIERGY SOURCES: Sq. Ftg. 11a i n
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
~ New Add Alter Pep.
Range -Fence Demo Change/Use
Val f <<oty Other- -
BUi~:i:O pe~it Info: Describe Workl;,e.. Build Single
Familv Residence With Attached Garaoel
1
Owne't~ \Jt(Ll\r ~
Addres~AA ~ t'1'Q. ~ 1\
c; 1 ')ORI\Q/. ~-J 4<{..()'~O\1
Construction Lendl~' \
~
I~
~
{namel
Phone
{address'
. r-
\wml.f'l\\J ~Un\1~
- \. -
Address
DE~lGN TEAM
{lies. no.'
{eXDiresl
(ohone no.
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
name
(addres.s\
l1ic~. no,\
(exoires.\
(ahane no. \
General
Pl umbi no
Electricalf \c\l.'l\r\.t),(~ fQortJ\IC', Il-(6 \'\\\\\\'{l't~'Cn} 1Y\t<-tb~~-0L\.??-
lIechanical . 1\'d.l\O\Cll)
PLUltB I NG
ELECTRICAL
MECHANICAL
NO.
FEE CH~RGE NO
FFF . rH~ NO.
FFF .rH~,
SQ. FT.
furnace/burner to
BTD's
Each single fixture
Residence of
Relocated building
(new fix. additional)
ru. )lew c.ircuits alts.
rJ J or extensions
Floor furnace
and vent
1
S.F. Residence
(l bath'
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~pac~ heater and vent
amps.
Appliance vent
<;.eo'Jrate
Stationary evap.
coolH
Vent fan wi th
sin~le duct
Vent system apart from
heatinq or A.C-
Mechanical exhaust
hood iIond duct
Wood stove/heater
Sewer'
Temporary Construction
Change in existing
r~s j ~eJ1ce
multifamlly, COIlll1. or
Industrial
Water service
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
_.cli..trih. fp~A<>...,
Of
amps.
I SSUANCf. OF PER/lIT
TOTAL CHARGES TOTAL CHARGES \ TOTAL CHARGES
WHERE STATE L\W REQUIRES that the Electrical work be done by an..Electrical Contractor. the electrical portion of thts penntt
shall not be vali1 until the 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 NO OCCUPAllCY will be made
of any structure without the penmission of the Building Division. I further 'certify that my registration with the Builder's
Board is in full force and effect as required by ons 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 701.055 will be used on this project.
IWtE(please pri~l ~~ SIGIIATURE :;;'Q1()S
. "V FOP. OFFICE USE DIlLY
Zone I Type/Canst. Units Sq. Ftg. t1ain
. .
Fire Zone Bedrooms Occy load Sq. Ftg. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
DATE
i
x
Value
Value
Value
x
x
TOTAL VALUATION
PLUI1BING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ .&.2!/R.1do P!'r Fpp
Plan Ck. Res
30%'Blda Per Fee
Fence
Systems. Development
Charoe (1. 5% . . .
~
BUILDING PERNIT
Charges and
Surcharges
Dljl!lo..
ELECTRICAL PERliIT
Cha rges and
Surcharges
_cA() . DC)'
1.12--
.Sidewalk
A/C Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
1 TOTAL
:1 '3.03
.
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. example- Lot I. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1'. example- heat/electrical ceilinq/or forced air Qas
-2. example- waterheater/electrlcalJor solar
E. Square footage or valuation, etc. -
1. examole- 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. exam~le - construct single family house with an
attached garage
2. example - 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 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. I
II. Abbreviated Plumbing, Mechanicai, & 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 CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY:
II
',J
.
PERMIT VALIDATION
J~~lg90
At.
\8145
Permit. Clerk ~~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date