HomeMy WebLinkAboutPermit Electrical 1982-11-16
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.
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lname)
Phone
(address)
INFORl1ATION liNt
726-3753
Sq, Ftg, "lain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add Alter Rep,
Range -Fence Demo ChangelUse
ValuE of HOfL) M. Other--
BuilciinQ Penni.1Info: Describe Work(i-.e.. Build Single
.. Family ~~~id~nce With Attached Garaae)
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(i its. no.)
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Owner.,. \ Of'PS\ ~
Addr.;, -I {)l.} (j -~.I f\'_1 ') \J&n~ ,
,-~Irl.. rJP.
Constructi~ l~der )
Address
UtSHiN TEAl.'
(exo; res)
(ohone no. J
Primary
Structura 1
Electrical
t1echan; ca 1
CONTRACTORS
(name)
(address)
(1;es. no.)
(exn;r~s)
(ohonP no.)
Genera 1
Plumbina
Electrical
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Q'14 7~ L./
~1echan;cal
PlUllBING
ELECTRICAL
MECHANICAL:
NO,
FFF rHARGF NO
~~~ r~AR~~ NO.
Hr: r~Alu~r:
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BTU's .
,
Relocated building
(new fix, additional)
S,F, Residence
(1 bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent ~
SERVICES
Recessed wall
~nArp nPAtpr Ann vpnt
Sewer
Temporary Construction Appliance vent
seoarate
Change in existing Stationary evap.
res i n..ence cooler
multifamily, conm. or Vent fan with
Innllc:.triAl sinole duct
Of amps.l Vent system apart from
heatinq or A.C.
COMfl./IND, FEEDERS I Mechanical exhaust
hood and duct
Install/alter/relocate I Wood stove/heater
nic:.trih_ fppnprc:.
Of amps.[
Water service
Storm Sewer
ISSUANCF OF PFRr1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE l,'lj REQUIRES that the Electrical work be done by an,.Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXNIINFD 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 IlO OCCUPAIICY 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 OP.S 7Ql~055 will be used on this project.
IWIE(please print) J c;(:.'l~/d /2,lTeriJV'_
SIGIlATURF~jf)( .12-~ OATE/I-/6'-g' 'L
Zone
Fire Zone
Flood Plain
FO~ OfFICE USE OfllY
TyoelConst, Units Sq. Ftg, f1ain
Bedrooms Occy load Sq, HI]. Access
Stories Occy Group Sq, Ftg, Other
x Va 1 ue
x Value
x Value
TOTAL VALUATION
BUILDING PERfIIT
Charges and
Surcharges
Plan Ck,
65%/Rlda
------------ Plan Ck,
30%/Bldo
I Fence
I Demo
__LU!.C!5 _-'Sidewalk
.4() I AIC Paving
Conm/lnd
P.rr Fpe
Res
Per Fee
Systems Development
Charqe (1.5%) .
PlU!1BING PERMIT
Charges and
Surcha rges
~
:.1> ~.J:I-I54 7
.cQO
ELECTRICAL PERlm
Cha rges and
Surcha rges
11ECHANICAl PERMIT
Charges and
Surcharges
Total Comb. rermit
TOTAL
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Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B, Legal Oescription
1. example- Tax lot 100. lane County Map Reference
1/ oj 43
2, example- Lot 1, Block 3, 2nd Addition to
sprlngtield Estates ,
C. Name. etc. of owner and construction lender
D. Energy'Sources
1. example- heat/electrical ceil;nq/or forced air Qas
2. example- waterheater/electrlcal/or ~
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
a ttached garage
2. examole - remodel existing garage into family room
3. . eX3rlJPle - 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 TE~l 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
0, 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 SATISFIED BEFORE OCCUPANCY:
-- I
,
PERMIT VALIDATION
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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date
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