HomeMy WebLinkAboutPermit Electrical 1989-9-11
CITY OF splirnGi'iELO :,-- INFOlU1ATION LJIIl
Cll/mlllArrON APPLICAUON/PERMIT , _'... ...._ ._. __..~2W7.5'
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I Heat ~q, rtg, Access,
II~ater Neater Sq, Ftg. Other
, Ilel< Add Alter rep,
Ran(H!_____~___ -raM" OamD ChAnoa/Uto
I V.lur of Hurk: Other- -
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Ilu~muolI LJ/lE
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10'71 I1MlnLJ tr:i
Job Address
Address
Phone
BUllt;inQ Permit Info: Describe Work{Le..
Familv nesidence Hith Attached Garace'
,WV/'U-
Build Single
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.le~al De~cription
Owner
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Construction Lender
Address
DDI(jr~ HAIl
(namel
Phone
(address)
(1 ics. no. \
lexniresl
(Rhone no.
Primary
Structural
Electrical
11echanical
COIITRACTORS
(namel
(address \
11lrs. no. \
(exo;rp.sl
(ohone no. 1
Genera 1
Plumbina
Electrical
H",,-,:,\\',,", j:::IN~r:c...
232 w .s-:Lb
<.o-l...? C
L/ %5" - t;'1ss-
~"echanfcal
PLUlm WG
ELECTRICAL
MECHANICAL
SQ, [T,
furnace/burner to
BTlI's
rL1.clJARG.
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NO, ..
, FEE 'CHARGE
NO
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'CIiAllliE'JIQ., I
Each single fixture
Residence of
each
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INew circuits alts.
or extensions
ISERVICES
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"v,ftil/.131
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Floor furnace
and vent
Relocated building
(new fix. additional)
S.F. Residence
11 bath!
10uplex (1 bath)
IAdditional bath
-----Iwater service
I Sewer
-----IStorm Sewer
Recessed wall
Snare ~patp~ ~nd vP~t
Temporary Construction
Chan~e in existing
res.i q~"nce_
multifamily. conrn. or
_lm!!.!HrJ..1
Of
amps.1
Of
amps.!
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CO/ill. II NO, FEEOERS
Install/alter/relocate
~i~trih_ feedpr~
I SSUANCF OF, PFRlm
TOTAL CHARGES
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permi t I
IWIE(please print)(Q", ",-;;\L.\j i-l.::\~,.\t,,-
I tlAVE CAREFUllY EXM1Itl[f) t.,e cornpleted aprlication for rlermit. and do hereh.v certify that all infonnation hereon is true
: . correct. and I further certify that any and all work nerfonned shall be done in accordance with the Ordinances of the City
,pring(;eld and the Laws of the State of Ore,:!on !'Jertainin~ to the work described herein, and that flO OCCUPAIlCY will be made
Of any structure without the nermission of the Ouildin9 Division. I further certify that my re~1stration with the Guilder's
Ooard 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 emnloyees who are in comoliance with Or.S 7~1.055 \.lil1 be used on this project.
SIr.lIATURE ~ LJI~ ~
FOr OFFICE USE 01lLY
Sn, Ft~, Itain
Sq, Ft9, Access
Sq, Ftg, Other
omi-\l-89 j
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Zone_
n re Zone
_..Tyne/Cons t._______l1ni ts
Bedrooms Occy load
Stories Occy Group
x
Value
Value
Value
,x
Flood Plain
x
TOTAL VALUATlOtI
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BUILOIflG PER/.IJT
Charges an~
Surcharges
I Plan Ck. Conm/lnd
_ _ _ _ _ _ _ _ _ _ _ _ 65't./B~9 PPr Fee
Plan Ck, Res
30t/Bldo Per Fee
Fence
ISystems. Development I
Cha roe (J, 5r.)
'JliBlNG PERMIT
...arges and
Surcharges
Demo
ELECTRICft,l rmr:1T
Charges and
Surcharges
__2.~.:S-D
1/3
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11ECHAN I CAL PERMIT
Charges and
Surc ha rlJes
Sidewalk
I A/C Paving
I Curb Cut
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ITotal f.omb. Permit
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
J. Appl icant to furnish
A, Job Address
O. legal Description
1, example- Tax Lot 100, Lane County Map Reference
II OJ 43
2, example- Lot 1, Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
I, example. heat/electrical ceilinq/or forced air Qas
2.. examYJc. waterheater/electrlCcll/or ~
E. Square footage or valuation, etc.
I, examole. 1250 SQ, foot house, 500 SQ, foot garage
2. example- if new project, check-nfw - if addition,
cneck add, etc.
F. Building permit information:
1. examp.le - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examyle - 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 MIO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
correctionst 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, Mechan;cal, 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. -
Ill. 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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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
signature
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date
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