HomeMy WebLinkAboutPermit Electrical 1988-8-2
Job Address
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CITY UF SPRINGFIE~O
COMBINATION APP~ICATION/PERMIT
ENERGY SOURCES:
Heat
\~ater Heater
Range_.__,
Valu€. of Work:
.
INFORltATION ~lNt
726-3753
Sq, Ftq, 1,Ia I n
~q. Ftg. Access.
Sq. Ftg, Other
Ilew Add Alter Rep,
-Fence Oemo Change/Use
Other- -
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I INSPECTION ~INE
726-3769
legal Description
Owner
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Builriino Permit Info: Describe Work(i.e., Build Single
Familv Residence With Attached G~raoel
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I!mr~ ' ...fLU- I!h. ~~ ~ f}.. - L-
(addre /llics. no.) (exoires\ ~ne no.
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Address
Phon€?26
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Construction ~ender
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Primary
Structural
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,
Electrical
Mechanical
CONTRACTORS
(name)
(address)
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(~xo;rps.'
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Genera 1
Plumbino
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Electrical
~lechanical
P~UlIB I NG
E~ECTRICA~
MECHANICAL
NO,
FEE CHARr,F NO
~~~ r~~ NO.
FFLJ:liAB.llE
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BTU1s
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath \
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tpr ~~rl vpnt
Hater service
I Sewer
I Storm Sewer
I
Temporary Construction
Change in existing
rp<;.jqenr.p
Imultifamily, comm. or
Inrlustri~l
IOf amps,
ICDI-IH./INO. FEEDERS
I Install/alter/relocate
rlic:trih. fpprlprc;.
IOf amps.
Appliance vent
<;.eo~r~tp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood ~nd rlur.t
Wood stove/heater
ISSUANCE OF PFRHIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrlcal 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 EX!\rlINED 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 1m OCCUPAUCY 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 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.
IWoIE(please print) IV\ l \L.E... ELI FH\JS SI"NATU~<>L. ~~ PATF 8- z.-88::,
FOR OFF I CE USE Olll Y
Zone Tvpe/Const. Units Sq, Ftg, t1ain , Value
Fire Zone Bedrooms Occy load Sq, FtD. Access x Value
Flood Plain Stories Occy Group Sq, Ftg, Other x Value
TOTAL VALUATION
BUIlOING PERmT
Charges anc
Surcharges
Plan Ck, Comm/Ind
65%/Bld~ Ppr Fpp
Plan Ck, R'es
30t/Bldo Per Fee
Fence
syste,ms Development
Charo. (1,5%) ,
PlU!~BING PERMIT
Charges and~.""'.'
Surcharges'
.Gcb)L
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I 1512'6 ,21)
Total Comb, Permit
OBiOO
, 2-2. .Sl)Sidewalk
------ I '-(-3-' AlC Paving
ELECTRICAL PERIHT
Cha rges and ,},
Surcharges V\
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
;;(3, 6~"
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B, legal Description
1, example- Tax lot 100, lane County Map Reference
II oj 43
2, examEle- lot 1, Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ce;l;nq/or forced air Qas
2. example- waterheater/electrical/or 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 permit information:
1. exam~le - 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, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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.
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V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.. .1'
PLANS REVIEWED BY:
.
name.
signature
date