HomeMy WebLinkAboutPermit Electrical 1990-4-17
Builtinq Permit InfO; Describe Wark{i.e.. Build Single
Facnlv P.esidenee Wit.h Attac::hP.f:l. f?~raQ~'
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CClHS!AATION APPUCATIONlPERKIT
EnERGY SOURCES:
Heat
!iater HeatB:r
) IIISPECnON LINE
1726-3769
Job Address 10th &
Legal Description
Centenrnial, Springfield
yZ-- () -lAJ
(...-1i,~t1iO-(
P.ange
ValUE: OT Hork:
{000
, Owner Oreaoil DeDartment of TransDorUtion
"Address Salem, Oreqon Phone
Construction lender
Address
'OI;SlGN TEAM
(name)--- -.
OSHD
Phone
(address)
, Pri~ry
, Structural
Electrical
!1eGhanical
CONTRACTORS
{name I
(address)
Linnea Electric Co.. POBox 925. Albany OR 97321 22-15C 10/1/90
926-4266
General
. Plumbina
El ectri c:a 1
Linnea Electric Co.
(( same))
.
Meehani ca 1
PlUt-1BIriG
EllCTRICP.t.
., '~"'l.",~.,
..
IN;ORMATION LIN~ .
726-3iS.3
SQ. Ftg. Main .
~q. Ftg. ACC8SS.
Sq. Ftg. Other
New Add Alter P~p-
-Fence Oemo Change/use
Other- -
Q
CHC::!L no.'
{ohone no. ,
(~ires)
MECHANICAL
Each single fixture
I FEE I CHARGE: NO. I I ~~ I tHAI1r.F NO_ I
Residence of furnace/burner to
SQ. FT. BTU's
I ~f C1iARG;
NO.
Relocated building
(new ffx. additional)
NItW circuits alts.
or extensions
S.F. P.esidence
n bath)
Duplex (1 bath) eaGh
Addit.ional bath
! SERVICES
I
ITempora~ Construction
Change in existing
T"li1s1(1F'n\":e
rilUltifcmily. COlim. or
T ndu<rt.ri a 1
IOf amps.
I COMH./IND. FEEDERS
lInstall/alter/relocate I
dir<1:.rib_ f~an:
lOf amps. I
I I
I I
I I
Water service
Sewer
Storm Sewer
F1 001' i'urnat;e
and vent
')') .~
I Recessed wa 11
SD~ep. heRT.F'r "nd vpn~
I
I Apol ianr;e vent
seoal"ate
Stationary ev!p_
cooler
Vent fan with
sina1e duct
Vent systl!l!l apan fl"Olll
heaj:ina or A.C.
Mechanical exhaust
hood and duc:t
Wood stove/heater
I
L l ISSUANCf OF PFP.11IT
2~~ TOTAL CHARbES
TOTAl. CHARGES TOTAL CHf.RGES
IlIiERE STATE UUi REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pen:rit
shall not be valH until the label has been signed by an Eleetric;al SUlJervisor and returned to the Building Division
-I-HAVE CAREFUllY EXA.'iINED t.'te completed appHeatfon for penmt. and do hereby certify that all infonnatiOl1 hereon is true
and COrT'ect. ami I fur""J1er certify that any and all werk oerfoTllled shaH be d.one in al;Cordance with the Ordinances of the City
of SDringfield and the Laws of the State of O~on 9l!rtaining to the werk d.escribed herein. and that UO OCCUPAnCY will be ~de
of any structure without the permission of the Building tnvision. I 'further certify that IllY registration with the Builder's
Board is in full force and effect as required by ORS 701.055. that i1' exemot the basis for exemotion is noted hereon. and th~t
o;;~fG~~~$lan~C;logtEl~f~&~atl~ ttiJ CPoS 701_055 Ifill be U5ed. on this~rojec:.
lWtE{please print) Bill F rOtJllrn ,3055 SI(;tL.UURE.~ (____ 0-!/-Yl.--WHE
~ '. 1-.. -
FOR url".t~ CSE/OM..V
Zone Tyoe/Const. Units Sq- Ftg.. Main
Fire Zone Bedro ems Occy Load Sq. Ftg. Access
nood Pl~in Stories pcey Group Sq. Ftg. Other
BUILDInG PERr-trr . Plen CIe. Cecar/lnd
Charges ant 65~lBlda P".,. pee
Surf;harges Plan (I::. Res
3~/BldG Per Fee
! PLUt~BING PERI1'IT Feno=
Charges and
Surcharges ~
ELECTRICAl PERr..Ii, --~~~-~ Sidewalk
Ch<t rges and
$urf;haryes A/CPaving
!1EOfANICAl PERMIT 1 Curb Cut
Charges and -----------
Surcharges I
4117/qn
x Value
x Value
x Value
TOif.t. VAlUATIOPI
ISYS~ Develap~~t
Chal"Q& 0- 5't:)
I
I
I
I
ITotal COlIlb. rennit
TOiAi.
:;gJ{p ~
'''~'"'W''''~'Q4;i7)9'O' ,~. o9':~uf'"Y'U5if3 726 3782
.'
CITY OF SPRNGFLD
~
COMBlNAn~ APPLICATION/PERMIT (CAP)
I. AppHe)l'lt,to furnish
A. Job Address
8. Legal Description
1. exilllll>le- T.x Lot 100., Lane County Map Referen~
IT 03-43
2. example- Lot 1. 8lock 3~ 2nd Addition to
springtield Estates
c. Name, etc. of owner and t=onstruction lender
. 0, Energy Sources
l~ example- heat/electrical ceilincr/or fv. ..c.J air gas
2. ~Ie- watertleater/el........ .callor solar
E. Square footage or valuation. etc.
1. examole- 1250 sq. foot house. 500 sq. foot garage
~. 6\XalllOle- if new pl"Qject. check nlllll .. if addition.
cn~k add. etc. .
F. Building peMDi~ information:
1. example - construct single fiilllriTy house with an
attached garage
2. exalJll)le - renodel existing garage ilt""..o far.rily . "'...
3. examole - convert single Talllny residence into
restaurant (change of use)
G. Value of work. as defined in Section 303 (a> of the
Strvc=tural Specialty Code
H. DESIGN TEAK AND '-WII~ORS
To avoid dl!$ign or construction delays., 8uilding
Division Staff IIIUSt be able to c:on~et appropriate
persons regarding design in........ .....tion Or jab site
CQ........l:ions~ etc..
c II. Abbreviated Pllllilbing. MeclIanfcal ~ & Electrical Schedules
A. Except where blank spaces occur in the description
portion of' the Mec:hanica.l and El........... ;cal Sc:hedules.,
the applicant need fin-in only the No. Boxes ad,iaCftllt
to the appropriate item(s) to be installed
8. Fun PIlllllbing., Med1anfcal. and E1......1.. leal Sdledules
are available at the Building Division
1. To conserve space on the permit form tbe sch@du1es
have been abbreviaUld
2. If the i1:@III(s} to be inS'"..alled are not c:overed on
the abbreviated st=hedules you should consult the
full s~hedu les
C. BUILDING DIVrSION STAFF WILL FILL OUT ALL FEES AIm
CHARGES ON THE SOlEOUlES
D. As noted on the CAP. the label lilUst be delivered to the
electrical c:ontnctor for signamre by lliS e1......... ieal
supervi lor. The genera 1 c.....~ ...etor is .92.t authorized
to sign the elec.trical label.
ItI. Applicant to sign and date
Whenever possible. the initial application wilT ~ used as
a worksheet only. Where possible. Building Division Staff
will prepare a type writ"'"..en copy and return it to the
apPlicant at the time tile actual perp;jt is issued for hi.s
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 tlIe5e
fees are paid. All other fees and chargesiAre due and
payable wen the permit is issued.
,. ~liR ij~Fta USE btkv
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAt~CY:
@003
.
PERMIT VALIDATION
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Ei efk .flJ (j)~f
2
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Pennit applicant exempt f. viII registration with the Builderls Board because:
,
Additional Project Information:
PLANS REVIEWED BY:
name
signatur~
date