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HomeMy WebLinkAboutPermit Electrical 1990-4-17 , j INSPECTION LINE . j726-3769 3157 H0.AdLn v Address Phone INfORltATION L!NL i26-3753 Sq, Ftg, I,:aio 1. '" ~Cl. Ftg. Access. ~ Sq, Ftg, Other \:::) Ilew Add Alter Reo, IC> Fence_Demo _Change/Use _Other I~ Bul1riinQ Permit Info: Oeser.be Work(i.e.. Build Single '-I ~Jtz;~liif~;;;;:ae~ b IWs. !\Jll)) serl/i tL . Job Address CITY Of SPRINGFIELD COMBINATION APPLlCATION/PER;~[T & 'J A , ~' EIIERGY SOORCES: 7~ -.Heat i./ Water Heater Range ValuE of I-lark: legal De~cr;ption Owner" E-W f; 1) Construction lender Address DESIGN TEAI1 (name) Phone {address' (lics.no.) {exoires1 (ohane no. ' Primary Structura 1 Electrical Mechanical CONTRACTORS {name} (address) (1 ics. no.) (pxo;rfl<;'\ (nhonp no. \ Genera 1 Plumbina Electrical ~lechanical PLOI,IBI NG ELECTRICAL MECHANICAL ...1!Q.. , FFF . CHARGE Nr FFF 'CH'IRIiE. NO. F'H .rH~ SQ, FT. furnace/burner to BTU' 5 Each single fixture Residence of Relocated building , (new fix. additional) New circuits altS'-L- or exte~sions Z- T ,;!;.:2.~ Floor furnace and vent S.F. Residence (] bath \ Duplex (1 bath) each Additional bath SERVICES /06 M11,p tfgD II J;J.!;l !}.l}.5: Recessed wall Sn~r.p hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent s~oaratp Stationary evap. cooler Vent fan wi th sinal~ duc~ Vent system apart from heatina or A.C. Mechanical exhaust hond rind dud Wood stove/heater Sewer Temporary Construction Change in existing rpc;.j4rnrp multifamily, COIJlll. or Tndllc;.tri~l ~Jater service COMfl,/INO. FEEDERS Install/alter/relocate distrib. feeners Of amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the TOTAL CHARGES that tile Electrical work be done by an label has been signed by an Electrical I ISSUANCf OF PFRllIT (47,~ TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXArllNED the completed aprlication for permit, and do hereby certi,fy 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 NO OCCUPAHCY will be made of any structure without the permission of th~ 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 a~:s ;;e ~:mPliance with ORS 701.055 will be used on t~,;;ct>e(t/t;J. f?~;""') NAI,:E(please print) ~ E ~1l'5"1v SIGNATURE ~4_ / tIt!f--, DATE7tJ7A?J , FDn OFFICE IISE1[I\ 1/ Zone Tvpe/Const. Units Sq. . t1ait x Value Fire Zone Bedrooms Occy Load Sq Ft9. Access x Value. Flood Plain Stories. Occy Group Sq. Ftg. Other x Value TOTAL VALUATION BUILDING PER~HT Charges and Surcharges Plan Ck, Comm/lnd 65%/Bldo Per Fp~ ------------ Plan Ck. R-es 30%/Blda Per Fee Fence 'Systems Development I. Charoe (1.5~) PLU'~BING PERMIT Charges and Surcharges Dljl!lo ELECTRICAL PERIHT Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges 1~7 6 _y"'__,___Q___ 8,61 Sidewalk A/C Pavi ng Total Comb. Permit TOTAL 10, r, Curb Cut . . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. legal Oescription 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 D. Energy Sources 1. examQle- heat/electrical" ceilinq/or forced air gas 2. exa~le- waterheaterjelectrical/or solar 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 permit information: 1. example - construct single family house with an attached garage 2. examele - 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 ANO 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, BUIlOING OIVISION 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, --- 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: . .J .., . I !I PERMIT VALIDATION o~ cJ- ~ ~r. 'd-1J?r ~\ ~ 01-3 ~v \~ATJ lD) Pennit Clerk g~ . Permit applicant exempt from registration with the 8uilder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date