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:
.
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..,
. I
!I
PERMIT VALIDATION
o~ cJ- ~
~r. 'd-1J?r
~\
~ 01-3
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lD)
Pennit Clerk
g~
.
Permit applicant exempt from registration with the 8uilder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date