HomeMy WebLinkAboutPermit Electrical 1990-4-2
~ CITY Uf SPRINGfiELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
J
r1dll1~
Phone
address
NF R/1AT ON
726-3753
Sq. Ftq, Main ,(\
~q, Ftg, Access. ~~
Sq. Ftq. Other
New Add Alter Rep.
Range_ -Fence Demo Change/Use
ValUE of Work: Other- - ~
BuildinQ Pennit Info: Descr,be Work( Le.. Build Single ~
Familv Residence Hith Attached Garaae: \J
Be::c//7/~ ,~~1
1
jINSPECTION LINE
726-3769
Job Address -=? ~~ ' ,-fL~Yl::>~ .~, ~
legal Oe,cription //-O7,-~ "~ t::!!'>~,~,:""
,
Owner
E W"c=-;8
Address 7.-L/ ~ /~/q~
c--~~_ ~~.
Construction lender. '
Phone
y.!!:,... ':? 'Y-?'
Address
Ut~ Juri I tJ\r'l
1 ics. no.
ex ires'
rnhnne no.)_____
Primary
Structural
Electrical
Mechanical
CONTRACTORS I name' (addre" '
General p~.r::; ~~T<jr/#-~r
Plumhino
(1 ir.o;. no, \
(exoirp,!')
(ohone M. )
Electrical
"
~1echanical
PLUllB ING
ELECTRICAL
MECHANICAL
NO. I
I FEE I CHARGE -1'n
<Fe 'rH'I!lliE. JiO.
FFF r~
SQ, FT,
furnace/burner to
BTU' 5
Each single fixture
Residence of
-Relocated building
(new fix. additional)
$.F. Residence
C1 bath\
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~c~ hp~t~r ~nn vpnt
Additional bath
I
Temporary Construction
Change in existing
res j de.nq>
multifamily, comm. or
~ndustri"l
t'S"
Appliance vent
spoarat~
Stationary evap.
cooler
Vent fan with
sin9le duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hond and duct
Wood stove/heater
~Iater service
Sewer
Storm Sewer
Of
CO~1,/IND, FEEDERS
Install/alter/relocate
rl'c;,tr;h_ fpprl~rc;
amps.
Of
amps.
TOTAL CHARGES
, WHERE STATE L.\\/ REQUJl(lo
shall not be valid until the
TOTAL CHARGES
tnat the Electrical work be done by an.
label has been signed by an Electrical
I SSUANCE OF PERllIT
/5:'~ TOTAL CHARGES
Electrical Contractor, the electrical portion of this
Supervisor and returned to the Building Division
permit
I HAVE CAREFUllY EXAMINED 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 performed 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 OCCUPAIKY 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.
Zo~e
Fire Zone
Flood Plain
Units
Occy Load
Occy Group
SIr,NATURE~ 1
FOP. OfF I CE USE DIlLY
Sq, Ftg, tlain
Sq, Ftg, Access
Sq. Ftg, Other
~ ~ let... DATE
,..
f-2.-?o
,
printl4L".IA/ aY/Vll < D ~
NAHE(please
Type/Const.
Bedrooms
Stories
~ Val~e
x Value
,x Value
TOTAL VALU~TION
PLUI1BING PERMIT
Charges and
Surcharges
Plan Ck, Comm/Ind
________-:.___~/Blc:lo Ppr Fpp
, Plan Ck, lies
30%/Blda Per Fee
Fence
syste,ms Development
CharQe (1.5~)' ' ,
BUILDING PERflIT
Charges and
Surcharges
ELECTRICAL PERlIIT
Charges and
Surcharges
D/jl!1o"
___&5::- 'Sidewalk
'~:;>~ AiC,P~~ing
ToJa' Comb. Pennit
TOTAL
I
,/.5-: ?';>
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
..
,..-.--.---- -~
.
.
,"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100. Lane County Map Reference
II uj 4J
2, example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and 'construction lender
D. Energy Sources
1. example- heat/electrical ceilinqfor forced air Qas
2. example- waterheater{electrlcal/or solar
E. Squar~ footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - 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 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job 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
signa ture.
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.
/t-0:::.
,
,
15:75'
V, FOR OFFICE USE ONLY
Permit' Clerk~~
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board b~cause:
Additional Project Information:
PLANS REVIEWED BY:
name. ~~~,~~~Signature
4~
date "'7'-7- ~a:>
"