HomeMy WebLinkAboutPermit Electrical 1982-3-17
I INSPECTION LINE
726-3769
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... \Job Address ~ S--.J1l1 /l r:AI'
Legal Description 11- n~ -:2,1:)' '2, \
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Nater Heater
Range
Value. of Work:
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INFORllATION UNt
726-3753
Sq. Ftg. ',lain
~q, Ftg, Access.
Sq, Ftg, Other
Ilew Add Alter Pep,
-Fence Demo Change/Use
Other- -
00
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9J
9J"
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II &frl)
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- .;Owner
,LIJRRy
; ~Address ,19 1 S.
R R R It l(J NIJ"/
h'<i?.::Ut Ii.
~ BuiltiinQ Permit Info: Describe Work(i.e., Build Single
Phone "W-<YfII 'Familv Residence Hith Attached Garaae)
.M n \ t-e.., tu -eTI r- b.roC
<i--n () lAJ'1 <;' I r>V ~
Construction Lender
Address
DtS HiN T EAr1
lname)
Phone
f address 1
(lics.no.)
(exoires1 .
~
(ohone no. )
Primary
Structural
Electrical
I~echan; ca 1
CONTRACTORS
lnamel
(addreso;; )
flic... no.
(exoireo;;)
fohone no.)
General
Plumbina
...,,> ,-Electrical
rJlvvliK
~1echanical
PLUllBING
ELECTRICAL
MECHANICAL
Each Single fixture
FF' CHARG' NIL..! ,<> rH'l.RIl.E..1Jll
Residence of furnace/burner to
SQ, FT. BTU's
~~~ rl-l~
NO,
Relocated building
(new fix, additional)
" S.F. Residence
11 bath I
IDuplex (1 bath) each
IAdditional bath
Iwater service
I Sewer
IStorm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~~e hp~trr ~nrl vpnt
TOTAL CHARGES
, WHERE STATE LAW REQUIRES
shall not be va1i1 until the
!TempOrary Construction
IChange in existing
rp~irlJ>J1r-p
ImUltifamily. COITlI1. or
Industrio:11
10f
ICOI-II'I./IND, FEEDERS
IInstall/alter/relocate I
rli~trib. feeders
IOf amp~1
I I I
I 1 I
I I I ISSUANCE OF PFR!1lT
TOTAL CHARGES I TOTAL CHARGES
that the Electrical work be done by an.-Electrical Contractor, the electrical portion 'of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
amps.]
App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatinq or A.C.
Mechanical exhaust
hood and du~t
from
Wood stove/heater
l'
'~
Zone
Fire Zone
Flood Plain
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 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 un OCCUPArKY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comPlianc~ with OP.S 7nl.055 :~i~ used~n~s project.
IlAI1E(please print) ill~(Y Ill3lZtjl'l""/lA/SIr.rIATuRE~Ji< O)~DATE 3~/1-'?)
FOr. OFFICE USE ~ / /
SqlFtg, l1ai~ C;-V
Sq. Ft9. Access x
Sq. Ftg, Other x
Type/Const,
Bedrooms
Stori es
Units
Occy Load
Occy Group
Value
Value
Value
TOTAL VALUATION
BUILDING PERfllT
Charges an~
Surcharges
, Plan Ck, Co,,"/lnd
____________~/Bldo P.er Fef>
Plan Ck, Res
30%/B1da Per Fee
Fence
Systems Development
Charae (1.5~) ",
PLUHBING PERMIT
Charges and
Surcharges
Demo
I
I
I,
ITotal Comb. Permit
1
I TOTAL
I
(tro,tt&
, - '\,
ELECTRICAL PERfiIT
Charges and
SurCharges
rlECHANICAL PERMIT
Charges and
Surcharges
JO.OG-ISidew,lk
---- --,-4t)-1 AIC Paving
I Curb Cut
I
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B, legal Description
1, example- Tax lot 100, lane County Map Reference
II 03 43
2, examole- lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D, Energy Sources
"i. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheaterfeiectr;cal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq, foot garage
2. exa~le- if new project. check new - if addition,
Cl1eck add. etc.
F. Building permit information:
1. examele - construct single family house with an
a ttached garage
2. examele - remodel existing garage into family room
3. exam~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 CDNTRACTORS
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
O. 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 CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
I3sgJ-2-?
fltd.
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/O,t}O
,710
Permit Clerk
~/~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
, , -
name r?~ d1____
signature
date
.5'/17 A>::r
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