HomeMy WebLinkAboutPermit Electrical 1990-6-7
jINSPECTION LINE
726-3769
~
[.IT':' Uf SPkiNGFIC.!J .
CaM8IilATlON APPUC.^,TlON/PERMIT
E!!ERGY SOURCES:
l:~at
I~ate:" HeJter
Range
IIIFORltATlON UNt
726-3753
Sq. Ftg. !'Iain
~q. Ft9. Access.
Sq. Ft9. Other
New Add Alter Rep.
-Fence Oemo Change/Use
Valuf ~T";: Other- -
BuilGlna ~ermit Info: Oeser,be Workli.e., Build Single
FaMilv ne~idence With Attached Garaae\
~ IN / - Ue,r>ce..
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8
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Job Address ("O~ \'Y1 cu,.,..V
Legal Oescription \ i(')2.,2.,S"2., 10<;</00
owner'~) ~;CLI t\YLA('L&v<:;....
Address Y Lj S< D $+ Phon eO
OQ. CJl4JI
Sru..d.
Construction ~~nJer~
Address
UES I GN TEAI~
(name)
Phone
(address)
(lics.no.)
,.."'~.,~".
no. j
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(addr~<;.s)
{liCe:. no.1
(e)CDires)
(Dhone no.)
Genera 1
Electrical
( J,) ()<,.p
(n1"PffIlii D71
.,.....L_ 'I..
~,:P )?t72(J
. - - .
/.a:-~&~ ~I/o/Z. C;<:'6-cf'?d5
Plumbina
~1echanical
PLUI1B I NG
ELECTRICAL
MECHANICAL
Each single fixture
FEE CHARGE NO
Residence of
SQ. FT.
I New circuits alts.
or extensions
SERVICES
FFL~ NO,
FFle_ '~
NO.
furnace/burner to.
BTU's
Relocated building .
(new fix. additional)
IS<rJI~""
Floor furnace
and vent
S.F. Residence
(J bath)
Ouplex (1 bath) each
Additional bath
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance. vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnod ~nd durt
Sewer
Temporary Construction
Change in existing
rec;j(te..nce
multifamily, comm. or
Industria 1
Water service
COMfI./IND. FEEOERS
Install/alter/relocate
di~trih. fppdpr~
Wood stove/heater
Of
amps.
~
'---'"
ISSUANCf OF PFRIHT
~ IS 00 TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\\~ REQUIRES that tile Electrical work be done byan'
shall not be vali1 until the label has been signed by an Electrical
I HAVE CAREFULLY EXAMINE" the cnmpleted 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 UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 7Ql.055 will be used on this project.
~//~e SIGIlATURE '>c~/~
IlAHE(please print) v::.
OATEh-;7- 0/'0
FOr. OFFICE
USE DilLY
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
r1ain
Access
Other
x
Value
Value
Value
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
x
TOTAL VALUATION
BUILOING PERflIT
Charges ant::
Surcharges
Plan Ck. Comm/lnd
65%/Rlda Ppr Fpp
------------ Plan Ck. Res
30%/B1 do Per Fee
Fence
'Systems Development
Charoe (1.5~)
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERmT
Cha rges and
Surcharges
Oemo
_ __L<?A)Q ___ 'Sidewalk
.75 AlC Paving
Total Comb. rermit
TOTAL
rIS./S
.
MECHANICAL PERMIT,
Charges and
Surcharges
Curb Cut
-
-
II ...
\. . .
,
(
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VAL}DATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II uj 43
2. example- Lot I. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name, etc. of owner and construction' lender
O. Energy Sources
.1. exam~le. heat/electrical ceilinqfor forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. fnot house, 500 sq. foot garage
2. examDle- if new project. check new - if addition,
check add, etc.
F, Building permit information:
1. exa"lPle' - construct single family house with an
attached 'garage
2. example'~ remodel existing garage into family room
3. exa~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. OESIGN TEAM ANO 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.
'11. 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 Nn. 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 {tem(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 ANO
CHARGES ON THE SCHEOULES
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. ---
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
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.
~ \ '1~1
f)C,
V. FOR OFFICE USE ONLY
Penni t Cl er/lJLe /aniL-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date