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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.. #I ! 8 )J ;"j .j 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