HomeMy WebLinkAboutPermit Electrical 1990-8-31
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. CITY UF SPRINGFIELD
COMBIIIATIDN APPLlCAHON/PERMIT
EilERGY SDURCES:
Heat
\~ater Heater
Range
ValuE of Harle
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IINSPECHON LINE
726-3769
Job Address 675 /1;';I'A1 <:;r-
Legal De,cription ~~A/~
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Owner'
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INFORlIATIDN LINt
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
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BuildinQ Permit Info: Desc~ibe t4ork(;.,e.. Build Single I ~
Familv nesidence lHth Attached Garaoe) _ ~
Address
Phone
Construction lender
Address
Ut,lt;N 1 tAI1
(namel
Phone
(address)
Primary
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(1 ics. nn 1
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Structural ~
Electrical 1311~C7i2dN(( ~t<no,\ls fV../lux t!bJFOtrtt:i2.vr &
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CONTRACTORS /" (hamel !';" (address) (;{cs. no,) (pxoired
General /' ~rA~~
Plumbina V
Electrical
~1echanical
PLUI.IBI NG
ELECTRICAL
Nn_
FEF CHAR~F NO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or "extensions / €!"f,
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
I Water servi ce
I Sewer
I ' " '
Storm Sewer ...
SERVICES
Temporary Construction
Change in existing
residence
muftfiamily, corrm. or
tndu~triill
::-
--'--
Df
amps.
, ,-
CDMM./INO. FEEOERS
Install/alter/relocate
d;~tr;n. fppdpr~
" .
Of
amps.
TOTAL CHARGES TOTAL CHARGES
, WHERE STATE L\\~ REQUIRES that the Electrical work be done by an
shall not be valij until the label has been signed by an Electrical
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MECHANICAL
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furnace/burner to
BlUts
Floor furnace
and vent
Recessed wall
SOilrp hp~tpr ~nrl vpnt
Appliance vent
~enilriltp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood tlnd dUl"t
from
Wood stove/heater
ISSUANCE OF PFRmT
"Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
TDTAL CHARGES
I HAVE CAREFULLY EXAMINEO 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" NO OCCUPAHCY 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 subcorytractors and employees who are in compliance with OP.S 701.055 will be used on this project.
HN1E(please print) SIGHATURE
FOR OFFICE USE OHLY
Zone Tyoe/Const. Units So. Ftg, f1ain
Fire Zone Bedrooms Occy load Sq. Ft~. Access
Flood Plain Stories Occy Group Sq. Ftg. Dther
BUILOING PERmT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Rldn ppr rpp
------------ Plan Ck. Res
30%/Bldo Per Fee
Fence
PLU'1BING PERMIT
Charges and
Surcharges
Oemo
_ _ _L~_~c:::.. ___Sidewa 1 k
,7fT Ale Paving
ELECTRICAL PERmT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
DATE
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charoe (1.5%)
Total Comb. Permit
TDTAL
15.75'
.
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__ 1
COMBINATION APPLICATION/PERMIT (CAP)
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I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 oj 43
2. examele- Lot I. Block 3, 2nd Addition to
Spr,ngtield Estates
C. Name, etc. of owner and construction lender
D. .Energy Sources. \ " . . <'. .
1. examDle~'neat/electrical ceiliriq/or~forced air qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation. etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check:ruew - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
".' 3. examele -,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
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.
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V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATI$FIED BEFORE OCCUPANCY;.
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PERMIT VALIDATION
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Permit Clerk #~H\<_
Permit applicant exempt from registration with the Builder's Board because;
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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