HomeMy WebLinkAboutPermit Electrical 1990-6-18
jINSPECTION L1f1E
726-3769
~
Job Address 1\ I \4 rN.l i [\ ,
Legal Oescription \l)()R~'8\~' ()~
CiTY U> ~PK1N">IELD
COMBlI1ATIDN APPLlCATION/PERlHT
EilERGY SOURCES:
Heat
Hater Heater
.
INFORltATION LINt
726-3753
Sq. Ftq. I-lain-
Eq. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
-Fence Demo Change/Use
Other- -
.>J
~
J
t-
Owner'\.~_~~'0\ \>~ ~ ~ Y'O I\(\~
Address \4 \ ~ v.::::>. ,\'-\11\, ~ ~Jhone
constru~ ~'f\ 0 \ CY\L C\ 'l4Gb
Range
ValuE of flork:
Builriinq Permit Info: Oeser be Work{i.e., Build Single
Famil v Il.es i dence IH th Attached Garaae)
dH-
OvlrLULS
Address
Ul:..~ lliN II:..Af~
(name)
Phone'
(address 1
(lies_ no.)
(expires)
(ohOnE! no.,
Electrical
~
r
Primary
Structural
Mechanical
CONTRACTORS
(name)
Caddrpss\
(lies. no.)
(exoired
(phonp no. \
Genera 1
Plumbina
Electrical \J trrn f-:,
Ci\ lfK) ~ ..!Df..O \ \ I 'lnFf.{)
~11nO'<1'_, Rn'3~ \ ~Ch.'f)ec1 ~.J\~,(0Lq4i-8Il.5
~'echanical
PLUlIB I NG
ELECTRICAL
MECHANICAL
SQ. FT.
furnace/burner to
BTU's
1m
r"ARliL
Each single fixture
FEE 'CHARGE NO~
Residence of
FFF
rH'IB.lif. NO
NO.
Relocated building -
(new fix. additional)
f\Jr.. .New circuits alts.
oJ' or extensions
Floor furnace
and vent
S.F. Residence
(l bath I
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~oarp hp~tpr ~nrl vpnt
Stann Sewer
Of
COMfI./IND. FEEDERS
Install/alter/relocate
di~trih_ fppdpr,
amps.
Appliance. vent
S~Dar"te
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood i1nd duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
resj ~eJlce
multifamily, comm. or
Industrial
Water servi ce
Of
amps.
ISSUANCE OF PFRllIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l~ REQUIRES that the Electrical work be done by an' 'Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CARErUllY 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 110 OCCUPAIICY 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 sUbco~a~s and employees who are in compliance with ORS 7Ql.055 will be used on :hiS project. \~~~
IIAlIE(PleaseAi~@...~ SIGIIATU~j_D, I3TlPr ,'JJ- DATEM~/9r
I FO~ OFF] CE USE OIIL Y
Zone_' Type/Const. Units Sq. Ftg. l1ain
Fire Zone i Bedrooms Occy load Sq. Ft9. Access
Flood Plaio Stories' Occy Group Sq. Ftg. Other
,
Value
Value.
Value
TOTAL VALUATION
x
x
BUILOING PERNIT Plan Ck. Conm/Ind
Charges and ------------ 65%/Blda Ppr Fpp
Surcharges Plan Ck. Res
30%/Blda Per Fee
PLU'~BING PERMIT Fence
Charges and ------------
Surcharges DfjfIlo
ELECTRICAL PERrllT &QL00 -Sidew.l k
Cha rges and - - 0_____-
Surcharges LIG A/C Pavi ng
I1ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charqe (1. 5~) ,
Total Comb. Permit
TOTAL
()3, b3
..
'.-
.,..-
.
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
II oj q3
2. exam~le- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc,'of owner and construction lender
D. Energy Sources
'1. examole- heat/electrical ceilinQ/or forced air Qas
2. example. waterheater/electrica(/or solar
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examp'le- if new project, check-new - if addition,
check add. etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage
2. examele - 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 infonmation or jOb site
corrections, etc. . I
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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
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.
. .
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
II
_~ I.
., '-11
II
-'
PERMIT VALIDATION
,/
~ r
~~ ~ (8; -cro
-# f'Jo91
Permit Cl erk
Ei<<5v
.
, /
Permit applicant ex~mpt from reg~stration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date