HomeMy WebLinkAboutPermit Electrical 1988-7-21
I INSPECTION LINE
726-3769
.
CITY Uf SPRINGFIELD
COHBIIIATlON APPLICATlON/PERMIT
,-
E!IERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork:
.
INFORllATlON LINt
726-3753
Sq. Ft9. 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add A Her P.ep.
-Fence Demo Change/Use
Other- -
0\)
10
~
\N
\N
legal
8' fo~' r1/!/ I1A~
Description /00'335 cf';;;;
Job Address
,/~
Owner
Address
ttc, 3
Phone
BuildinQ Permit Info: Describe Work(i~e.. Build Single
Family nesidence With Attached Garaoel
I'~ :Jf) ( .ft.~C
Construction Lender
Address
Ut;lbN TEAI1
(name)
Phone
(address)
(lies. no.)
(exoiresl
(ohane no.
Primary
Structural
Electrical
r.,)
"'", I
s~ou
Mechanical
CONTRACTORS
Plumb;na
{n....!
_.:Za .A.A... --"
, ' r1
(""'
r \ /:.(addresc;.)
A-n...~J-.
(1 i('~c no.)
(pl{o;re~'
(opnnp
~
no )
Genera 1<:::::::---
~1echanica'
"'/
.?r<
Electrical
PlUIIBI NG
ELECTRICAL
MECHANICAL
-1!Q."
Each single fixture
FFF n-lARr,F Nn______ H~ rl-I;RG.E. NO
Residence of furnace/burner to
SQ. FT. BTU's
!:'t=t= 1...cHARG.E..
IRelocated building
(new fix. additional)
I'S.F. Residence
(j bath I
louplex (1 bath) each
IAdditiona1 bath
I ~/ater service
I Sewer
I Storm Sewer
INew circuits alts.
or extensions
I SERVICES
Floor furnace
and vent
Recessed wall
~o~rp np~tpr ~nrl vpnt
,
ITemporary Construction
IChange in existing
rpsiq~n('p'
Imultifamily, COnln. or
Tnrluc;,triill
10f amps.1
ICOMM./INO. FEEDERS I
IInstall/alter/relocate I
dic;,trih. fpprlprc;
10f amp,.1
I
I
I
Appliance vent
'ieoaratf'!
Stationary evap.
cooler
Vent fan wi th
c:innlp duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dUI".t
Wood stove/heater
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LA1~ REQUIRES that the Electrical work be done by an,
shall not be valij until the label has been signed by an Electrical
ISSUANCF OF PFRf1IT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
Zone
Fi re 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 performed 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 rw OCCUPAr~CY 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 compliance with OP.S 701,055/'y11 be used on th;~~e~ !
IWIE(please print) SIGNATURE\ /.f/~ OATE~
FOP. OFFICE USE DillY / I
Sq. Ftg, liain x Value
Sq. Ftn. Access x Value
S9. Ftg. Other x Value
Type/Canst.
Bedrooms
Units
Occy Load
Occy Group
Stori es
TOTAL VALUATION
BUILDING PERflIT
Charges and
Surcharges
Plan Ck, Comm/Ind
65%/Bldo Ppr Fpe
------------ Plan Ck. Res
30%/B1do Per Fee
Fence
syste,ms Development
Cha rqe (1. 5~) .
PlU11BING PERMIT
Charges and_.----.
Surcha rges .
Demo
ELECTRICAL PERIH!
Cha rges and
Surcharges
'Sidewalk
\~
/ '3, u'U
MECHANICAL PERMIT
Charges and
Surcharges
Ale Pavi ng
I Curb Cut
I
Irotal Comb. Permit
I
I TOTAL
/3,00.
.
.
L
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
l. Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot laO, lane County Map Reference
II 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electr;cal/or solar
E. Square footage or valuation, etc. -
1, examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building pennit information: .
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exarnyle - 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 TEM1 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.
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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
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.
</'Vr r-q:
V. FOR OFFICE USE ONLY
Permit Clerk
C--~
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
-.
"-'
PLANS REVIEWED BY:
name
\
signature
date