HomeMy WebLinkAboutPermit Electrical 1983-8-16 (2)
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I INSPECTION LItlE
726- 37 69
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INFDRllATlON UN'
726-3753
Sq. Ftq. t.lain
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other- -
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Job Address SO:s ~ ~
legal Description - ~~ N ~d...l~1
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Owner (~CL/,'j':ff~
Address &!t/)"')O<;( ~J~ I?P+~
97'177
CIIY OF SPRINGFIELD
CDrlBHIATlON APPLICATION/PERMIT
EllERGY SOURCES:
Heat
Nater Heater
Range
ValUE of Hork:
Buildina Permit Info: Describe Work(i.e., Build Single
Phone~,?~AO Familv Residence With Attached Garaae1
~i./ JJ.
Construction lend~
Address
UI::.:::dtiN Il:.Af1
(name)
Phone
(address)
?1!~ Lud'J - ~
L/...-o"'t. ~1 _ , (I
(i;"cs. no.)
{exoiresl
(ohone no.')
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
lnamel
{addre~s1
(1 ic~. no.)
{exoires1
(ohone nn.1
Genera 1
Plumbina
Electrical
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PLUtm ING
ELECTRICAL
MECHANICAL
NO.
FEE I CHARr,F Nn
~~~ r~~ Nn
~~~ r~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
/
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
Floor furnace
and vent
S.F. Residence
(I bath)
Duplex (I bath)
Additional bath
each
SERVICES
I '-{rr/v
ITemporary Construction
IChange in existing
rp~jqr.nr:e .
Imu1tifamily, COI11ll. or
Inrlustrial
10 .oD
.'-10
Recessed wa 11
SnArp hp~tpr Ann vpnt
Storm Sewer
10f
ICO~1./IND. FEEDERS
I Install/alter/relocate
.r!i<:t!'"ih_ fppr!pr<:
10f
I~. ,PM
I # or;,g9 6
I
amps.
Appliance vent
seoaratp
S-tationary evap.
cooler
Vent fan wi th
~inole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hnod and durt.
Wood stove/heater
from
,/a ter servi ce
Sewer
amps.
,Zo
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TOTAL CHARGES TOTAL CHARGES /f4 eO TOTAL CHARGES
WHERE STATE L..'I/ REQUIRES that the Electrical work be done by an,'Electrical Contractor. the electrical portion 'of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
ISSUANCf OF PFR!1lT
Fire Zone
I HAVE CAREFULLY EXN1INED the completed aprlication for permit, and do hereby certify that all information hereon is true
aod correct. and I further certify that any aod all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield aod the laws of the State of Oregon pertaining to the work described herein, and that fW OCCUPA[~CY 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 701.0551 that if exempt the basis for exemption is noted hereon 1 and that
only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project.
IlAJIE(please printJ.A: ,hi P [?, Lila //r~ QSIGIlATURE~'-~-:;(' #L2-
FOR OFFICE USE O;l~ .
So. Ftg. l1ain
Sq. Fta. Access
Sq. Ftg. Other
DATE >?Ar-2L1
Zone
Tvpe/Cons t.
Bedrooms
Units
Occy Load
Occy Group
.x
Value
Value
Value
TOTAL VALUATION
x
Flood Plain
Stories
x
BUILDING PER~IIT Plan Ck. Conm/Ind
Charges and ------------ 65%/B1 do Pp!'" Fpe
Surcharges Plan Ck. R-es
3D%/Bldo Per Fee
PLU'1BING PERMIT Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PERI:IT _ _Ji2.J2!)_ ___ 'Sldewa I k
Charges and
Surcharges . LID A/C Pavi ng
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charae (1.5~) .
~. jakJL
#- osgc;
.20
Total Comb. Permit
TOTAL
/0.60 --1
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, lane County Map Reference
II oj 43
2. example- lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examDle- 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 new - if addition,
cneck add, etc.
F. Building permit information:
1. examele - construct single family house with an
attached garage
2. examele - 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.
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 OIVISION 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. ---
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 penmit 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:
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PERMIT VALIDATION
Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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date
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