HomeMy WebLinkAboutPermit Electrical 1990-6-5
....
l IN'P~CTION LINE
1726-3769
.
CITY Of SPRINGfIELD . INFORllATION liNe
COHBIIIATiON APPLICATION/PERMIT 726-3753
E!lERGY SOURCES: SQ. Ftg. '.la i n
Heat ~Q. Ftg. Access. :3
Hater Heater SQ. Ftg. Other
flew Add Alter Pep. I
Ranqe -Fence Demo Change/Use _.
____ ValUE of ('lark: Other- - ~'\ \
?---- '\ 1
nConc7J' BUji1tiinQ P~rmit Info: Describe Work.{Le., Build Single D..:..\
~!''' 7::::jFa""1V neSldence 1.l1th A.ttached Garaoel (:)"i,
1/ tV CIa') r-aAt10)L ';{
( f Ye c...fv'iL- +0 0 c, C<l.S ')
c.
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Job Address ''JO 3 . mtw ill SY""
Legal Description 1/03367; I - 12-70V
Owner T '^^ ~1.V\e<,
Address 3:::>.", VY\ 0..:\ '^ s+-
50 r7 t/lc, h' (> / J.. 012.. 7 7 L/ 7 7
.' dJ ~
Constructlon Len er
>J
Address
DES I oN I EAI~
(name)
Phone
(addressl
(lies. no.)
(exn;res\
(ahaM no.
Primary
~
Structural
Electrical
Mechanical
CONTRACTORS
(name}
(address'
(1 ics. no. \
(pll'n;rpc:,\
fnhfl"'" n... \
Genera 1
Plumbina
Electrical ;?
-flech;jni~a1 (I:.~#7 ~/~.
J 'PLU/1BtNG'
('j'b C;l.,c>v
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,
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ELECTRICAL
MECHANICAL
Each single fixture
FEE . r:HARGF" . Nl' F'F'F . rH'iRG.E. NO_ ' FF'~\.GliARG.E.
Residence of furnace/burner to
SQ. FT. BTU's
NO. .
Relocated building .
, (new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~hp~tpr ~nrl vpnt
amps.
Appliance. vent
~roarate
Stationary evap.
cooler
Vent fan with
sin~:J1e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rps i QeJ1('p
multifamily, comm. or
lnd.J,l<:.trial
~Iater servi ce
Storm Sewer
Of
COffi1./IND. FEEDERS
Install/alter/relocate
distrih. feeders
Of
amps.
TOTAL CHARGES '. TOTAL CHARGES
WHERE STATE LA\~ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I SSUANCf OF PFRfllT
-~-
TOTAL CHARGES \ tl. ~
'Electrical Contractor, the electrical p6rtion of this permit
Supervisor and returned to the Building Division
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 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 /10 OCCUPAllCY 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 subcontractors and employees who a~e in compliance with ORS 701.055 will be used on this project.
IlAf.1E(please print) SIGIlATURE
FOr. OFFICE USE OIILY
Zone Tvpe/Const. Uni ts Sq. Ftg. t1ain
Fire Zone Bed rooms Occy Load SQ. FtQ. Access
Flood Plain Stories. Occy Group SQ. Ftg. Other
,ryATE
I
x
Value
Value.
Value
,
x
TOTAL VALUATION
BUILDING PERfllT I Plan ek. Coom/l nd
Charges and ------------ 65%/B1do Pj'r Fpf:l
Surcharges Plan Ck. Res
30%/B1do Per Fee
PLUl1BING PERMIT Fence
Charges and ------------
Surcha rges Demo
ELECTRICAL PERInI Sidewalk
Cha rges and - --- -- --- ---
Surcharges 6 ~~ A/C Paving
MECHANICAL PERMIT \ .~ Curb Cut
Charges and -----"i-----
Surcharges <~
, ,
ISystems Development I,
Charoe (L5~)
Total Comb. Permit
TOTAL
j \ 6."15
II!'
.
.
,. ,
...Il1 ,_'.1.,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION.
__, J. Applicant to furnish
f A. Job Address
B. Legal Oescription
1. ~xamp'le- Tax Lot 100. Lane County Map Reference
~ II 03 qJ
2. examole- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. exa~le- waterheaterjelectrical!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,
Check add, etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage
2. examole - 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. DESIGN 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 bee~ abbreviated
2. .. If the item(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 AND
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. ---
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.
Put'
~+t
(\.2..<-- J:-
. n?<-t~
V. FOR OfFICE USE ONLY
Permi t Cl erk
l~l~
- ,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registrati on with the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
name
signature
date