HomeMy WebLinkAboutPermit Electrical 1990-1-30
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N Rl1AT ON
726-3753
Sq, Ftg, 14ain
~q, Ftg, Access,
Sq, Ftg, Other_
Hew Add Alter Rep,
-Fence Demo Change/Use
Other- -
I
I.egal
TY SPR NGFIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES,
Meat
Ilater Heater
I
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Owner , Km ---r'e, TV
Address ~ ~ ~~ J '-- ~ Q JrrY\ ti ~fbt Q
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ValuE.
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BuilriinQ Ptrmit Info:
Familv nes'dence With
Oescrlbe Work(i,e,. Build Single
Attached Garaae'
Address
Ul:.~ltiN H:.m~
"
Phone
address
name
Primary
,
Struc tura 1
Electrical
t~echanical
CONTRACTORS
name
(addr~ss\
(1ic~. no.)
Ce.xpires\
(phone no. )
General
Plumbino ~
Electrica (}f' J. L )~ ol1[L
~'echanical (
7' 00 1'111/A' J
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PLUllB I NG
ELECTRICAL
MECHANICAL
NO, '
I FEE - CHARGE NO
':E.L.cHARliE. NO,
" , .cHARliE.
Each single fixture
Residence of
furnace/burner to
BTU's
Relocated building
(new fix. additional)
SQ, FT.
~ 1\ New circuits alts.
rJ\ or extensions
!1/J r:y)
Floor furnace
and vent
S.F. Residence
II bath'
Duplex (1 bath) each
Additional bath
,SERVICES
Recessed wall
~n~~p hp~tp~ ~~rl VP"t
Storm Sewer
amps,
Appliance vent
!.eoaratp
S.tationary evap.
cooler
Vent fan with
sin91e duct
I Vent system apart from
heatlno or A.r..
Mechanical exhaust
hood and duct.
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp~ j qe.nl".p.
multifamily, comm. or
Inrluc;trial
Water service
-,
Of
COMl-I, II NO, FEEDERS
Install/alter/relocate
rl~c;t.rih. fepders
,Of
amps.,
TOTAL (fIARGES
WHERE STATE 1..'1/ REQUIRES
shall not be valiJ until the
TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
I ISSUANCF OF PFRIIIT
rOr{).'Sf:.-. TOTAL CHARGES
Electrical Contractor, the electrical portion 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 nerformed 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 un OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I fur~e certify that my registration with the Builder's
Board is in full fo~ce and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon. and that
onl sUbcontractp~[fld emP10Y~I:~(CJLJr\~h O~I.O~5 i be use n this project,
IlAIlE(ple se print) q SIGrlATUR
Zone Type/Canst. Units FOr. orFICE ~~~or~1 Itain
Fire Zone Bedrooms Dccy Load Sq. t~. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
DATE
x
Value
Value
Value
x
x
TOTAL V ALUA TI Ot!
BUILDING PWIIT ' Plan Ck, Conmflnd
Charges and ------------ 65%/Bl do Per Fpe
Surcharges Plan Ck, lies
30%/Bldo Per Fee
PLUt4BING PERMIT Fence
Charges and ------------
Surcharges DemO
ELECTRICAL PERliIT cQ&. SO 'Sidewalk
Charges and - -------
Surcharges " L~ AIC Paving
rtECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges I
'Systems Development I
Charae tL5~) -
Total Comb, Permit
I TOTAL
;{3. fo3
-
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A, Job Address
B, Legal Oescription
1, example- Tax Lot 100, Lane County Map Reference
11 OJ 43
2, exa~le- Lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O~ Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check new - if addition.
check add, etc.
F. Building permit information:
1. examJPle - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examyle - 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
cqrrections. 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 BuildingfDiv;sion'~
1. To conserve space on the penmlt 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. ---
111, 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
signa ture.
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:
e
..
PERMIT VALIDATION
, ."!c~,
Permit Clerk
.
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. (51\ ~:\
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( ;:sQ()7
Hrm
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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