HomeMy WebLinkAboutPermit Electrical 1981-04-01INSPECIION I.INE
7263759
CITY Of SPRINGFIEID
COMBINAIION APPTICAIION/PERMIT
INFORMATION tINE
726-3753
Job
ENERGY SOURCES:
Heot
-
5q. Frg. Moin
5q. Ftg. Accesr.
Sq. Ftg. Other
-New -Add-Alter--ReP.,---Fence-.-Demo-Chonge/ Use
--Other
-
Woler Heoler
Volue of Work:
Bui ng Permit lnfo: Dercribe Work (i.e.,8uild Single
Fomi ce Wilh Attoched
s
oa)A)a
I 2-7Ie9o I
Address Phone
Co
Add re ss Phone
DESIGN TEAM (nome)(oddresr)no.)(expire r)
Primory U
Structu ro I
Ele ctrico I
s
Generol
Plumbinq \o4+BElectricol
Mechonicol
PLUMBING ETECTRICAT MECHANICAL
No. I I FEE CHARGE NO FEE CHARGE NO.FEE CHARGE
I
I Eoch single fixture
Residance of
fr.
furnoce/burner to__Bru's
Relocoted bvilding
(new {ix. odditionol)I
I
New circuits, ollerotions
or exlensions
Applionce vent
seporqte
S.F. ReridencE
(l both)SERVICES
Stotionory evop.
cooler
Duolex (l both) eoch
I
I Temporory Conslruclion
Vent fqn with
single duci
Additionol both Ampr.
Venf system oport from
heoting or A.C.
Woler rervice
Mechonicol exhousl
hood ond duct
Sewer Wood stoveT'heoier
Slorm 5ewer FEE DE RS Heot Pump
Amps.
Air hondler to
r0,000 crM
Air hondler over
'r0,000 cFM
ISSUANCE OF PERMIT
TOTAL CHARGES TOTAT CHARGES TOTAT CHARGES
WHERE SIATE fAW REQUIRES rhot ,ho Electricql work be done by the Etectricol Conlrcclor, the electricol portion of lhis Potmit sholl not bc volid until a
lobel hot been rigncd by on Elcctricol Contlodor ond ottochad to the electricol ponel
I HAVE CAREFULty EXAMINED the completed opplicotion for permil, ond do hereby cartify thot oll informotion hereon is lrue ond correcl, ond I further
<errify thof ony ond qll work performed sholl be done in occordonce with the ordinqnces of the City of Springfield ond lhe Lows of lhe Stote of Oregon
pertoining to tle work described herin, ond rhot NO OCCUPANCY will be mode of ony srructure withou, ihe permission of $e Building Division. I further
certlfy rh;r my registrorion wirh thc Builder's Boord is in full fore ond effect os reguired by ORS 70,t.055, thot if exempt the bosis for exemption i:'noted
heron, ond thot mly subconrroctor5 ond employeer who ore in complione wiih ORS 701.055 will be used on ihis proiect.
Bosis for Builder's Boord exemption:
NAME (pleore prinr)SIGNATURE DATE
FOR OffICE USE Y
Zone
-Iypai
Const.
-Units
v
Sq. Ftg. Moin x
-Jolue
x
-Volue
Fire Zone-Bcdrooms occy Lood 5q. Ftg' Acce::
FloodPloin-Sloriar-occyGroup-Sq.Ft9.other_-----------lJ-x-Yo|ue
TOIAT VALUATION,
BUITDING PERMIT
Chorger ond
Surchorges
Plon Ck. Comm/lnd
-cl4Ige--lell".-Plqn Ck. Rer
309'"/Blds Per Fee
Systems Developmeni
Chorge (1.59'o)
PI,UMBING PERMIT
Chorges ond
Surchorges
Fence EC
Demo Toiol Comb. Permit
ELECTR.ICAI PERMIT
Chorger ond
Surchorges
CN Sidewolk
A/C Povinq
I'\ECHANICAI PERMIT
Chorges onci
Surchorger
Curb Cut
TOTAT }D r&
-a\ rt\0\ q s
^+.,
r.-th.
I
(nome)(oddress)(lics. no.)(expires)(phone no.)
L &ax - RSqq
0
i
I ,r)
COMBINATION APpLICATtON,/PEr.ralT (CAp)
l. ,Appliconr. to furnish
A. Job Address
B. Legol DescriptionI. exomple-tox lot I00, Lone County Mop Reference I7 03 43
2. exomple-Lot l. Block 3, 2nd Addition to Springfield Esrotes
C. Nome, etc. of owner ond construction lender
D. Energy Sources
or forced oir gos
or solo r
l. exomple-l 250 sq. foor house, In0 rq. foot goroge
2 . e-xE milE- i T-n e w p r o i e c t. c h e c k -n e w - i i o d d i t io n, ci e c k;EA;;
F. Building permit informotion:
'| . exomple-construc, single fomily house with on ottoched
goroge
2. exomple-remodel existing goioge into fomily room
S. 4@il-g-convert single fomily residence into
iEITEIIEnt (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Structurol Specio Iry Code
H. DESIGN TEATA AND CONTRACTORS
To ovoid design or construciion deloys, Building Division
Stoff must be oble to contoct oppropriote persons regorCing
design informction or iob site corrections, etc.
Abbrevioted Plumbing, Mechonicol & Elecrricol Schedules
A. Except where bionk spoces o€cur in the description nortion
of the Mechonicol ond Electricol Schedules, the oppiicont
need fill-in oniy fhe No. Boxes odiocent to the oppropriote
item(s) to be instolled
B. Fuil Plumbing, Mechonicol, ond Electricol Schecjules
ore ovoiloble ot the Buiiding Division
I. To conserve spoce on the permit form the schedules :
hove been obbrevioted
2. lf the item(s) to be insiolled ore nof covered on the obbrevi-
oted schedules you should consult the fuil schedules
C. BUILDING DIVISION STA.FF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
Applicont to sign onci dote
Whenever possible, the initiol ooplicorion will be used os o
worksheet oniy. Where possible, Buiiciing Division Stoff will
prepore o typewritten copy oncj return it to the ooplicont ot
the time the octuol permit is issued for his signoture.
Fees cnd Chorges
Plon check fees ore due ond poyoble qt the time of the opplicofion,
ond no plons will be processed until these fees sre poid. ail
other fees ond chorges ore due ond poyoble when the permit
is issued.
FOR OFFICE USE ONLY
I. exompie-heotrelectricol ceiling./
2. e-iE mEG-*o ter IEElEiGTEiiii co I
E. Sqr".. io"i"g" o. ,olrotioi, "f-
IV
v
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion;
nclme signoture dote
f
PLANS REVIEWED BY.
PERMIT VALIDATION
Permit Clerk