HomeMy WebLinkAboutPermit Electrical 1981-04-01 (2)INSPECTION I.INE
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CIIY OF SPRINGTIETD
COI'IEINAII ON APPTICAII ON / PERAAII
INFORIAAIION tINE
,2(}i753
o
Addre
Legol De:cription
Addrerr Phone
Sq. Flg. Orhcr
-New -Add-Alter--ReP.
- -Fence--Demo-Chonge/ Ura
--Olhcr
-
Building Permit lnfo: Dercribe Worl (i.e.,8ui Single
Ron
Volue of Workr
5q. Ftg. Accctt.
Reridence wirh Attoched
Sq. Frg. Moin
Addre rr Phone
OESIGN TEAM (nome)(oddre:s)no.)no.)
Primqr
Struclurol
A{echo nicol
ddre no.
Plum
4+Electricol
l'{echonicol
PTUMBING EIECTR ICAt MECHANICAL
No. l i FEE CHARGE NO. I FEE CHARGE NO.FEE I CHARGE
I Eoch rinqle fixtura
I Reridence of
--sq:
fi.
furnocefburner to
--BTU'S
New <ircuirs, slterolions
or exlensionr
Applionce vent
seporoteI
I
Rclocoted building
(new fix. odditionol)
SERVICES
Stoiionory evop.
cooler
S.F. Reridence
(l borh)
Temporory Conriruclion
Vent fon with
sinqle duclDuolex (l both) eoch I
I
Additionol bolh Ampr.
Vent system oport from
heoting or A.C.
Mechonicol exhoust
hood ond ducrWoler:ervice
Wood stovel'heoterSewer
FEEDERS Heot PumpSlorm Sewer
Ampr.
Air hqndler ro
't0,000 cFM
Air hondler over
t0,000 cFM
ISSUANCE OT PERMIT
WHERE STATE tAW REQUIRES rhot thc Elsctricol work be rione by lha Elsctricsl Conlroclot, thc alettricol portion of thir permit sholl not ba valid until o
lqbcl hor bmn rigncd by on Elcctricol Contrqctor and qttachsd to tha electricol pcnel.
I HAVE CAREtUttY EXAI{INED the ompleted opplicotion for permit, ond do heraby certify ,hot oll informotion hereon is lrue ond correcl, ond I further
certify thot ony ood qll work pertormed sholl be done in occordoncE with ihe OrCinqnces of rhe Ciiy of Springfield ond the lowc of lhe Slote oi Oregon
perroining ro rhe work described herin, ond thot NO OCCUPANCY will be mode of ony siruclure withou, lhe permirsion of the Euilding Division, lfurther
ertlfy thlt my regitforion wirh the Builder's Eoqrd is in full {oro ond effect os reguired by ORS 70L055, thot if eremPt the bosis for exemption is'noted
heron, ond thot only 3ubcontroctors ond employrer who ore in complione wiih ORS 701.055 will be used on lhis proiect.
Zonc
-Typc/
Const.
-_Unit:
---Sq.
Ftg. }{oin
tlood Ploin
-Stori.3--Occy
Group-Sq. ttg. Olher "
TOTAT CHARGES
DATE
Y
tire
TOTAT CHARGES TOTAT CHARGE5
Eorir for Builder's Boord exemption:
NAlr\E (pleore prinr)
FOn OrHCE UsE
SIGNATURE
x ----------Volua
x
-[6lys
x
-Volue
TOTAT YATUATION.
Bedrooms occy Lood Sq. Ftg. Accerr
Systems Developmcnt
Chorqe ( I .5?'o)
PIon Ck. Comm/lnd
65?e/Bldq Per tee
Plon Ck. Rer
3oo,'o/Bldq Per Fee
BUITDING PERMIT
Chorger ond
Surchorges
ECFence
Totol Comb. PermitDemo
PTUMBING PERA{IT
Chorger ond
Surchorges
Sidewolk
(n
A/ C Povinq
ELE TRICAT PERMII
Chorge: ond
Surcho rgcr
Curb Cut
rOTAT
(pMECHANICAT PERMIT
Chorger ond
Surchorge r
ENERGY SOURCES:
Heot
-
Wolcr l{eolet
TCT*.RRqLII
CoMBTNATION AppLtcATtON,,'pE. _,lT (CAp)
Applicoru. ro furnish
A. Job Address
B. Legol DescriptionI. exomple-tox lot .l 00, Lone County Moo Referer2. exEmilE-Lot l. Block 3, 2nd Addition to SpringfiC. Nome, etc. of owner ond construction lender
D. Energy Sources
exomple-heot,/electricol ceili
2 exornole-woter eoter.,eci
V. FOR OFFICE USE ONLY
PTANS REVIEWED BY:
PERMIT VATIDATICN
OF SPRINGFIELD
CirY Holl
Springfield, Oregon
Deporlment of Public Works
OFFICIAT RECEIPT
No. B 56200
CITY
E. Sguore fooroge o. roluotiof]Il-l. exompjs-.l,2Ig rq. foor house, 500 sg. foot gorog2. exomole-if new proiecf, check-new_if oddition, ciaEe.;?c:
F. Building permit informorion:l. exomple-construc, single fomily house with on olgoroge
2. exomple-remodel existing goroge into fomily rooJ. exomple-convert single fomily residence into
resrouront (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of theStrucrurol Speciotry Code
H. DESIGN TEATA AND CONTR.ACTORS
To ovoid design or construciion deloys, Building DivisStoff mus, be oble to contqct oppropriole p".rJn, ."gdesign informction or iob site correclions, etc.
ll. ,Abbrevioted Plumbing, Mechonicol & Elecrricol SchedulesA. Except where blonk spoces occur in fhe description poof the Mechonicol ond Electricol Schedules, rh. ";pi;;need fill-in only the No. Boxes odiocent to the oppropitem(s) to be instolled
8. Full Plumbino, Alechonicol, ond Elecfricol Scheciulesore ovoiloble ot the Buiiding Divisionl. To conserve spcce on the permit form the scheduleshove been cbbrevioted2. lf the item(s) ro be instolled ore not covered on the ,. oted schedules you should consult the fuil schedulesC. BUILDING DIVISION STAFF WILL FILt OUT ALL FEES ANCHARGES ON THE SCHEDULES
lll. Aoplicont to sign onci dote
Whenever possible, rhe initiol opplicorion will be used os cworksheet oniy. Where possible, 'Builciing Division Stoff wilprepore o rypewritten copy oncj return it to the opplicont othe time the octuol permit is issued for his signotuie.
lV. Fees cnd Chorges
r9
Rec''d From IK
Add
Received Fotr
(,
c
(
L
reI
(l
(f
Amount Received
i,EY
ZEO SIGNATURE
SHELTOT'TUii'uLL ltltlEi3' EU6IX' or t"ol l!!tl_'
Permit Clerk
(
+-
Plon check fees ore due ond poyoble of the time of the opplicotion,ond no plons will be processed unril rhese f"";;.; p;U. iTl"--"'other fees ond chorges ore due ond poyobl" ;;"; ii"l.r-rtis issued.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiec lnformotion:
nclme a
signoture dote
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