HomeMy WebLinkAboutPermit Electrical 1984-05-01IiISPECTION LiIIE
7?6-37 69
CITY OF SPRINGFIELD
COMBI iIATI ON APPL I cATIoNIPERMIT
fNFORrrAimN-ITSf
726-3753
Job Address /30 EIIERGY SOURCES
Hea t
l,later Heater
Ranqe
Sq . Ftq . l'la i
Sq. Ftq. Access.---
sq. Ftq. othe!_
_llew_AddJ1 ter_Pep.
_Fence_Demo ChangeiUse
-othe.---
l-egal Oescription )
I Value of l,lork:
0wner
rl'+'Y<-'l-:Phone -----Bu n t : Descri beh Attached IFGara
.e., Build Single
\ A n\q-u)
Construction Lender 0 rilc iirto
Phone
name address l ics. no.exot res ohone no.
Structura I
E l ectri cal
l.lechanical
name
Plumb
PLUI{BI NG ELECTRI CAL MECHAN I CAL
N0.FEE CHARGE NN FFF CT,IA PGF NO FFF
Each single fixture Residence of
SQ FT
urnace/burner to
BTU' S
Relocated building
(new fix. additional)
New circuits alts.
or extensions 4,*r ?*Floor furnace
and vent
S. F. Residence(l bath)SERV I CES
Recessed wall
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on
Apo'l i ance vent
seDa rate
[.iater servi ce
C hange
rpsi de
in existing
nce
Stati onar.v evap.
coo l er
Sewer
multifamily, conrn. or
IndustriaI
Vent fan with
sinole duct
Storm Sewer
0f
Vent systern
heatinq or A
apa
,. c.
rt from
c0Mr.1./IND. FEEDERS
I'techani cal exhaust
hood and duct
Instal I /aI ter/re1ocatedistrib. feeders
l{ood stove/heater
0f
ISSUANCF OF PFRIIIT
TOT.AL C HARG ES TOT AL c HARG ES
TOT AL I HARGES
do by E1 ec t rl ca I Con tractor the e I e ctri ca I port 10n of th 'I S Perm'1 +
I.lHERE sT TE 1,1!l REQU I R ES tha t the 'I ec t r I ca I w0 rk be ne an
Bu 'I I d 'I Di vt 'I on
'I gned by EI ec tri ca 'I 5u pervi sor a nd re tu rn ed to the ng s
s ha I I no t be va ,l '|t UN t'i 'I t he 1 a be 't ha s been s a n
ti rml t and do hereby cert 1 tha t a n format 'I on he re0n 'l s true
Ci ty
made
E Y t he comp ted ap!-)ca 0n r
cordanc wl h the 0rd I nance S of th e
and I fu rthe cert 'I fy t ha t any and al I
0regon
the Bui l
wo rk sh a I I be done 'I n ac
OCCUPANCY wl 1
''|beandc0rrectr
1 to th k descri bed herei n nd tha t t,tctSD'I f 1 I d a nd th e Laws of t.he S ta te of 0e rta I n ng e wor 'l v,l th the D 'I I de r srngeding Division I further certifY th a +my reg .I s trat 0n u
f any 5 truc tu re w1 th ou t t he p erm I s s 'I on
'I f t he ba 'I fo r exemp t '|on 'I s not ed hereon and tha tt as required bY ORS 701 .055, tha t exemp sBoard is i full force and effec
0 P,S 701 055 1 'l I be used on thi s proj ec +
I s ubcon tr to rs and oyees who are in comoliance withonv
l{I$.lE(pl ease pri nt)IGNATURE
FI
ni ts Sq ' FtC ' t'lai a lue
Zone--TYPe/Cons t
Ftg. Acces x, Va]
Fire Zone Bedrooms occy Load
Occ.y Group Sq.alue
Flood Plain Stori
lan tems e 0pmen
BUILDING PERI.IIT
Charges and
Surcharges
1
anC
3 Per
Ind
Fts 0ther
PLUtlBING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICA,L PERI:IT
Charges and
Surcharges I
Sidewal k
A/C Paving
Curb Cut
Total Comb. Permit
TOTALIIECHANICAL PERMIT
Charges and
Su rc ha rge s
Addres s
(\ c\r
Addres s
>0
C"
J
=C
S
1
I LAI,I {
Primary
o
*
TOTAL VALUATIOII.-
COMBINATION APPLI CATION/PERI,IIT ( CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. glample- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sourcesl'
2.E. Squa
or forced air gas
valuation, etc
electrical
e ec or solar
1
2
examp-le- l?50 sq. foot house, 500 sq. foot garageexample-.if new project, check-new - if adAition,check add, etc.
II.
tll.
F. Building permit information:1. elample - construct single famity house with anattached garage
1. exgmp-le - remodel existing garage .into family roomJ. examDle _ convert single family residence inioiesTfirant (chanje-oi'ri.i-'''G. Value of work ai defined in-i6ction 303 (a) of the.. Structural Specialty CodeH. DESIGN TEAM AND CON1RACTORS
To avoid desion or.construction delays, BuildingDivision Stafi must be able to coniitt appropriatepers0ns.regarding design information or jbo iit"--corrections, etc.Abbreviated plumbing,. Mechanical, & Electrica.l Schedu.lesA. Except wheie brlnk ap;;;;-;;;r; ;;';i. descriptionportion of the Mechanical anO fleitricat Sctreiuies,the appjicant need fttt_ln-onty'il;'N.. Boxes adjacent_ !o-lhq appropriate item(s) to "oe-insiatteaB. Ful t ptumbing, llecnaniciil iro-rr"l,iiica.l Schedu.tesare available at the Building Divisionl' To conserve space on ttre-permit iorm the schedureshave been abbreviated2. Lf tt,: item(s).to Oe-instal.led are not covered onthe abbreviated schedu.les you-s[oula .onirii-tn..'ful'l schedulesc. qgllglNc DivrsroN STAFF WrLL FrLL OUT ALL FEES AND- CHARGES ON THE SCHEDULES0. As noted on the CAp; i[; Iabe] must be delivered to theelectrical contractor fo" signulr". 6, ,,r, electricalsupervisor. The.general .oniri.lo. ii ,ot authorized. -to sign the electiicai .lalel. --'-'
Appttcant to sign and dateIJhenever possibre, the initiar. application wi.n be used asa worksheet only. Hhere possibtt, griiii;g Division staffwill prepare a ivoe written-iopy-;.;-;;;r;, it to the
:?3ll;;l:.at the time the u.il;i ;;;,;i"i' i'i,"i io" r,i,
Fees and Charqes
P'lan check feis are due and payable at the time of theapplication, and no oturi,riii'6;';.il.;& untit thesefees are paid. Al l btner r"., ino'.ii"r.!'r". due andpayable when the permit is lssueJ]
vlrerrgJ
FOR OFFICE USE ONLY
IV
v
PERMIT VALIDATION
(t3t77
Permit Clerk d/a,
PROJECT CONDITiONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Pe rm t'l a I ci na tpp ft rer0mexemp 'l ts tra oI ng w t'l h t Bhe 1u dI e r S oaB rd be aL u s e
Additional project Inf ormation:
PLANS REVIEWED BY:
name
da tes'l gna tu re