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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