HomeMy WebLinkAboutPermit Electrical 1982-07-12TI
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7?5-
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COI1B I i N lCATION RMIT 7?6:37 53
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Range
l,later Hea
EIIERGY
Hea t Sq. Ftg. Access.-
. Ftg. t{a n
Val ue of llork
/
Owner
Address
.e., Bui1d Singie_E,ffiq PJrrt Info: Describe l'lork(''Fanily Residence llith Att
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cLConstruction Lender
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/O fu,/ e/z7.Addres s Phone
exo l reslics. no.addressIN TEAI{name
El ectri cal
Structura l
Primar
llechanical //tlSt <Y f:pYn l rtrq ohone no.I i cs. no.addres snameCONTRACTORS
Genera I
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Pl mbi
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MECHAN ICALEL ECTR I CALPLUIlB I NG
FFF l.HARI]Fl^HA AGF 11()(^HA RG F NO FFEFEE 73/
furnace/burner toatel BTU',s76dFa
Residence ofEach single fixture
tQ,n
Fl oor furnace
and vent/
New ci rcui ts a'l ts
or extensions)
Relocated bui 1 ding
(new fix. additional
Recessed wal l
Snacp heatpr and ventSERV I C ESS . F. P,es i dence(1 bath)
Duplex (l bath) each
Temporary Construction Apol iance vent
sepa rateAdditional bath
Change in existing
rp< i dpncp
Stationary evap.
cool ertlater service
Vent fan with
sinole ductindustrial
muitifamily, comm. orSewer
0f Vent systern apart from
heatinq or A.C.Storm Sewer
c0r,1r'1. / IND. FEEDERS
Mechanical exhaust
hood and duct
['Jood stove/heaterI n sta I I /a 1 ter/ rel ocate
di stri b. feeders 7.*0f S.
ISSUANCE OF PFRIlIT cu/o
TOTAL CHARGES D,*TOTAL CHARGES TOTAL CHARGES /o,cs
WHERE STATE L1II
shal I not be val i'J r
REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
until the label has been signed by an Electrical Supervisor and returned to the Bui'lding Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereb-y certify that all information hereon is true
and correct, and I further certify that any and all work rrerformed shall be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPAI'ICY will be madeof any structure without the permission of the Building Division. I further certify that m.y reqistration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and employees who are in comcliance with 0l1S 701.055 r,rill be used on this Droject.
llAl'1E(please print)S IGiJATURE o rc 7-rz:i zt-l <*G_L, P
FOII OFFICE USE Oiit
Const. Units Sq. Ftg. l,lain xZone lue
Val ue
/ Rx7.
Fire Zone
Flood Plain Stories
TOTAL VALUATIOII
xsBed rooms
,I
0ccy Load
Group Sqft**
Ftg. Access
Ftg.Other
Plan Ck. Comm/ind
65%/B1do Per Fee
Svstems Deve
cha.qe ( 1.5q
o pmer tBUILDING PERI,IIT
Charges and
Su rc ha rges Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Su rc ha rges D6rno
S i dewa.l kELECTRICA.L PERIlIT
Charges and
Surcha rges ---/Q.6)a
TA-A/C Pavi ng Total Cornb. Permit
Curb CutIlECHANICAL PERI'.lIT
Charges and
S urc ha rges ---D:&_-,7*TOTAL fu.4,
l-ega l Descri ption 2- r E -7
. Ftg
(<everM
SQ. FT.
trical I in
er e ec
COMBINATION APPLICATION/PERI,IIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. 9-IaTelg: Tax Lot 100, Lane County Map Refer,t7 03 43Z, example- Lot 1. Block 3, Znd Addition toS['FTilTield Estatesq. Name, etc. of owner and construction IenderD. Energy Sources
CITY OF SPRINGFIELD
Gity Hatt
Springlield, Oregon
Department ol pubflc Works
OFFICTAL RECEIPT
PERMIT VALIDATION
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2.E. Squa
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BY
valuation
foot house,500 sq. foot ,project, che ck new - if add Date
NO. B 59,4 13I
2
exampl e-
exampl e-
check add
1250 sqif new I
etc
tt i
F. Building pe.rit information:l. example - construct single family house wit
a ttached garage2. example --.em6dej existing garage into fami3. exanlpfe - convert singie iaf,ify'resioence irestaurant (change of use)G. Value of work ai defined in Section 303 (a) of.. Structurai Specialty CodeH. DESIGN TEAI.I AND CON1RACTORS
To avoid design or construction delays, BuildinrDivision Staff must be able to contait'app.opii,persons.regarding design information or jbb sit,corrections, etc.
Abbreviated Plumbing, l"lechanicai, & Electrica.l ScherA. Lxcepl vrhere blank spaces occur in the descript.portion of the Mechanical and Electrical Scheduthe applicant need fill-in only the No. Boxes ar
^ to_the appropriate item(s) to te installedu. tul t plumbing, l'lechanical, and Eiectrical Schedrare available at the Building Divisioni. To conserve space on the-permit form the sclhave been abbreviated2. If the item(s) to be installed are not coverthe abbreviated schedules you should consul.fulI schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I
CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivererelectrical contractor for signature by his e.lec.supervisor. The general contractor ii.not authrto sign the electrical labelApplicant to sign and date
lJhenever possible, the .initial application will be ra.worksheet only. Where possibie, Building Divisiorwill.prepare a type written copy ind returi it to ilapplicant at the tjme the actuai perm.it is issued fr
s i gna ture.
Fees and Charges (
Plan check fees are due and payable at the time of r \
application, and no pians wiil be processed until tl,.:"fees are paid. All other fees and charges are due andpayable when the permit is .issued.
FOR OFFICE USE ONLY
(
Rec'd
Fleceived For:8
Amount
I inlceg patnrsng/LrrHoeRApHEas. EucENE. oREcoN
Permi t Cl erk
date
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IV.
PLANS REVIEWED BY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit appf icant exempt from registration with the Builder's Board because:
Additional Project Information :
name signature