HomeMy WebLinkAboutPermit Electrical 1983-08-23L CITY OF SPRINGFIELD
COMBI I{ATION APPLICATION/ PERMIT
Job Address EIIERGY SOURCES
Hea
llate r.
Ftg. l'lain
Sq
Sq
Ftg. Access
Ftg lteT neF.
nc hange/ Use
Nus
-a
F
l-egal Description \2-, r-
Owner
Value
Addres Builciin
Fami I v
q Pernlit Info: Descrfbe Work('
llesidence liith Attached Garaqe
.e., Build Single
))
f,
IConstruction Lender I
Addre s s Phone (
DESIGN TEAII name addre s s
Pri ma ry
Structura I
E I ectri ca I
Mechani ca l
CONTRACTORS n ame address lics. no.exD l res ohone no.
Genera'l
Pl umbi nq 1zb-'|ffi5
'5
anl I
PLUIlB I NG ELECTR I CAL MECHAN ICAL
FEE CHARGE NN FFF al.ra pGF NO FFF l^HAAGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated bui lding
(new fix. additional)
New ci rcui ts al ts
or extensions
Floor furnace
and vent
S, F. Res idence(l bath)SERVICES
Recessed wal I
Snacp hcatpr and vpnf
Duptex (1 bath) each
Additional bath Temporary Construct i on Apol iance vent
seDarate
[.later service Change in existing
resi dence
Stationar-v evap
cool er
Sewer multifamily, comm. or
Industria l
Vent fan with
sinole duct
Storm Sewer
Vent system
heatinq or A
apart from
,. c.
COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct
InstaI 1 /a l ter/rel ocate
di stri b. feeders l'Jood stove/heater
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
HHERE STATE LAtl REQUIRES that the Electrical work be done by
shall not be valil until the Iabel has been signed by an Electri
an Electrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Building Division
ffithecompletedapp1icationforpermit'anddohereb.ycertifythatal]informationhereonistrue
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NC OCCUPAI'ICY will be made
of any structure without the permission of the Building Division. I further certify that rny registration 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 that
only subcontractors and ernployees who are in comcliance with OPS 701.055 vli'll be used on this nroject.
l,lAl.lE(please print)IGNATURE DATE 8,' 3/g=
FF I
Zone Cons t Uni ts Ftg . ru#x alu
Fire Zone Ra drooms Occy Load Sq. Ftg . Access x Val ue
Flood Plain Group x Value
ToTAL VALUATIoN_
Stori es Ftg. 0ther
BUILDING PERNIT
Charges and
Su rcharges
Plan Ck. Conrn/lnd
65%/B1do Per Fee
Svs
Cha
tems Deve'rse (1.5%l
opment
Plan Ck. Res
30%/Bldo Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERI|IT
Charges and
Surcha rges
Sidewal k
A/C Paving
Curb Cut
Total Cornb. Permit
T4ECHANICAL PERMIT
Charges and
Surcharges TOTAL /Dg
4----
0 \
\QrrrrtFo, (
PYnl rps onp no
0f amps
0f amps
t
COI,IBINATION APPLICATION/PERI,IIT ( CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition to
$iFii6'field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1 electrical ceilin r forced air gas
sol ar 84 E32tereecca0rIE. Squa valuat on
hIexamol e-
examp l e-
check add
1250 s q. foot ouse, 500 sq. foot garage
2 lT-new project, check new - if addition,
te \5q'1, etc
II
F. Building permit information:l. exampie - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building0ivision Staff must be able to contact appropriate
persons regarding design informat.ion or job s.itecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Fu'll P'lumbing, Mechanical, and Electrical Schedulesare available at the Building Divis.ion1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult the
f u'l I schedul esC. BUILDING DIVISION STAFF I,JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for s.ignature by h.is electricalsupervisor. The general contractor ii not authorizedto sign the electricai label.Applicant to sign and date
Whenever possibie, the initial app)ication will be used asa^worksheet only. llhere possible, Building Division Staffwili prepare a type written copy and return.it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. Atl other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III
IV
V Permi t Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name signature date
Ob'trA,tr