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Home My WebLink AboutPermit Electrical 1985-03-29L COHBI L IT 726 Job Address /4 Legal Description EIIERGY SOURCES Hea t llater Heater I a I n 0wner Jllnryn Value of lJork Sq. Fto. tlain_ Sq. Ftg. Access._ Sq. Ftg. 0ther_ _l{ew_Add A1 ter_Rep. Fence Demo Chanqe/Use -0ther- Address Aa{V1. -yW vnoae /A I t In Fami I n s .e., Build Single 7V Constructlon Lenaerl U (ol,-+l rrjl Addres s Phone / \_1 6< rd S \,) oa UT5IGN TEAI.I name res Primary Structura I , El ectri cal Hechani cal CONTRACTORS name addres s lics- no-exol res ohone no- ) Genera I P l umbi ng I i'lechanicai v PLUI.IB I NG ELECTR I CAL MECHAN ICAL ilO-FFF CHARGF NO FFF .HAACF N0 FFF CHAPGF Each single fixture Residence of FTSQ furnace/burner to BTU' s Relocated bui lding (new fix. additional)I New ci rcui ts al ts. or extensions b9 Fioor furnace and vent S.F. Residence ( l bath)SERV I CES Recessed wall Snacp hpatcr and vpnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDa rate l.later servi ce ge in existing dence Chan res i Stationary evap cool er Sewer mult'i family, comm 0r Industrial Vent fan with sinole duct Storm Sewer 0f s Vent system apart from heatino or A-C- COMTI./IND. FEEDERS Mechanica l exhaust hood and duct Insta l I /al ter/rel ocatedistrib. feeders ['lood stove/heater 0f .amp s. ISSUANCE OF PFRI,IIT TOTAL CHARGES lo2TOTAL CHARGES .TOTAL CHARGES I'IHERE STATE !-1ll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical port.ion of this peniitshall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apnlication for oermit, and do hereb.v certitv tnat att intoand correct, and I further certify that any and all work performed shall be done in accordance with theof Springfield and the Laws of the State oi 0regon Dertaining to the work described herein, and that l{0of any structure without the permission of the 6uilding oiviiion. I further certify that my reqistratiBoard is in full force.and effect as required by ORs 701.055, that if exempt the baiis for Lxemption isonly subcontractors and er,'rployees who are in comcliance with 0l?S 701.055 rvilI be used on this oroject. 3-27-85t'lAl.lE( pl ease print IGNA rrmation hereon is true 0rdinances of the City | 0CCUPA['|CY will be made on vrith the Builder's noted hereon, and that Uni ts TOTAL VALUATIO}I Ftg Const Ftg Zone Val ue x Val Fire Zone Bedrooms Occy Load . Access . 0ther Ftg. t'lain x Valu Flood Plain Stories 0cc.y Group Plan Ck. Conrn/Ind 65%/B1do Per Fee tems Deverqe (1.52 Svs Cha opmentBUILDING PERI.IIT Charges and Su rcha rges Plan Ck. Res 30%/B1do Per Fee FencePLUI4EING PERMIT Charges and Surc ha rges D6mo Sidewal kELECTRICAL PERIIIT Charges and Surcha rges ----la -:__y'o Total Cornb. PermitA/C Paving Curb CutI,IECHANICAL PERMIT Charges and Surc harges TOTAL lo 40)14:- \_ COI4BINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to SfFin-g'Fi el d Es ta tesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION ilk bz//{? 1. 2.E. Squa example- heat/electrical cei I ino/o.*rp T.- wa te rheaTEi/ e iEEt rl c a-l-l o rre footage or valuation, etc. r forced air gas sol ar l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. example - convert single family residence intorestaurant (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, Bu.ilding Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. 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 theful I schedulesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical iabelApplicant to sign and date Whenever possibie, the initial application w.ill be used asa worksheet only. Where possible, Building Division Staffwili prepare a type written copy and return it to theapplicant at the time the actual permit.is issued for his si gnature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY tt 1 ) II III. IV. V Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name si gnature date