HomeMy WebLinkAboutPermit Electrical 1986-03-24INSPECTION LINE
7?6-37 69
CITY OF SPRINGFIELD
COHBI NATI ON APPL ICATION/PER}'IIT
I}IFORIIATIOI{ LINE
726-3153
JobAddress -:2A 5 ;fl/,
Legal Description tlater Heater
Ranqe
EIIERGY SOURCES:
Hea t
Va l ue of l,lork :
Sq. Ftg. Access._
Sq. Ftg. Ha
d /e,Owner /,
o:.e., Build Singleehone /fu!-f,1Address 'Zd a S ,lrf,l- /
Construction Lender
o)
R
5
-0
Addre s s Phone
address tcs. no-exoi res ohone no.DESIGN TEAI{name
Pri mary
euJ nZa,or M. ZO'//Oo /z(a
Structura l
EI ectrical
Mechani ca I
name address 'I i cs. no.exDt res ohone no.
Genera I
Pl umbi no
/ z9 z-'o-o (/trt cI'|t/Z d)t
ELECTRI CAL MECHAN I CALPLUI{BI NG
FFF CHARGF NO FFF l^HA AGF FFFN0.NO CHARGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTLI' s
Relocated building
(new fix. additional)
New circuits alts
or extensions
Floor furnace
and vent
SERV I CES ,r )2a Recessed wal I
Snerp hpafer end vpnt
S.F. Residence(l bath))
Duplex (I bath) each
Additional bath Temporary Construct ion Apol iance vent
s eDa ra te
[.later servi ce ge in existing
dencp
Chan
res i
Stationary evap
cool er
Sewer l ndrrs tri a l
multifamily, comn. or Vent fan with
sinole drrct
Storm Sewer 0f Vent system apart from
heatino or A.C.
coMr.r./IND. FEEDERS
l4echan ical exhaust
hood and duct
Instal I /a1 ter/rel ocate
distrih, fpcders llood stove/heater
0f
ISSUANCF OF PFRI{IT
TOTAL CHARGES ?e 50TOTAL CHARGES TOTAL CHARGES
t,,lHEP.E STATE Lll'l REQUIRES that the Electrical work be done by an Electrical Contractor, the e'lectrical portion of this permit
shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAHINED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accoidance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0reoon pertaining to the work described herein, and that NO OCCUPAI'ICY will be mad!of any.structure without the permission of the Building Division. I further certify that my reqistration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the baiis for bxemption is noted hereon, and thatonly subcontractors and employees who are in comoliance with 0l1S 701.055 will be used on this nroject.
SItlAl.lE (pl ease pri nt\PpkpL 3-
Value
ToTAL VALUATT0N_
Val
Flood P1ain Stories Occ.y
Load
Ftg . Other
ts Ftg. l'lai
Fire Zone
Zone--TYPe/ const.
Ftg. Access
PIan Ck. Corm/lnd
65%/Bldo Per Fec
tems Deve
57,
BUILDING PERNIT
Charges and
Surcharges Plan Ck. Res
30%/81dq Per Fee
FencePLUI.4BING PERMIT
Charges and
Surcha rges Dgmo
Sldewal kELECTRICP,L PERTIIT
Charges and
Surcha rges o
2a__
A/C Paving Total Comb. Permit
Curb CutI,IECHANICAL PERMIT
Charges and
Surcharges 9> yoTOTAL
. Ftg.0ther
__2?_
COMBINATION APPLI CATION/PER}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, 2nd Addition to
SEIInlg-fi et d EstatesC. Name, etc. of owner and construction lender0. Energy Sources
PER}4IT VALIDATION
I t/ el cal i I in or forced air qas
2.e sol arE. Squa r valuat on, etc
F
l. example- 1250 sq. foot house. 500 sq. foot oaraoe2. exarnplEJT-new project, cheik-n-ew.- if .aaiiioi,
check add, etc.
Building permit information:1. example - construct single family house with anattached garage
?. examp]e - remodel existing garage into family room3. example - convert single family res.idence iniorestaurant (change of use)
Value of work as defined in Section 303 (a) of theStructurai Specialty Code
OESIGN TEAM AND CONTRACTORS
G.
H
II.
To avoid design or construction delays, Bu.ildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Divis.ionl. To conserve space on the permit form the scheddles
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF I,JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his ejectricalsupervisor. The general contractor is.not authorizedto sign the electrical label
Applicant to sign and date
l'lhenever possible, the initial application will be used asa worksheet oniy. Hhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans witI be processed untiI thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
8b
III.
IV
v Permi t Cl erk
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 s'l I nature date
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