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Home My WebLink AboutPermit Electrical 1987-12-0369 CITY OF SPRINGFIELD COMBI NATI ON APPLICATION/PERMIT 726-31 53 Job Address l-egal Description EIIERGY SOURCES Hea t l,later Heater . Ftg . Ftg . Ftg l,lew . l'lai n_ . Access._ . Other Add Alier _[ep. -Sq Use \ \ & iv \ Val ue of l.lorkownerrffiT)dyrL DfgOA Address d Construction Lender rnli t e ng e Ga ,Aa^Phone ULSIGN ILAI.1 /name addre s s tcs. no.exD l res ohone no. Pri Structura I r{E lec Hechanical CONTRACTORS name addres s lics. no.pYnl rpq (nhone no- Genera I L P1 umbi 'b El ectrica'l ZIkc $\r Itlec ha ni ca I PLUMBI NG ELECTRI CAL MECHAN I CAL FEE CHARGE NO FFF THARGF NO FFF CHARGE Each single fixture Residence of sQ FT furnace/burner to BTU' s Relocated building (new fix. additional)L--New circuits alts. or extensions2 >.2 *aalJG 2?-y Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal i Soace heater and vent Duplex (1 bath) each Additional bath Temporary Construct i on Apol iance vent sPna ratP l,later servi ce Chang resid e in existing ence Stati onar.v evap cool er Sewer multifami1y, comm or I ndust-ri a I Vent fan with sinole duct Storm Sewer +-Of C5:> amps,Vent systern apart from heatinq or A.C. COI,lI1./IND, FEEDERS Mechanical exhaust hood and duct Insta l I /a1 ter/re1 ocate dist-rib. feeders l,Jood stove/heater 0f {ia :?<ra- amps.<zSt L*a ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES '5. ee TOTAL CHARGES WHERE STATE LAI,I REQUiRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed apolication for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certif_v that any and alI work rreof Soringfield and the Laws of the State of 0reqon oerta1niof any structure without the permission of the Building Div Board is in full force and effect as required by ORS 701.05 only subcontractors and enployees who are in comcliance wit rformed shall be done in accordance with the Ordinances of the City ng to the work described herein, and that NC OCCUPANCY will be made ision. I further certify that m.y reqistration vrith the Builder's 5, that if exempt the basis h 0l?S 701.055 wilI be used o for exemption is noted hereon, and that n this t ^rllAt''lE(p1ease print IGNA FOP (.)FFII : USE ONt Zone st. Uni ts So Ftg Ftg Ftg l'la i I llp Fire Zone Bedrooms Load Acces s x Value Flood Plain S 0cc.y Group Sq dt TOTAL VALUATION tori es 0ther BUILDING PERI'IIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldo Per Fec Svs cha teris De ve 5%rge (1.opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICP,L PERI,IIT Charges and Surcha rges 7. Sidewal k A/C Pavi ng Curb Cut Total Comb. Permit I4ECHANICAL PERMIT Charges and Surc ha rges TOTAL ?z >;r- Addres s COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construct.ion lenderD. Energy Sources PERMIT VALIDATION 1. 2. Sq 1. 2. exampl e- examp I e- uare footag hea t/e I 'ica l 1i or forced air gas wa or solar E e or valuat on, etc. example- 1250 sq. foot house, 500 sq. foot garage example- if new project, check-new - if addition, EIEEI*add, etc. II F. Building permit information:1. examp]e - construct single family house with an attached garage2. example - remodel existing garage into family room3. example - convert single family residence into iEsTiuFant (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, Bui)ding Division Staff must be able to contact appropriatepersons 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 Scheduies,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are 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 thefulI schedulesC. BUILDING DIVISION STAFF WILL 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 electr.icalsupervisor. The general contractor is not authorizedto sign the electrical label.Appiicant to sign and date l,lhenever possible, the initial application wilI be used asa worksheet on1y. Where 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 PIan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. AII other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY ,yllt III IV V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY name si g nature date