HomeMy WebLinkAboutPermit Electrical 1986-03-24A6AA@
INSPECTION LINE
726-37 69
CITY OF SPRINGFIELD
COHBI NATI ON APPLICATION/PERI{IT
I}IFOR'IATIOI{ LINt
726-3153
Job Address D55 t V\Hea t
llater Heater
Ranqe.
EIIERGY SOURCES:
Lesal Description l) O
ttaanilfh'
o7
Owner 2
Va lue of l,Jork:
Sq. Ftg. llain_
Sq. Ftg. Access._
257 , l5'"]h' Ph'*DtAddress lllork
A 'e., Build Single
ql q.j
Construction Lender
Address Phone
^,1)V
0-
a
c
F\
DESIGN TEAI4 name address exDl res ohone no.
Primary
Structura I
El ectri ca l
Mechanica l
CONTRACTORS name addres s ohone no-'
Genera I
Pl umb i nq E r\e +(-4q )D )o-)rtC - 5oco
l.techanical
PLUI,IB I NG ELECTRI CAL MECHANICAL
N0.FEE CHARGF NO FFF .HAAGF N0.FFF CHARGF
Each single fixture Residence of
SQ. FT
furnace/burner to
8TU' s
Relocated buildino
(new fix. additioiat)I New circuits alts.
or extensions /5,oO
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES Recessed wal I
Soace heatpr and vpnt
Duplex ('l bath) each
Additional bath Temporary Construction Apol iance vent
s eDa ra te
Hater service )hange in existing
'es i dence
Stationary evap
cool er
Sewer multifami1y, comm. or
I ndu stri a I
Vent fan with
sinole duct
Storm Sewer I of zoo 7t,a apart from
.c.
Vent system
heatinq or A
COMH./IND. FEEDERS Mechani cal exhaust
hood and ductInstal I /al ter/rel ocatedistrib. feeders lrlood stove/heater
0f
ISSUANCE OF PFRTIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
HHERE STAshall not be
TE-LAl,l REQUIRES that the Electrical work be done byvaliC unti l the labei has been signed by an E1ectrrl
an Electrical Contractor,cal Supervisor and returned
the electrical portion of this permitto the Building Division
Fire Zone
ToTAL VALUATIoII_
Zone
t,ta x
Rad
lueFlood Plain Stori es I
Va
Gro
Const. Uni ts_ So i Value
Ci ty
madete of 0reqon
n of the Bui
N eted onatccomp tapppermi certi n rmat ifo on1Iathereb.y s truefyc0ndaItrrecandrfurthe'Icert tha t nd Ia Iafyany wor k Iperformedhas I donebe I nceaccorda thwl het 0rdi nances theofto'Ie anddngfi Lawsthe theof taSSpri ni'I toperta workthe crIdes bedng here i n thand NCatt wlOCCUPAI,ICY I befostrucwltureanytthoutheperm r 1SS o d t D I sI o'I nI IngIhefurtcertirthatItra ts 'Ifymy on thtrl the der sul1re!lnIIrdBoafu11fosrcendaffecteasredORS701requ i 0s5 tha 'I fbyt theexempt bas s'I for on'I sIexempt hereonnoted and thatIonsubcontractorsvandIempwhoreanIoyeesIanI|vlce 0t?sthc0mD 701 055 w1 'I I us ed 0n t shi ectprojbe
llAllE(please pri
DATE ,
INFtg
Ftg
Ftg
. Acces
. 0ther
rooms Occy Load
:
IGNATURE
Plan Ck. eo'Tm/Fa--
65%/Bldo Per Fee t.5t
BUILDING PERI'IIT
Charges and
Surcharges Pian Ck Re
Pe
s
r30%181ds Fee
FencePLUT,IBING PERMIT
Charges and
Surcha rges Demo
Sldewal kELECTRICAL PERI,IIT
Charges and
Surcharges
50,5A
D A/C Paving Tota'l Comb. Permit
Curb Cut
I{ECHANICAL PERMIT
Charges and
Surc harges 53-,o;vTOTAL
Pvnt rpq
coMBrNATr0N AppLrCATIoN/pERr.trT ( CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 43?. example- Lot 1. Block 3, Znd Addition toSlTiilTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PER}4IT VALIDATION
1. exampl e-2. exampl e-
Square foota
air gas
E 1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- jf new project, check new.- if addition,
EhEEr-Ead, etc.F. Building permit information:
1. example - construct single famiiy house with an
attached garage
2. example - remodel existing garage into family room3. examole - convert single family residence into
i6ETiuFant (change of-use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & E'lectrical SchedulesA. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installedB. Fuli 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 on
the abbreviated schedules you should consult the
fu'l I schedu'lesC. BUILDING DIVISION STAFF l.lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be de'livered to the
electrical contractor for signature by his electrical
supervisor. The generai contractor is not authorized
to sign the electrical label.
Applicant to sign and date
l,lhenever possible, the initial application wi'lI be used as
a worksheet only. Where poss'ibie, Building Division Staffwill prepare a type written copy and return it to the
applicant 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 the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
t" eJ dY-
Bt+t.)
II.
III.
IV.
V. FOR OFFICE USE ONLY Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Proiect Information:
PLANS REVIEWED BY:
name s'l g nature date