HomeMy WebLinkAboutPermit Electrical 1985-10-01W t^oaz1 ) U.eu*/*
ON LINE
COMBI NATI ON APPL ICATION/PERMIT
Job Address T//
LesaiDescription /a 03 3b 62 a7b/llater Heater
EIiERGY SOURCES
Hea t
0wner
Va'l ue of l,lork
_l{ewadd1l ter_Rep.
_Fence_Demo_C han ge,/ U se
0ther
Ftg
FtgSq
n
Sq.. Access
. 0ther
/Cfn vtone)-t fi Builr.inq Permit Info: Describe l,dork(.
Fami ly llesidence llith Attached Garaqe'
:e., Build Single
OZO Q Jut.u7z. a4/u- Jr) r) a-o,*ol,o
Construction Lender hl*np* i-ve4 ibn
)o.n
Q)'
\
N
Addres s Phone
$ailleDES i GN TEAI.I address I ics. no. 'exD l res ohone no.
Pri mary
Structura I
Ei ectri ca I
Mechani ca'!
CONTRACTORS I flalrie add res s I i cs. no.exDt res ohone no.
Genera I
P l umbi nq
PtuilflBlI,{G ELECTRI CAL MECHAN I CAL
FEF CHARGF NN FFF IlHARGF N )FFF CHARGF
Each simqle rf ixtlire Residence of furnace/burner to
BTLI' S
Relocated fu.!id.ing
(new fix. additiornal)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence(I bath)SERV iCES Recessed wal I
Snacp heatpr and vent
Duplex (1 bat;la) each
Addi tional ba'th Temporary Constructi on Apol iance vent
seDa rate
tlater seryice Cha
res
nge in existing
i dence
Stationary evap..
cool er
Sewer multifamily, cornm, or
lndustrial
Vent fan with
sinole duct
Storm Se*er 0f Vent systern apart from
heatinq or A.C.
COMI.I./IND. FEEDERS
Mechan i ca.l exhaust
hood and duct
Instal I /al ter/re1 ocate
d.i stri b. feeders tlood stove/heater
0f .ampa
.),
n ol o^vr{-r 4n ,7,n
4 I 4o ISSUANCF OF PFRIlIT
TOTAL CHARGESTOTAL CHARGES 3/, "4DTOTAL CHARGES
WHERE STATE LAI,J
shall not be val i'l
REQUiRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
until the label has been signed by an Electrical Supervisor and returned to the Buiiding Division
Y EXAMINED the completed apolication for Dermit, and do hereb.v certify that all i
and correct", and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springf.ield and the Laws of the State of 0regon oertaining to the work described herein, and that NC OCCUPANCY will be made
of any str,ucture without the permission of the Building Division. I further certify that m.y reqistration vrith the Builder's
Board is l'n tflulll force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcoratnacfoi"s and enrployees who are in comnliance with 0l?S 701.055 wilI be used on this oroject.
tlAt"lE(please IGNA TE t()-/-F5
rmation hereon is true
Fire Zone Bedroors_____________.10ccy Load Sq
Ftu
Ft!
Ftg
l4ain
Val ue
x
x
xFlood Plain Stori Fq
q
t
Group
TOTAL VALUATION-
---i-
ts SoZone
Value
al ue
. Acces
. 0ther
Plan Ck. Conm/Ind
65"1/81r1o Ppr Fpp
Svsterns Deve
charqe (1.5%
opmetrtBUILDING PIHF{IT
Charges anC
Surc harges PIan Ck. Res
30%/Bldq Per Fee
€la L-b-(FencePLUI4BING PIR}'IIT
Charges and
Surcha rges Demo # bKqS I
Sidewal k
A/C Pavi ng Total Comb. Permit
Curb Cut 36"@bo
ELECTRICAL PERI1IT
Charges and
Surcharges
I,IECHAI'IICAL PERMIT
Charges and
Surc harges
o
5. "o
TOTAL
Addres s
sQ. FT.
h
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. example- heat2. exEmElE- wateE. Square footage or
/e1 ca eiIi r forced air gas
sol ar
val uation, eEl. example- 1250 sq. foot house, 500 sq. foot garage2- ermple- lT-new project, cneik-i-ew - it adaitioi,
EIEEI-fdd, etc.F. Bui)ding 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 Specia)ty CodeH, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriite
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanicai and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, 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 thefull 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 electricalsupervisor. The general contractor is not authorizedto sign the electrical label"Applicanl to sign and date
Whenever possible, the initial application will be used asa.worksheet only. Hhere possible, Building Division StaffIrill 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 will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
II l0'/-rt
rfr /D
III.
IV
v Permit 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 s't g nature date
A c