HomeMy WebLinkAboutPermit Electrical 1982-11-17iIISPE ON LiIiE LiiY r'ri SPRIIiGFILLD ffir
CCI'BI IiAIION APPL I CATICN,/ PERXiT -37
St 'uct:.:ra l
Eleci-r'i c:l
l,,cnJniCal
nane
:LLIiI3I;'iG
Cer:r^: l
10
4
l-ega'I Description
Job Address
Ranqe
EIIERGY SOURCES:
Heat f1.',0"- B.i\"ith.-<
l'Jater Heater
T.: - t-ar- B,f.c.a Val ue of l,lork:
t'.€at-t
So . F tq. l.ia rn--
Sq. Ftq. Access
Sq. Fto. }ther 36>t>llew Add'r(Al ter --11-eD.
_Fence_06ilo Change/Use
0ther
ng leAddressFamil
uPhoneaL:*:a
a
Construction Lender
Pernri t Info
th
Descri be
heci
Address r-?>-l .-\c> t {'\\ o**onon JllL -$qi .t?
-]e
DE5:Gi.i ITAII name ( addre s s I no exni res ohone no-
Pri mary
Pl urnoi nrl
rt
",:cranic:i
<>
f,t ca-1lf ^l l'lECHAN I CiiL
llii.F'C i
'HARGF
irO. I FFi CHARCF
iacn sinqie iixture Resi dence o;
sQ. rr.S
furnace/burner to
BTLI
i iir 1..'lI'
, ieiocarec lur ldir:g
1(r-",v li x. :iditrllnai)Nev; c ircu.i ts al ts
or extensioirs '{oo Fl oor furnace
and vent
I
I
I
S . F. ies i oence
( I natr, I SERV I C ES Recessed i,ral l
Soace heatcr and vpnt
lDuolex (l barh) each I i
Additional bath I Temporary Construction Apoi iance vent
se Da ra f,e
l,later service I Chan-oe in existing
rp< i dpnce
Stati onar-v evap
coo l er
I
I
Sewer I lndustri a I
multifam.i 1y, comir. or Vent fan with
sincle duct
Stoi n Sewer I 0f _ amps.Vent systern apart from
heatinq or A.C.
CO|1I.1./IND. FEEDERS Mechanical exhausl
hood and duct
Instal I /al terlrel ocate
distri b^ feeders i'iood stove/heater
0f amps.
I
I ISSIJA!'JCF OF PFRIiIT
I U IAL LhA}.:UL5 'f- -,-:TOTAL CHARGES TOTAL CHARGES
I HAVE CAREFULLY E)(irl'!llitD t:le comoleted apnlication for oermit, and do here
and correct, and i further certif,v that any and all work Derformed shall be
Dertaining to the work described herein, and that NC 0CCUPAIICy rvill be made
hout the permission of the Building Division. I further certify that m.y reqistration vrith the Builder's
ce and effect as reQuired by ORS 701.055, that if exemot the basis for exemot'ion js noted hereon, and that
and emDloyees rvho are in comcliance lvith 0l?5 701.055 vrilI be used on this oro,ject
S IGNATURE
'/
tlAllE(p1ease print)/(:DATE ///tz./lrt
b.v certify that aiI information hereon is true
done in accordance with the Ordinances of the Cityof Soringfield anri the Laws of the State of Oreqonof any structure wit
Board is in full for
onl-v subcontractors
'F t /1,/, n
So
5q
Flood Plain St<;ri es
TOTAL VALUATIOII
x *r.0ther
-\.. 0ccy Load
its
Group '.\q. Ftg Val ue
Val u
_Tyoel Con s t
Fire Zone Bedrooms
Zone l Fto. l"lain x Value
Fto. Access x
Plan Ck. Cornm/Ind
651/81do Per Fee
q \a-nd-Systens Develocment
Charqe ( 1.57)BUILDING PERI'lIT
Clrarqes anC
Surcharqes
I
L
i ,D P.lan Ck. Res
3jii/Bldq Per Fee 5sr q?: tl-l 1-80
FencePLUI'4BING PERMIT
Charges anci
Su rcha rqes Demo
Si dewa I kELECTRICAL PERIlIT
Charqes and
Surcha rges A/C Pavi nq Total Comb. Permit
Curb CutI,IECHAII I CAL PEP.I'4 iT
Charges and
Surcha rges 3l ,toTOTAL
.e.,
|.',HERE STATE 111'l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical nortion of this pennitshall not be vali.j unt.il the.label has been signed by an Electrical Supervisor and returneci to the Bui)ding Division
t
-d#--.d!H
bp Eo\rlb
lbpC bp
fuL 662fr
PERI,lIT VALIDATION
Permi t Cl erk
5v
b
b
t50c
3l Lo
COMBINATION APPLI CATION/PERMIT ( CAP )
Applicant to furnish
A. iob AdCress
B. Leqal Description
1. examole- Tax Lot 100, Lane County Map Reference
I/ UJ CJ2. examoie- Lot 1. Block 3, Znd Addition to
SiTin'6-iield Estates
C. Name, etc- of owner and construction lender
D, Energy Sources
1
2
cc
exarrrol e-
e.Yai:)e-
quare rooEa
heatlei ectljcaI cei !ing/o
rva terhea terl e I ecTil cIlTor
qe or valuation, etc.
r forced a'i r oa s
sol ar
F
l. examole- 1250 sq. foot house, 500 sq. foot garage
?. exanpie- jf nel project, check nei.r - if addition,
checx add, etc.
Br:i lding pernii tnformation:i. exancie_ - construct single farnily house ivith aii
;i+!anoa nlarna
2. e.rancie - r'emodel ex.istjng garage into family room
3. eGi:le'- convert single fami1y residence into
i.-stIuFanc (change of- use)
Value oi'work as de'iined jn Section 303 (a) of the
S ll^uclura I Specia I t-v Code
DESiGi,] TEA|; Ai.ID COII iRA.CTORS
Io avcid cesilivision S'!3i
gn
must De able to contact
cr ccnsiruciion clela-vs, 3ui ldin_o
persons regarding ciesign information or
correc!lons. etc.
appropri ate' job site
Abbreviarec Plunling, ilechan.ical, & Electrical Schedulesi.. :.\cepc r.,'nere rlank spaces occur in the description::r:icn of:re llecnanical and Electrical Schedules,
:ne apliicant neeo t'il1-in only the No. Boxes adjacent
:3:ne acorccriate item(s) to be installed5. Full Plu:::ing, ilechanical, anci Electrjcal Sch'eciules
are available ar :he Bui.ldinq Division1. lo ccnserve soace on the permit form the schedules
have been aobraviated?- If rhe icem(s) to be installed are not covered on
the aDoreviated schedules you should consu'it the
ful I scnedulesC. BUILDIIiG DIYISi0i,l STAFF rs,ILL FILL OUT ALL FEES AND
CHARGES OiI THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electrical
supervisor- ihe general contracror .is not authorizedto sign the electrical label.
Applicant to siqn and date
Hhenever possible, the initial appiication r.riII be used as
a worksheet oniy. l^lhere possible, Building Division Staffwi.li orepare a type written copy and return it to the
applicanr at rhe time the actual perrnit is issued for his
s i gna ture.
Fees and Charqes
Plan cneck fees are due and payable at the time of the
aopl ication. and no o'l ans wil l be processed untr'.1 these
fees are paid. All other fees and charges are due and
payable when the permit js issued.
II.
III.
IV-
U. FOR CFFICE iJSE C,'ILT
PROJECT CONDITIONS TO tsE SATISFIED BEFORE OCCUPANCY
*/*d4- -l;---L-*+l
-*-$-,{-;./Jt
Permit appl'icant exernpt from rreg'istrat'ion with the Builder's Board because
Additional Project Information
PLANS REVIEI,JED BY
date,.:'/*tf*{Cname
_--1
sig nature . ':r'--'. r
I
,,t