HomeMy WebLinkAboutPermit Building 1988-07-12Ftg.0ther.
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Structura I
El ectri cal
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MECHANICAL
ISSUANCE OF PFRIIIT
WHERE STATE !-l}d REQUIRES that the Electrical work
TOTAL CHARGES
shall not te valiC until the label has been signed by
be done by
an Electri,
an Electrical Contractor the electrical portion of thi s pernitcal Supervisor and returned to the Building Division
the comp apr)on for t, and do reb,y certi that all in tioncatand correct, aod I further that any and a'll work oe shall be done in acc ordance with the 0rdi nances of the
is trueof Springfield and the Lawsof any siructute withou
Board is in full force
State of 0reoon
ssion of the Buil
cert i fyof thet the permi
and effect
oe rta ining to the work described n, and that N0 0CCUpAl,lCy will beherei Ci ty
madedingDivision. I further certi fy that my registrati on with the Builder,sas requi red by ORS 701 055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and emp l oyees who are in compl i ance wi th ORS 701 .055 wi] I be used on this project.
(please print)IGNATURE
st.ts Ftg. l,lain lueFire Zone Bed rooms Load Sq. Ftg. Access x Va lue
F lood P'l ai n-Stori es Occv Gro Val
TOTAL VALUATIOTI
s
Job Address a
Legal Oescription l,,ater Heater
Ranqe
EIIERGY SOURCES:
Hea t
Owner Value of l.lorkdlr
Sq. Ftg . Access
Sq . tla
Address e??Phone
A
t
ce s ng e
2{
Addres s
Prima
(lcs. no-(exoires -Lhone no.
nl
PLUAIN6 ELECTR I CAL
FEE CHIRGE NO FFF CHA RGF Irl0
Each siagle f,ixture Residence of
SQ. FT _ BTU, s
to
Relocated fuilding
(new fir. additimal)New circuits alts.or extensions Floor furnace
and vent
F
SERV ICES Recessed wal I
Dupler (l barh) each
Additional bath Temporary Constructi on iance vent
Uater servr'ce ge in existing
dence
Chan
Ies i ti onar.v evap.
Sewer multifamity, conrn. or
lndu stni a l fan th
Storm Serer
'\lent system apart fromheatinq or A.C.
col4l.l./IND. FEEDERS Hechanical exhaust
hood and ductocateInstalI/alter/reidistrib. feeders l'lood stove/heater
0f
TOTAL CHARGE TOTAL CHARGES
PIan Ck. Conm/InZ-
65%/8ldo Per Fee
Systems Deve
Charqe fI.51
0pmeotBUILDING PERI'IIT
Charges and
Surcha rges PIan Ck Re
Pe
S
r10%/Bldg Fee
Fence
DEmo
SldewalkELECTRICAL PERI:IT
Charges and
Surcha rges A/C Paving Total Comb. Permit
Curb CutHECHAIIICAL PERHIT
Charges and
Surcharges TOTAL yoft€ -
0therFtg.
se0a ra te
0f amDs
PLUI,ISING PERMIT
Charges and
Surcha rges
a
!.i ,t
at
I
COMBINATION APPLI CATION/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 to
SE7insf,iela Estates' C. Name, etc. of owner and construction 'lender
D. Energy Sources
PERI'IIT VALI DATION
l. example-2. exampie-
E. Square foota
a!r gas
l. example- 1250 sq. foot house, 500 sq. foot garage-
2. EiainplFIf,new proJect, check newl-'jf atldition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage2. example - remodel existing garage into family room3. exanrplE - convert single family residence into
iEiTiriFant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
0ivision Staff must be able to contact appropriate
. persons regarding design information or iob site. corrections, etc.
Abbreviated Plumbing, Mechanical,'& Electrica'l Schedules- -A. Except where blink spaces occur in'the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. FuIl 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 theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI{D
CHARGES ON THE SCHEDULES0. 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 labe'l.
Applicant to sign and date
llhenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staffri'|1 prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his
si gna ture.
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
It
III.
IV
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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