HomeMy WebLinkAboutPermit Electrical 1988-01-08I
7
LINE CITY OF SPRINGFIELD
COHBI NATION APPL ICATION/PERMIT 726-37s3
Job s
l-egal Descri ption
EIIERGY SOURCES
Heat
llater Heater
Ranqe.
tg.n
Sq. Ftg. Access._
Sq. Ftg. 0ther_
J{ew_AddJ1 ter_ReP.
_Fence_Demo Change/Use
-other---
aS\
\S
Value of Hork:
fr As-aDOwner
Address tO Phone-v-d
7(
t
Fanr s dence th
n9 e
ci$K.ion Le,{ae.
Addres s Phone
name addre s s exDt res ohone no.
Primary
Structura l
El ectri ca l L
Mechani cal
name address'( l ics. no. )exor res ohone no.
Genera l
Pl umbi nq
,*-7
I'techani ca I
PLUI{BI NG ELECTRI CAL MECHAN I CAL
FFF NN FFF CHARGF NO FFF l^HAAGF
Each single fixture Residence of furnace/burner to
BTLI ' S
Relocated building
(new fix. additional)
New circuits alts
or extensions WSe
Floor furnace
and vent
S. F. P.es i dence(1 bath)SERV I CES
Recessed wal I
Snace heatpr and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
hlater serv i ce Cha
res
nge in existing
i dence
Stat'i onary evap
cool er
Sewer multifamily, corm. or
I ndrr stri a I
Vent fan with
sino'le duct
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
COMI.1./IND. FEEDERS
Mechanical exhaust
hood and duct
,^\I ns ta i I /a I ter/ re l ocate
di stri b. feeders l'Jood stove/heater
(, tAt 0f\7
N*.L0" ^P*-Y'O4
\ISSUANCE OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES
4,17,*S TOTAL CHARGES
WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permi t
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
c0mp 'I ted apfrl i ca
'and alI' 0regon
the BuiI
ti on for Derm l t an d he reb.y ce rt a I I fo rmat 1 on hereo n i s true
the City
be made
a nd co rrec t and I further certify
the Laws of the
thout the permi
rce and effect ,
t hat any
tate of
work perfo rmed s hall be
work de
furtherf exempt
.055 wi l
don e I n ac cordan wl th t he 0rdi na nces of
of Spri
of any
Board i
ng fi e I d and S DE rta I '|ng to the s crl bed he ret n and I ha t NC OCCUPANC'w1 I I
s truc ture wl 'I of d ing Divi
701.055
s 1 0n I cert I fy tha t m.y reg i S tra t 'I on u|l th the Bu I I de r s
'I ful '|fo as recl 1 red by ORS th at 'I t he bas 'I S for exempt 'I o n I S noted he re0n and tha t
on 1y s ubcontr ac to rs a nd emp I 0yee s who are I n comD I 'I ance wl th 011s 7 0 be us ed on th I s p roj ect
I'lAtlE(please print)a I GNATURE DATE
Fon (E
Zone Cons t.ts Sq.Ftg. l'lain x Value_
Fire Zone Bedrooms 0ccy Load Sq. Ftg . Access x Val ue
Flood Plain S tori es Group Ftg.0ther x Value_
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcha rges
Plan Ck. Conm/lnd
65%/81do Per Fee
Svs
Cha
terns Deve
rqe (1.52 opme-nt
Plan Ck. Res
30%/Bldq Per Fee
PLUMBING PERMIT
Charges and
Surcha rges
Fence
Dgmo
ELECTRICAL PERI,!IT
Charges and tSurcharges L \
{oo__1 e
Sidewal k
A/C Paving Tota'l Cornb. Permi t
I,IECHANICAL PERMIT
Charges and
Surc harges
Curb Cut
TOTAL { +r.f{Xa/.(. /o?ae .ao
/)r^f>1^-/
TEAI'{
1
s0. FT.
coMBINATI0N AppLICATIoN/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfie)d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1.
2.E. sq
1.
2.
exampl e-
exampl e-
uare footag
heat/electrical cei I in or forced air gas
wate ea e ec tr CA or solar
e or valuati on, e
examp]e- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addit.ion,
check add, etc.
II
F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family room3. example - convert single family res.idence inlorestaurant (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)dingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc,
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be.installedB. Full Plumbing, Mechanical, and Electrical Schedulesare 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 schedu'les you should consult theful I schedul esC. 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 electricaI label
Applicant to sign and date
Whenever possible, the initial appl.ication will be used asa worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai 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. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information
PLANS REVIEWED BY:
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