HomeMy WebLinkAboutPermit Electrical 1982-07-01IIISPECTIOII LIIIE
726-37 69
CITY OF SPRI|IGFIELD
COMBI|IATION APPL ICAIION/PERMIT
INFORI'ATION LiNE
726'-i753 b
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Job Address gb I lh 2lZL .h So. Ftq. l.lain_
Sq. Ftg. Access._
Sq. Ftq. 0ther--_
_l{ewaddJl ter_P.ep.
_Fe n ce_Demo_C ha n ge/ U s e
-other-
r-esar Descriotion /)- O A -3 / -0 O T/ , e YO L
Value of l,lork:/j|7s eeOwner.fulii,q-f,)uzlta *l
Add res s *,J Phone Builciinq Pernlit Info: Describe liork(
Farni ly Residence liith Attached Garaqe
.e., Buiid Single
('ir.rru-r-'fi ' Az,Jrz-b lW-
Construct'i on Lender Fa a Qp:a
-
PA^, E fh^il<
Addre s s Phone
name addres s exDl res ohone no.
Prima
Structura I
El ectri ca l
l'4echani ca l
n ame add res s (l ics. no. ) (expires nhonp no, )
Gene ra I
Plumbinq
El ectrical
l'lec ha n i ca I
PLUIlB I NG ELECTR I CAL MECHAN I CAL
FEE CHARGE NO FFT THAAGF NO FFF CHARGF
Each single fixture Residence of
sQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)/
New ci rcui ts al ts.
or extensions /oe
Fl oor furnace
and vent
S. F. Res i dence
( l bath)SERV I CES
Recessed wal I
Snaae heatFr and vent
Duplex (l bath) each
Addi tional bath Temporary Constructi on Apol iance vent
seoa rate
tlater service Change in existing
rps i dpncp
Stati onar,v evap
cool er
Sewer multifamily, comrn. or
I ndus tri a I
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
c0r.1H./IND. FEEDERS
Mechan ical exhaust
hood and duct
InstaI I /a l ter/rel ocate
di stri b. feeders I'Jood stove/heater
0f
ISSUAI']CE OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES /o,q TOTAL CHARGES
IIHERE STATE Lll,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division
CAREFULLY EXAIIINED the completed application for permit, and do hereby certify that a i nformat on hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the Cityof Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that i.l0 OCCUPAI,ICY will be madeof any structure without the permission of the Building Division. I further certify that rny registration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and enrployees who are in comcliance with 0l?S 701.055 will be used on this nroject.
llAllE(p1ease print)./1 I(sae'n=r J Lr*Breel-e,,S I GI{ATU R TE -Pz--
Zone 1oe/Const. J-Uni ts Fts l4ain x Value
- 4rtre 10ne Bedrooms Load - Sq. Ftg Acce s s x al ue
flood Plain 4,/O S 0c c.y Gro Ftg. 0ther x Val ue
TOTAL VALUATIO
ootori es
BUILDING PERNIT
Charges anC
S u rcha rge s
LIL
,bl
Pl an Ck. Cornm/ Ind
65%/B1do Per Fee
ya stems Deve
1.51
Plan Ck. Res
30%/B1dq Per Fee
f e3.^ O aJU-
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Dgrno
ELECTRICAL PERIiIT
Charges and
Surcha rges
/.8._o_o_
,
Sidewa i k
A/C Pavi ng Total Comb. Permit
I,IECHANICAL PERMIT
Charges and
Surc ha rqes
Curb Cut laL,ol
,
TOTAL
EIIERGY
Hea
l^la ter
ILAI,I
tT0Rs
FOP OFFIC
o pmen t
L
I
COMB INATION APPLI CAT] ON/PERI'IIT ( CAP )
Appl i cant to furni sh
A. Job AddressB. Legal Description
examp I e-
TZ-03-73
exampl e-SEil;sri
PERMIT VALIDATION
I
1
2
Tax Lot 100, Lane County Map Reference
Lot l. Block 3, 2nd Addition toeld Estates
heat/electrical cei n or forced air gas
wa ea ter e ec or sofar
ge or valuati o[t
C, Name, etc. of owner and construction lenderD. Energy Sources
1. exarnol e-
^---.r_l. examo I e-E. SquaiEfi-ta
1. example- l?50 sq. foot house, 500 sq. foot garage2. example- iT new project, check-i-ew - if additio;,EIec?-add, etc.F. Bui lding permi t information:1. example - construct single family house with anattached garage
2^. examp-le - remodel existing garage into family room3. example - convert singie family-residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specia lty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumb.ing, Mechanical, & Electrical SchedulesA. Except vrhere blink spaces ociur in the description -
portion of the Mechanical and Electr.ical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropr.iate item(s) to be installedB. Fu'lI Plumbing, I'lechanical, and Electrical Schedulesare available at the Buitding Divisjon1. 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 theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON IHE SCHEDULES0. As noted on the CAp, the label must be de'livered to theeiectrical contractor for signature by his electricalsupervisor. The general contractor ii not authorizedto sign the electrica'l labelIII. Applicant to sign and date
Whenever possibie, the initial application will be used asa.uorksheet on)y. Where possible, Building Division Staffwill prepare a type written copy and return it to the
, applicant at the time the actual permit is.issued for his
s I gna tu re.IV. 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.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Permit applicant exempt from registration with the Builder's Board because:
Additf onal Project Information :
PLANS REVIEWED BY:
date 7-J - tLnames'l g na tu re