HomeMy WebLinkAboutPermit Electrical 1989-11-27
--. CllY Uf SPR1NGfJE~D . I NFDRl1ATlON' LINE
CDr1BIIIATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. 1.lain //
Heat' ~q. Ftg. Access./
I~a ter Hea ter Sq. Ftg. Othec/
Ilew Add A Iter Pep.
Range -Fence Demo Change/Use
ValuE of 1,'or~~~;J ~o~r7-
BU1101nQ pern~i\ Info: Descr1be Work{l.eo, Build Single
Familv nesidence With Attached GaraQei
I HlSPECTION LINE
726-3769
Job Address \ L\ LICLf \\'{\ l\-(' \J \ ()
Owner NLll ff\QX\ V J\C\C\ l) <f ~
^JJrcssY\~l)() to. \~~w~on'!.
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)
~egal Description
Construction lender
Address
DESIGN TEAr~
{name}
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
General
)\QVI'~<;\.Q. \tro{\~Qfj
. ,() -f 0J. neuh""'-,
- V
+-
Phone
{address \
(lies.no.\
(exo;resl
{ohone no. I
~,
(address'
(l ice;.. no. \
(exDire~) (ohane no. \
. ,
Plumbino
Electrical ~ s::I ~ F{Jo(TtlljJ.J
c{J14!) (IQ IY1QAA'IG. 0; & ?~I
'0<:\ 4lZ '3 (p
I HAVE CAREFULLY EXM1INED the comrleted aprlication for permit. and do hereby certify that all information hereon is true
and correct, and 1 further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the S ta te of Oregon pe rta i n i ng to the work descri bed herei n. and that NO OCCUPAIKY wil 1 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s
Board is in full force and effect as required by Or.S 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
SIr,rlATURE#~ cf)V
FO~ OFFICE USE OIIL Y
Sq. Ftg. llain
Sq. Ftc]. ~ccess
Sq. Ftg. Other
~1echanical
PLUIIB I NG
-tiO.1
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(t bath)
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be va1i~ until the
ELECTRICAL
MECHANICAL
I FFF rll~ jj(l
c~~ r~~ NO.
'furnace/burner to
BTU's
Residence of
SQ. FT.
New circuits alts.
or extensions <:9+
SERVICES \CX)~f)
,Ioo(\tu-\~)
~~~orary Construction I
~nge in existing
re5.i de.nce
multifamily, comm. or
TndLJ'\triill \
Floor furnace
and vent
9{)~'
9Q~1
Is.bC
Recessed wall
Snil~p hpiltpr ilnd vpnt
amps.
Appliance vent
c;.poarat.p
Stationary evap.
cooler
Vent fan with
sinolp rhr("t
Vent system apart from
: heatino or A.C.
. Mechanical exhaust
hood ilnd duct
Of
COMl.1. /IND. FEEDERS
Install/alter/relocate
rlic;trih fpprlpro;.
Wood stove/heater
Of
amps.
ISSUANCF OF PERIIIT
TOTAL CHMGES ( of)O::; TOTAL CHARGES
that tile Electrical work be done by an,'Electrical Contractor, the electrical portion of this
label has been signed by an Electrical Supervisor and returned to the Building Division
IlAI-lE(please print)
!/vv,'/ ~ A I J[;;I- P
DATE
Zone
F1 re Zone
Flood Plain
Type/Cons t.
Bedrooms
Stories
,
Units
Value
Value
Value
TOTAL V ALUA TI ON
x
Occy load
Occy Group
x
x
Systems Development
Charqe (1.5~) "
BUILDING PERfllT
Charges anc
Surcharges
Plan Ck. Comm/lnd
____________~/Rldo Ppr Fpe
Plan Ck. Res
30t/Bldq Per Fee
Fence
PLU!1BING PERMIT
Charges and
Surcha rges
D~mo
ELECTRICAL PERmT
Cha rges and
Surcha rges
lo-O-:g;
~.
Tota' Comb. Permit
MECHANICAL PERHIT
Charges and
Surcharges
Sidewalk
A/C Paving
Curb Cut
los.oo
TOTAL
o
cJ1
C'H r:1.lAB.G.L
permit
'~/;I/fr l
.
.
J
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VAll DATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
II oj 4J
2. example- Lot I. Block 3. 2nd Addition to
. , springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1: exam~le- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
r. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check new - if addition.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
~ivision Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. -
III. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
\\_g.'1-'3~
\ S4 \ <6
V. FOR OFFICE USE ON~Y
Cl"k~~
.J
Permi t
PROJECT CONDITIONS TO BE SATISFIED BEFDRE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
,I