HomeMy WebLinkAboutPermit Electrical 1989-6-28
INFORJ1ATION LINt
. 726-3753
Sq. Ftg. 1,Iain
~q. ~tg. Access.
Sq. Ftg. Other
flew Add A Iter Rep.
Range -Fence Demo Change/Use
Valu€ of Hark: Other- -
~':.....~
BUildint('permit Info: Describe Work(i.e.. Build Single
Family nes;dence With Attached Garaae)
I INSPECTION LINE
726-3769 -:z~t:>
'n.' .... '
Job Address_\ \~ ~
Legal Description
.
CITY OF SPRINGFIElO
COMBINATION APPlICATION/PERMIT
EIIERGY SOURCES:
Heat
Ha ter Hea ter
\"v-. ~ r C>\-J.>-. J;?D .
I\D\.I..."'-:~\<._ ~~IJ'\c.E,
Owner \\\~N--\
~t.~\.~S
Phon~'tI1 \
Address
.
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:,
~
~
C)
-
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Construction lender
5/rc- C~7?';'/~ ~A
A?7/S~#'--'./A Ai'?_/-<'A'A'7'~
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Address Phone
DES I GN T tAI1 (name) (address) flies. no. ) (exo; n~c;)
Primary '2.o,;.,MP>...~-\<.I...f:I.~ ~<-'" roR.,\.,~~t"\ \\fi
Structura 1
Electrical \'-\<;=\\'-.. ~6~ p()~\. !'\t-...\CJ 4~
~f
r1echan; ca 1
CONTRACTORS (namel (address) flies. no. ) (pxoirps)
Genera 1 'L.'-O'-\.a~.'=\ \ ,:,->\ \'l\.~ v...\~'U ~~, ~'?::>
Plumbina
r4AB.IiE .J!lL...1
I furnace/burner to
BTU's
I Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Electrical ~\...E.~.::n:~..,-I='C"!:~ \0,,-0 ~'";\...p.,~ ~'L">
'Cr{J-~
~lechanical
PlUllBI NG
ElECTRICAl
NO,
FEF
rHARr,E
Nn
"<>
Each single fixture
Residence of
SQ. FT.
Jr"
it
Relocated building
(new fix. additional)
New circuits alts.
or extensions
I
~~ 150
11/3
I
I
I
I
S.F. Residence
(] bath 1
10uplex (1 bath)
IAdditional bath
~Ia ter servi ce
SERVICES
each
6~
ITemporary Construction
IChange in existing
rps j dJmrp
Imultifamily, COlTll1. or
Tnrluc:trial
I
j
Sewer
Storm Sewer
I
10f
ICOMM,/IND. FEEDERS
l'Install/alter/relocate I
dic;"trih. fpprlprc:
10f amp~1
I
I
I
I
I
~3 U'J
amps.1
TOTAl CHARGES TOTAl CHARGES
WHERE STATE l,'I~ REQUIRES that tile Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
(ohone no .~)
(ohonp nn )
Pi}€>-~,-\,\
\a\\\p,q
. \
\'"\\-6.~?'l
MECHANICAl
il ~cLl...c.HA.R.G.t
~.
~.$.
.
m
I Appl lance vent
seoaratp
I Stationary evap.
cooler
I Vent fan with
sinole durt
I Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and dud
Wood stove/heater
ISSUANCf OF PFRlllT
TOTAl CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAtlINED the completed aprlication for permit, and do hereby certify that all infonnation hereon is true
and correct, and I further certify that any and all work oerfonned shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the Sta te of Oregon pertai n i ng to the work descri bed herei n. and that HO OCCUPAUCY wi 11 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 employees who are in compliance with OP.S 701.055 wi~~sed on ~ro:ect.
NAI,IE(please print)~ \\~~o;;;::.~-? SIGfIATUR~~ DATE~pf\
FOR OFFICE USE'OlllY ( I . I
Sq. Ftg. f-tain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Units
Occy load
Occy Group
Stories
BUIlDING PER~llT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Rldo P€'r Fpe
------------Pian Ck. Res
30%lBI do Per Fee
I Fence
------------
I Demo
____:? .:?...,.>z:::>1 Sidewalk
/ . /;S I A/C Paving
I Curb Cut
I
PlUt1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
11ECHANICAl PERMIT
Charges and
Surcharges
TOTAl VAlUATION
Systems Development
Charqe (!.5~) ,
ITotal Comb. Permit
,-
IIOTAl
~
2:?-cb,:5
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description .....
1. example- Tax lot 100, Lane County Map Reference
17 03 43
2. example. Lot 1, Block 3. 2nd Addition to
sprl~gtield Estates .
C. Name, 'etc.~ of owner and construction lender
. D. Energy Sources, .
1. examDle~heal/erectrical ceiliilQ/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check:ruew - if addition,
check add. etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - 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. OESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays. Building
Division 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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
signa ture.
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.
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V. FOR OFFICE USE ONLY
P,noit Cl'~'^--
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
,I