HomeMy WebLinkAboutPermit Electrical 1990-6-19
I INSPECTION LIIIE
1726-3769
Job Address dOOS- /'Y7o.-+-c.dk '\~~
Legal Dmription I ()(x"~~L~ Me on I
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CITY UF SPRINGFIELD
fOMBINATION APPLICATION/PERMIT
.
INFDRlIATIDN LINt
726-3753
Sq, Ftg, 1,Iain
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Pep.
--Fence Demo Change/Use
Other- -
I
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~
,:--
o
E!IERGY SOURCES:
Heat
I-later Heater
(ohone no. \
Primary
Electrical
~
'*
Structural
Mechanical
CONTRACTORS
(name I
(address)
(lic~ no,'
(px!)i:"p<; ,
(ol-lnl'l" n('1 \
Genera 1
Plumbina
Electrical (!,I~E/ /htI-m 1<-7VA.l
~1echanical
l3Le:J. W) <c:N IlJ)K E)1Xl ~ 4 -Us-c <:) cf-qO 4'i s"".ss
Q,440L \O~f) ~ r:J/{)'7 fa /
f
PLUI,IBING
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE Nn
,EE r"ABGl Nn
~~LJ:HARG..E..
Each single fixture
Residence of
SQ. FT,
furnace/burner to
BTU's
Relocated building
(new fix, additional)
,~,Uew circuits alts.
)-Y' or extensions
(~S)
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance- vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sin~J1e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood <lnd duct
Sewer
Temporary Construction
Change in existing
res j rje.nce
multifamily. comm. or
Industr;al
Water service
COffi1,/INO. FEEDERS
Install/alter/relocate
d;strib. feeders
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFR'lIT
;:;2 310 3 TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information 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 City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055. at if exempt the basis for exemption is noted hereon. and that
o I sUbcontra~\~d\Y\:c:rYee~e with ORS nl,055 will be used on this project,
e print) '(\...."';\l Ll Wi3_clto,", SIGIIATURE'1t ~ J1J~ DATr6- 15-10
FOP. orF I CE USE OlIL Y
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. r1ain
"Sq. FtlJ. Access
Sq, Ftg, Other
x
x
Value
Value
Value
x
TOTAL VALUATIOII
BUILDING PERfllT
Charges an~
Surcharges
Plan Ck, Comm/lnd
65%/Bldo Per Fep
------------""'P'ian Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charoe (1.5~)
PLUt1BING PERMIT
Charges and
Surcha rges
Demo
ELECTRICAL PERIHT
Cha rges and
Surcharges
IIECHAN I CAL PERMIT
Charges and
Surcharges
_ci!6!~~
( . ('-~
Sidewalk
AIC Pavi n9
Total Comb. Permit
Curb Cut
TOTAL
d 3.(03
.
.
- I. _ _ ..l_.~ _ . .:....
IW
-- .
"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane Co",nty Map Reference
'1/ oj 43
2, exam~le- Lot 1, Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilin~/or forced air QdS
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq. foot house. 500 sq, foot garage
2. example- if new project, check-new - if addition,
cnecK add I etc.
F. Building permit information:
1. exa~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, DESIGN TEAM AND 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. BUILDING OIVISION 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, ---
Ill. 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.
# IJ11)7
to ~ /L!- C/O
V, FOR OFFICE USE ONLY
Cl,Mm ')
Permit
J
I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
. .
Permit applicant exempt from registration with the Builder's Board because:
.
Additional Pro~ect Information:
PLANS REVIEWED BY:
name
signature
date