HomeMy WebLinkAboutPermit Electrical 1990-1-15
Legal Description
. LITY Uf sPKINGFIELD . INFORllATlON LINE
COMBINATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg, I~ain
Hea t ~q. Ftg, Access.
Water Heater Sq, Ftg, Other
New Add Alter Pep,
Range -Fence Demo Change/Use
Val U€ of HorN I {), Other - -
BuildinQ Permit Info: Describe Workl Le., Build Single
Familv nesidence Hith Attached GaraQel
!
:B
Cj
~
~
jINSPECTION LINE
726-3769
Job Address ;</10 liJll-I<OOLII RtJIff)
Ownerflll/Il7Ir1J 1R{}f}r;RTI~S Nt{)
Address q (}O ;1/. 71J/J7I1/JllttJK 73'/ /JAIfJhondfPll1;
~RTL/liY[) O~ q7l/7 VK'vr;;.
Construction lender.
v\ev
Address
OESI!;N IEAH
lnamel
Phone
(address \
flies. no.1
{exnires1
(ohone no. I
Primary
Structural
~
~~
V--<>
Electrical
Mechanical
CONTRACTORS
(name}
(addressl
f1 ics. no_)
(exo;res)
(ohane no.1
Genera 1
PlumbinQ
Electrical
L, R, f;f(lfbH-!h~\rN~. {tJ-j) W."Q";n: So!-LD 6J< 17/fT7 J{)'~1~
,
10-/- 90
7 f/-7-f6ciJ
~lechanlcal
PLUI.lBI NG
ELECTRICAL
MECHANICAL
SQ, FT.
,I, OFF
rlJABGl:. NO,
FFF
r'JARliE..
....!J!hl
Each single fixture
FEE
CH~RGE
NO
Residence of
furnace/burner to
BIll' 5
SERVICES
;1;1,50 -JJ .~c.
I
/0011 ra[)~ ,~.so i'~5C
Floor furnace
and vent
Relocated building
(new fix. additional)
New circuits aIts.
or extensions~ t7~
S.F. Residence
11 bath \
Duplex (1 bath) each
Additional bath
Recessed wall
So~rp hp~tpr ~nrl VP"t
Storm Sewer
Of
amps.
Appliance vent
s~oaratp.
Stationary evap.
cooler
Vent fan with
s;nr1e duct.
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnnrl "nd rjur'f
Water service
Temporary Construction
Change in existing
rp)i~€l.nce
multifamily. camm. or
TndlJc:trial
Sewer
CO~1./IND, FEEDERS
Install/alter/relocate
rl~~trih fpprlpr~
Wood stove/heater
Of
amps.
7'S.lV
~..<5 I SSUANCE OF PERlilT
TOTAL CHARGES TOTAL CHARGES tl7,45. TOTAL CHARGES
WHERE STATE L\!/ REQUIRES that the Electrical work be done by an,'[lectrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 1m OCCUPAIKY 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. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Units
Occy Load
Occy Group
SIGIIATURE
FOP. OfFICE USE OIlL Y
Sq, Ftg,
Sq, Ft~,
Sq, Ftg.
'-/
.' ../ &e/!L. DATE //~/ 0/ tJ
IlN1E(please print)
LmerUJ R .f;I?R8HJJnl
,
Type/Const,
Bedrooms
Stories
f1ain
Access
Other
x Value
x Va 1 ue
x Value
TOTAL VALUATION
BUILDING PW1lT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Blda P~r Fee
Plan Ck,'Res
30%/Blda Per Fee
Fence
systernsDeVejOpment
Charae (1,5% -.
PLU!~BING PERMIT
Charges and
Surcha rges
D~'
'Sidewalk
ELECTRICAL PERliIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
A/C Paving
Total Comb. Permit
Curb Cut
TOTAL
.
.
.
,
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Appl icant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
17 03 43
2, exa~le' Lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examjple- heat/electrical ceilinq/or forced air Qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. examp 1 e- if new proj ec t. check new - if add i t i an.
check add. etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examOle - 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 TE~1 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:'Oi.vjsi~n.\:\.
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.
\Q~OO -
( -5,gc)
V, FOR OFFICE USE ONLY
Permit Clerk
EAJflc:'_)
.
.a .
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