HomeMy WebLinkAboutPermit Electrical 1989-11-28
Owner.
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. CITY Uf SPR NG IELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Range
Valu'f{ I'~: )
Bui16inQ Permit Info: Descr be Work{i.e..
Fami 1 v rtes idence I-li th Attached GaraQe)
J
NF Rl1ATlDN
726-3753
Sq. Ftg. Main
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep,
-Fence Demo Change/Use
-Other- -
I INSPECTION LINE
726-3769
Job Address d J rO Q I '\ n \\(\f1\ ('\
Address
Phone
Build Single
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Legal Description
Address
DESIGN TEAt1
{name)
Phone
{address'
[Q0M'~ ~tlQtq~/.:J
(liCS.\)) [exniresl (o~ne
no.
Construction lender'
Primary
Structura 1
Electrical
1$-
Mechanical
CONTRACTORS
(namel
(address'
(l ir:s. no.'
lexnires)
("hnnp nn.'
Genera 1
Plumbino
Electrical
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R.
cA ~____
~'echanical
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PLUl,iBING
ELECTRICAL MECHANICAL
FEE ..QjARGE "n ", r':IARIiE. "0 I :IT- LliARGL
Residence of furnace/burner to
SQ. FT. BTU's
I New circu~ts a~.~ Floor furnace
or extenslons and vent
SERVICES Recessed wall
S"il.ce h~~tp~ ~nrl vpnt
NO. '
Each single fixture
Relocated building
(new fix, additional)
S.F, Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
Sewer
Temporary Construction Appliance vent
sp,)aratp
Change in existing Stationary evap.
rp'Sj4r.nrp rorl er
multifamily, comm. or Vent fan with
Tndtlc;,trial sinale duct
I Of~O Vent system apart from
amps. heatina or A.C.
CDMI1,/lND. FEEDERS Meehan i ca 1 exhaust
hnnrl and r1ur:t
Install/alter/relocate Wood stove/heater
dic;,tri~. fee~p~c
2> Of lOr) amps.:
Water service
Storm Sewer
ISSUANCF OF PFRIIlT
TOTAL CHARGES . TOTAL CHARGES I TOTAL CHARGES
, WHERE STATE L.\\/ REQUIRES that the Electrical work be done by an-Electrical 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 application for permit. and do hereby certify that all information hereon is true
and correct, and 1 further certify that any and all work oerformed 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 110 OCCUPAI~CY 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 ons 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 7Ql.055 will be used on this project.
Type/Co"st.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGIIATURE
FOr. OFFICE USE ONLY
Sq. Ftg. f1ain
Sq. Ft!J. Access
Sq. Ftg, Other
DATE
IWIE(please print)
Zone
Fire Zone
Flood Plain
x
x
x
Value
Value
Value
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
, PIa" Ck, Conm!lnd
65%/Blda ~pr Fpp
Pla" Ck. Res
30%/Bldo Per Fee
Fence
.Systems Development '
Charoe (1,5~) .
PLur~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlllT
Charges and
Surcharges
IAJn .CO
to. CD
Demo'
'Sidewalk
AIC Paving
Total Comb. Permit
TOTAL
I/d&.cP ,
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
17 03 43
2. ~xam~le- Lot I, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinQ/or forced air qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I, example- 1250 sq. fool house, ?OO sq. foot garage
2. example- if new project, check new - if addition,
check add I 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. exam~le - 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 ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design informatioJl 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.
Ill. Applicant to sign and date
Whenever possible, the initial application will b~ 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.
V, FOR OFFICE USE ONLY
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
/ ' I
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.
'.
PERMIT VALIDATION
II ~6 o'8Q
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Permit applicant exempt from registration with the 8uilder's Board because:
Additional Project Information:
/
PLANS REVIEWED BY:
name
signature
.
date