HomeMy WebLinkAboutPermit Electrical 1983-7-20
/; ~ .
eL, m~~mON LIIIE ) ('(\{\ , (\\.~ )CjlMBIllm~NU~p~r~m[M7~ERMlT
Job Address 7_~9(,) ~/--.~;:;J;t."_,, , ~~~~GY SOURCES:
Legal De5Cription --~-.otJ!f. - 0 ~",l, I-later Heater
" I Range
C\.-".:..... lsl,.~.uo \'\1"\9 Valu, on/ork:
Owner ~ArQ' ~~ CO
Address ,!.)74-1 \ I?, ~ ~"+ ~ Phone
)51'0..,..,. ()u
.
INFORlIATIDN LINt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access..
Sq. Ftg. Other
lIew Add Alter Rep.
-Fence Demo ChangelUse
Other - -
c()
~
-..()
o
(}J
BuildinQ Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaael
Construction lender
Address
Ut~ I (;11 r tAl1
(name)
Phone
r address 1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
I name I
(address'
General
Plumbina
Electrical
- :S u.. e-,
~'echanical
PLUllBHlG
ELECTRICAL
-1!Q.,.
I FE"F . rHARr.F
Nf' I I ~J:'~
Each Single fixture
Residence of
SQ. FT.
IRelocated building
(new fix. additional)
Is.F. Residence
(] bath 1
IDuPlex (1 bath) each
IAdditional bath
I ~Iater servi ce
I Sewer
Istorm Sewer
New circuits alts.
or extensions
SERVICES
Temporary Construction
Change in existing
rpS.irlpj'll"'P
multifamily, comm. or
Tnrlu"t.rial
Of
COMI-i.IlND. FEEDERS
Install/alter/relocate
rli"t.ritL fpprlprc:
amps,
Of
amps.
_)"",?~. f~
~ lf~'{ D
I MECHANICAL
'r"~-1ID......'
furnace/burner to
BTU's
-r~
f1 ics. no.)
f1 ir~ no.)
ro.(p
I
I
I
I
I .ZQ
I .~O
I
ID.lj D
.P Ou .
~,~
(exaires)
,.
(ohane no.)
(pxoirpc: )
(I)hnnp no )
I ~~~
I~.
/
floor furnace
and vent
Recessed wall
So~~p ~~~t~~ ~"rl ~pnt
Appliance vent
c:eoari'l.tp
Stationary evap.
cnnlpr
Vent fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and rlurt
Wood stove/heater
ISSUANCf OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\li REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
shall not be valiJ 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 Orei]on pertaining to the work described herein, and that rm OCCUPArKY 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 ORS 701.055 will be used on this project.
fA IlI?P II SIGIIATURE 1)t7Y10?d 1 ~-A- ",--t!-(
FOIfOFFICE USE DIlLY
Sq. Ftg.
Sq. Ft~.
Sq. Ftg.
IIAI.IE(please print)~r'I A./~. I 'T)
f.
Zone
Fire Zone
Flood Plain
TyoelConst.
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILDING PERmT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Bldo P.rr Fpp
------------Pian Ck. Res
30%/Bl do Per Fee
Fence
PLUMBING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERI~lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I-Sidewalk
I AIC Paving
I Curb Cut
------------1.
__JP__O 0
- lj 0
t1ain
Access
Other
I
J TOTAL
DATE J ~ o. ~3
x
Value
Value
Value
x
x
TOTAL VALUATION
syste.ms Development
Charoe (1.5%) '.
ITotal Comb. Permit
.I
\o.~o
-
.
iI
COMBINATION APPLICATIDNIPERMIT (CAP)
l. Applicant to furnish ..
A. Job Address
B. Legal Description
1. example- Tax lot 100. lane County Map Reference
11 U3 43
2. examole- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exa~le- heat/electrical ceilinq/or forced air qas
2. examyle- 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-new - if addition,
check add. etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family foom
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 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
'),7 fa G
)~(yQ ~ 0 ~ &/131
. 'feW
jJ~
Permi t Cl erk
o
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
PLANS REVIEWED BY:
name
signature
date
.1
'.