HomeMy WebLinkAboutPermit Electrical 1981-8-7
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INSPECTION'L1NE
72~J769
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CITY Of SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
726-3153
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I ENERGY SOURCES:
Heat
I Water Heater
Ronqe _
Value of Work:
Owner
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Buildinq Permit In/o: Oe~crjbe Work (i.e., Build Single
Fomih Residence With Alloched Gorooel
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I Sq. Fig. Main
i Sq. ftg. Accen.
I Sq. fig. Olher .
_New __Add _Alter _Rep.
. _~Demo_ChongeiU,,,
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Job Addren
le~ol Description
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Add"" 2::fq4?- (\ ~ CL.. Phon.
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Con...;,,;on l.nd,,\...:funO~Q ~JJ.. !
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Addreu
DESIGN TEAM
(nOfTle;
(address)
(lies. no.)
(expires)
(phone no.)
Primary
Structural
Electrical
I M"hon;'ol
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CONT~ACTORS
{name}
(address)
(lics. no.)
(expires) (pnone no.)
Gl!'nerai
Plumbino
'electrical'
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,~'l\l. \C.. c.., < lJ. 'LQ~i\ l C" )
Mechanical
PLUMBING
ELECTRICAL
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FEE . CH'ARGE I NO.
MECHANICAL
NO.
f:C
CHARGE NO.
FEE ! CHARGr_
Residence of
furnace/burner to
ll.TU',
Appliance vent
separate
Stotionor:.' evap.
cooler
Vent fOil wilh
sinqie duct
Vent .system aport from
heotinq orA.C.
Mechanical exhaust
hood and duct
Eoc;, linqle f;.ture
R~locall!d building
(new ti... additional)
S.F. Ro!lld.n~e
(1 bothl
so: ft.
New circuils, aiteratiollS
or e.'en,ions
SERVICES
Ouall!l( (1 bothle-ath
Temporary Canstruction
Additional balh
Amps.
Water senite
Sewl!r
Wood 'tove/heoler
Slar,m Sewer
FEEDERS
Heo. Pume
Air handler to
10.000 CFM
Air handler o'nr
10.000 CFM
Amp,.
r
I TOTAL CHARGES
I
TOT At CHARGES
ISSUANCE OF PEItMIT .
I TOTAL CHARGES
WHERE STAre LAW REQUIRES thot .he Electr;tol work b. done by the Eleo-tricol ContraCTor, the electrical p'Or.ion of this permit shall not b. Yalid until a
label has be.n si!;Jned by on floctricol Contractor and attached to the electrical panel.
I HAVE C1'\REfULLY EXAMINED Ihe completed application for permit, and do hereby cerlify that all information hereon i," true and correct, and I further
certify that any and all work perfar""l'd sholl b. done in accordance with the Ordinances of the City af Springfield and !he Laws of the State of Oregon
pertaining to Ihe worlr. descriDea herin, and that NO OCCUPANCY will b. mode af any structure without the perminion of tn. Building Division. I furtnet
certify that my re!;Jistratian witn tne Builder', Board is in full farce and eff.ct a s required by O~S 701.055, tnat if uempt the. basis for uomptian is noted
neran, and that only subcantroctoti and employees who ore in compliance with ORS 701.055 will be used an tnis project.
Basis far Builder's Boar~tian:
NAME (please prin'> I ~ J11/f/
U/; If I!"
SIGNATURE' ~uI;f
- -
DATE~
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fOR OffiCE USE ONLY
Zan~
fire Zone
Flood Plain
Typel Canst
Bedrooms
IInits
l"'I~cy Load
nccy Group
Sq. Ftg. M~in
Sq. Ftg. AcCen
Sq. Fig. Olher
Value
Valu.
Value
TOTAL VALUATION
x
x
<::tari.,
BUILDING P!:RMIT
Charges and
Surcharge s
plan CIt. Comm/lnd
65~ol Bldo Per Fee
Plan (k. Res
3o'!o/Sldq Per Fee
Systems Development
Choroe fl.5%\
PLUMBING PERMIT
Cnorges and
Surcharges
Fence
Demo
I Total Comb. Permit
ELEORICAl PER.MIT
Charges and
Surchor!;Jlu
'4DCO
-- -,. '(QO
Sidewalk
AI C Povino
TOTAL
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MECHANICAL PERMIT
ChorgeS and
Surthorge.
Curb Cut
III. Applicant to sign and date
Whenever possible. the initioJ application will be used as a
worksheet only. Where possible, Building Division Staff will
prepare a typewritten copy and return it to the applicant at
the time the actual permit is issued for his signatur~.
IV. Fees and Charges I-
Plan check fees are due and payable at the time of the application.
and no pions will be processed until these fees are paid. All
other fees and charges are due and poyable when the permit
is issued.
COMBINATION APPllCATIOARMIT (CAP)
I. Applicant to furnish
A. Job Address
8. legal Description
" examole.tax lot 100, lane County Map Reference
2. example-lot 1. Blo,k 3, 2nd Addition to Spring Held
C. Nome, etc. of owner and construction lender
D.. Energy Sources
1. exomcle-heot/electricol ceilinq/or forced air gas
2. exomole.woter heater/electrical/or solar
E. Square footage or valuation, etc.
1. examole-1250 sq. foot house, 500 sq. foot garage
2. exompie.if new project. check ne;,-if addition, cheel
add, etc.
F. Building permit information:
1. examole-construct single family house with an attoc
garage
2. examole-remadel existing gorag& into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (oj of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Divisio
Staff must be able to contact appropriate persons regar
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A; Except where blank spaces occur in the description porti
of the Mechanical and Electrical Schedules, the appliear
need fill.in only the No. Boxes adjacent to the appropric
item(s) to be installed
B. Full Plumbing, Me<:hanical. 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 ilem(s) to be installed are not covered on the Q.
ated schedules you should consult the full schedules
. C. BUILDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
name
"',ignalure _
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PERMIT VALIDATION
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CITY OF SPRIN~FIELD "I
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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57037 (I
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No. B
C\UQ, ~ 19rd '
Rec'd From' O~i\\ \ f\ J\~',.
Address 4L\ 4 ~ ~ ("j{\Q" \ c.-
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Date
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Received For:
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Received
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Permit Clerr
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