HomeMy WebLinkAboutPermit Electrical 1984-1-4
ValUE of I\Qrk: 0
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BUilGina Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaae)
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I INSPECTION lINE
726-3769
Job Address &- ~ <.0 c.{ ~ d,-ibu..cf
legal Description \,"'1Il.{JO I O:ill)~
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Address lo, "2.,Cc I.( Y1\..~~ ..)..i. Phon"'J:1!...5SS'
CITY UF SPRINGfIELD
COMBIIIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
Owner
Construction lender
Address Phone
Ut>IGN I tAt1 (name) (addres s 1
Primary
Structural
Electrical
Mechanical
CONTRACTORS (namel (ildrlrp<;.<; l
Genera 1 .~J "
Plumbino
Electrical ~o-vcrvI. ~
~1echanical
PlutlB ING
ELECTRICAL
NO.1
Each single fixture
I FEE" I rHARhf Nn I
Residence of
furnace/burner to
SQ. FT. BTU's
I ~l=l= 'n./t1Qr.l=
Relocated buildin9
(new fix. additional)
New circuits alts.
or extensions
Is.F. Residence
(I bath I
I Duplex (I bath)
IAdditional bath
Water service
SERVICES
each
1/10
Temporary Construction
Change in existing
rp5; rtflnrp
multifamily, corrrn. or
TnrilJ,t.riill
Sewer
Storm Sewer
Of
amps.1
COMM./IND. FEEDERS
I Install/alter/relocate
rlid_rih fpprlpr"
10f amp~1
I
I
I
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'I~ REQUIRES that the Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
nics. no.l
nil'":" nn,)
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INFORflATlON LINt
726-3753
Sq. Ftg. t.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other - -
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(exoi res) "(,1
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(ohone no.)
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(pxoires)
(ohon... nn)
MECHANICAL
Floor furnace
and vent
Recessed wall
~~~~~ h~~t~~ ~n~
"~nt
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hnnrl ...no duc.t '
Wood stove/heater
ISSUANCF OF PFRtHT
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
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 NO OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OP.S ](11.055 wil' be used on this project.
IWIE(please print) fSAR \A T 't:"E:R.jIfJ~ _., SIGNATURE ~~ J, ~I\-<A....
FOn OFF I CE USE ot4l Y
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftg. r1ain
Sq. Ft!J. Access
Sq. Ftg. Other
DATd-I1-.5? L[
I
x Value
x Value
x Value
TOTAL V AlUA TI Otl
BUILDING PERfIlT Plan Ck. Comm/Ind Shstems Development
Charges and ____________.-ill/Bldo Ppr I='ee C arqe (1.5~)
Surcharges Plan Ck. Res ..Pi!.u . QU . c..n
30%/Blda Per Fee
PlU'1BING PERMIT Fence I ;!:! m:"g rs
Charges and ------------ I
Surcha rges Oemo
ELECTRICAL PERr:IT IS.DO I Sidewalk I I
Cha rges and -----.-GB----' A/C Paving ITotal I
Surcharges Comb. Permit
MECHANICAL PERMIT I Curb Cut I o@ c
Charges and IS. '60
Surcharges -----------:-1 I TOTAL ;
.r
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax lot 100. lane County Map Reference
11 03 43
2. example- lot I. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examp'le~ heat/electrical ceilinq/or forced air QdS
2. exa~Je- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I. example- 12S0 sq. foot house. SOO sq. foot garage
2. examole- if new project. check-new - if addition,
chee k add. etc.
F. Building pennit information:
1. example - 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 TEM4 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.
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
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
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
signa ture.
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.
,
II.
be delivered to the
by his electrical
is.not authorized
III.
IV.
V. FOR OFFICE USE ONLY
j
1.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
PERMIT VALIDATION
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Permi t appl icant exempt from regi strati on with the Buil der' S Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date