HomeMy WebLinkAboutPermit Electrical 1990-4-18
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Legal De,cription c4:- ~ I () I~ater Heater Sq. Ftg. Dthe
t \UI~'~' -6,6~DaYJ)() Range -1;:~c/d~em~'t~~~e
DwneU?'\f\O D~~) Valu' of'({ork! G\ 0 / Dther--
":'<. \--' ) "\ v\D j BU1101nQ Pl!!:'}lit In~ Descrlbe I~ork.(,.e., Build Single
Address *\ ~ \ (ul!; ) q~41l Family Resid,nce I~it~ Attach~raqe)
, Constructi~n ~\~~e~ '\ l Q ~ Q m ll' n '-)::;
Jot. .I\ddress
INFORllATlDN UNt
726-3753
r.1ain
cess.
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Address
DESIGrl I<AI~
(name)
Phone
(address)
(l ics. no.)
(exoires)
(ohane no. I
Primary
Structural
~
Electrical
Mechanical
CDNTRACTORS
(name)
(address 1
(lies. no.)
(exnires) ~ (ohane no.)
Genera 1
Pl umbi no
\\'l~1 Ql.f\."d'g \J\\t:~~
Lo'SCO'0
-Ole{ I
Electrical
~1echanical
PLUr1BING
ELECTRICAL
MECHANICAL
.....llih
FEE . CH~RGE Nn
FF~..cHARG.E. NO.
FF F .LHARGL
SQ. FT.
furnace/burner to
SlU1s
Each single fixture
Residence of
Relocated building -
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
l
SERVICES
. ill\ (\ ..!:1l 'fl ) .
T~mpO~~ry Construction
Change in existing
res j rtepce
multifamily, comm. or
Tnrlustrial
Recessed wall
Snace hpater nnn vpnt
. IS-ex )
Storm Sewer
Df
CDMI.I./IND. FEEDERS
Install/alter/relocate
dic;,trih. feeders
amps.
Appliance vent
se')arntp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnn and duct
Wood stove/heater
~Iater service
Sewer
Df
amps.
, MJO C!.d.:tQ ~
f/-1.'
ISSUANCE OF PFR!1IT
TDTAL CHARGES TDTAL CHARGES ?Sf.) .CP TDTAL CHARGES
WHERE STATE L\W REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this pemit
shall not be vali1 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 I 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, an"d that UO 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 7nl.055 will be used on this project.
'v: ;?/l/-, /j7 .
rW-IE(p1ease print) t;.,._____... /~{. /('/ CI.,1{..../!
Units
Occy Load
Occy Group
SIGi/^TURE
FDr. DFFICE USE DilLY
So. Ftg.
Sq. Ft~.
Sq. Ftg.
DATE
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
t1ain
Access
Dther
x
Value
Value
Value
x
x
TDTAL VALUATION
PLUI1B ING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Rlda Per Fee
------------ Plan Ck. ROes
3D%/Bl do Per Fee
Fence
Systems Development
Cha rqe (I. 5%)
BUILDING PER/lIT
Charges anc
Surcharges
ELECTRICAL PERIIIT
Cha rges and
Surcharges
I1ECHANICAL PERMIT.
Charges and
Surcharges
Demo
_~U~OJ .Sidewalk
I ,~() AIC Paving
Total Comb. Permit
TOTAL
3l.30
Curb Cut
.
-
.
... _._.._ .11
J
COMBINATIDN APPLICATIDN/PERMiT (CAPl
PERMIT VALIDATION
i. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100, lane :::ounty Map Reference
'17 oj 4j
2. example- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinqlor forced air Qas
2. exam~le- waterneater/electrlcal/or solar
E. Square footage or valuation, etc.
I. example- I25D sq. foot house, 5DD sq. foot garage
2. example. if new project. check-new - if addition,
Check add, etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage .
2. example - remodel existing garage into family room
3. exa~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 AND CDNTRACTDRS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons1regard)ng design- infonnation 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 fonn the schedules
have been abbreviated
2, h I f the item( s) to be ins ta 11 ed a re not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISIDN STAFF WILL FILL DUT ALL FEES AND
CHARGES DN 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 penmit is issued.
4-,\~ ~q7J
V. FDR OFFICE USE DNLY
Permit Cler
ll)LA_/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from re9.istration with the Builder's Board because:
Additional Project Information:
,
PLANS REVIEWED BY:
name
signature
, date
,I