HomeMy WebLinkAboutPermit Electrical 1988-8-11
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Builciino Pennit Info: Oescribe Work(i.e., Build Single C) \
Familv nesidence liith ~.ttached Gara~e) . ~
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IINSPECTION'LINE
726-3769
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CITY Uf SPRINGFIELO
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Range
ValuE. of Hark:
.
Job Address
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Legal Oescription /?-.tn.",;~;y?~ t:7~:;-~-:I a:rc;o)
Owner. ~d III f. {j}
Address I If 3 if (/ 1i1~
5 '1ft, 5
Phone 711
'7 Sht/
Construction Lender
Address
UES IGN TEAI~
(name)
Phone
(address)
-----------
Primary
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Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addresc;.)
ni~c;.. nn.'
Genera 1
Plumbino
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Electrical
~1echani ca 1
PLUflBING
ELECTRICAL
NO.1
Each single fixture
INFORMATION LINE
726-3753
Sq. Ftq. 1.la i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other- -
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(pxo;rpc;. )
(o~onp nn.)
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MECHANICAL
FEF rHARGE NO I...rrLJ.ClIARli.E. Nn. I
Residence of furnace/burner to
SQ. FT. BTU's
I ~~~ I fll
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
S.F. Residence
(1 bath1
Duplex (1 bath) each
Additional bath
SERVICES
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ITemporary Construction
IChange in existing
rp'i j qe.n('~
Imultifamily. COITIn. or
Induc;,trii'll
IOf
ICO~~./INO. FEEDERS
Install/alter/relocate I
d;c;,trih_ fppc1prc:
Of ::?~ amps.~,;;<:>
,t$~
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Water service
Sewer
Storm Sewer
amps.1
.:2,
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~l
Floor furnace
and vent
Recessed wall
~ni'l(,p hp~tp~ ~nrl upnt
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinnlp rluct
Vent system apart from I
heatino or Ar
Mechanical exhaust
hood and du('t
Wood stove/heater
I
I ISSUANCE nF PFRtllT
~- TOTAL CHARGES
'Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\li REQUIRES that the Electrical work be done by an
shall not be va1iJ until the label has been signed by an Electrical
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 Spri ngfi e 1 d and the Laws of the Sta te of Oregon pertai ni ng to the work descri bed herei n. and that rw OCCUPAHCY wi 11 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project.
IW.IE(please print) ~A LPH \); Her
SIGNATUR~~~
Foif"OFFICE USE DIlL Y ~
Sq. Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILDING PERfllT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Bldo P~r Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
O~RlO
I'Sidewalk
I AIC Paving
Curb Cut
PLUt~BING PERMIT
Charges and_......-
Surcharges.
ELECTRICAL PERlllT
Cha rges and
Surcharges
_ _ _..6t? :-,
3: t>c>
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DATE,.il' -//-,f".y
t
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charqe (1.51) .
: Total Comb. Permit
MECHANICAL PERMiT
Charges and
Surcharges
TOTAL
6"5. =0
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100. Lane County Map Reference
II U3 43
2. examEle- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceili~Q/or forced air Qa5
2. example- wat~rhe~ter/electrlcal/or solar
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, 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. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 3D3 (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. ---
Ill. 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 SATISFI~D BEFORE OCCUPANCY:
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PERMIT VAUDAUON
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
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signature
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date I?-/r~
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