HomeMy WebLinkAboutPermit Electrical 1985-9-23
'I INSPECTION LIrlE
J 726-3769
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CITY OF SPRIIIGFIELD '
COMBINATION APPLlCAHON/PERHIT
EilERr,y SOURCES:
Heat
l~ater Hea ter
Ranqe
ValuE of \.jork:
SL/L( 7
Lega 1 Oeseri pt i on / '+ ,,")
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53q /_ 03300
Job Address
Owner
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Phone
INFORlIATION LJNE
126-3753
Sq, Ftq, 1.lain
~q. Hg. Access.
So, Ftg, Other
Uew Add Alter Rep,
--Fence Demo Change/Use
Other- -
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Builriinq Permit Info: Describe Work(;.e.~
Fami 1 v !1es i dence l~ith /l.t tached Cla race)
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Address
Construction lender
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Address
Ul:.~ lliN r cAr"
Phone
(address)
(name)
flies. no.)
Primary
Structural
Electrical
f1echanical
CONTRACTORS
(name)
(address)
(l ice;,. no.)
Genera 1
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Plumbina
Electrical
~1echan;cal
PLUIIB I NG
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Ir"~l
ELECTRICAL
NO.
FFF
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ccc
Each single fixture
Residence of
SQ, FT,
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
11 bath)
Ouplex (1 bath) each
Additional bath
Storm Sewer
SERVICES
~ h tmtup
Temp~rary construct/mi.
Change in existing
rp~ j qp.nrp
Imultifamily, comm. or
Tndu<:;tri<ll
10f amps.1
ICO~1,/IND. FEEDERS
IInstall/alter/relocate I
di~trih. fppdpr~
Of amps.l
It) iDO
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I
I
Ha ter servi ce
Sewer
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,c(o
8uild Single
uf
ij
(exnires)
{ohone no.
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(pxoirp,,)
(ohnnp nn.)
MECHANICAL
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furnace/burner to
BTU's
I f:'f:'F I rliARG..E. '
Floor furnace
and vent
Recessed wall
~n<lrp hp~tpr ~nrl vpnt
Appliance vent
seoarate
Stationary evap.
conler
Vent fan with
..ino1e duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hond and durt
I Hood s tove/hea ter
I
I
I
I ISSUANCf OF PFR!1lT
TOTAL CHARGES TOTAL CHARGES It:) _ (1'1) I TOTAL CHARGES
WHERE STATE L'\H REQUIRES that the Electrical work. be done by an.Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oregon pertaining to the work. described herein, and that IW OCCUPAIlCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
:~II:(:~::::t::~:::S 't;;~es ~o :~i~;~i~e with :::rl:::R~;;n this oj ~TE q_ 2 3-~~
FOR OFFICE USE DIlLY
Sq, Ftg, liain
Sq. Ft!]. Access
Sq, Ftg, Other
Zone
Tvoe/Const.
Bedrooms
Units
Occy load
Occy Group
Fire Zone
Fl ood PI a i n
Stories
BUILOING PERMIT
Charges and
Surcharges
Plan Ck, Comm/lnd
65'UBldo P.er Fpp
Plan Ck, Res
30%/Bl do Per Fee
I Fence
I Oemo
10,00 I Sidewalk
_-_n-n-:-~6-1 A/C Paving
I Curb Cut
------------1
PLU'lBING PERMIT
Charges and
Surcha rges
~
ELECTRICP.L PERf:IT
Cha rges and
Surcharges
/1ECHANICAL PERMIT
Charges and
Surcharges
,x
Value
Value
Value
x
x
TOTAL VALUATION
Isystems .Development
Charoe (1.5~)
I
I
I
Total Comb. Permit
I
I TOTAL
IlJ--:+O
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
II 03 43
2, example- Lot I. Block 3, 2nd Addition to
Sprlngt;eld Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examQle- heat/electrical ceiling/or forced air QdS
2. example- waterheater/electr;cal/or solar
E. Square footage or valuation, etc.
I, example- 1250 sq, foot house, 500 sq, foot garage
2. examyle- if new project. check-nfw - if addition,
check add. etc.
F. Building permit 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. Vaiue of work as defined in Section 303 (a) of the
Structural Specialty Code
H_ OESIGN 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
0, 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.
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V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
,
---- .
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signature
date