HomeMy WebLinkAboutPermit Electrical 1983-3-8
I INSPECTION L1IIE.
726-3769
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work:
Job Address 0') 0 '5 r>;~ 2.-1.
Legal Dmription \ ~ DL 3~4 l f)~.-:vY)
Owner' (;)~ ~~ J?1a.tdv #~
/ 7 ^/q n;;L..Jf
1,o,U'cI. cnr ~
Construction lender
INFORlIATION LINt
726-3753
Sq. Ftq. 1,Ia i n
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Pep,
--Fence Demo Change/Use
-Other- -
\)C)
vJ
---
--
6'
~
Address
Builriina Permit Info: Describe Workli~e" Build Single
Phone7~b'l?2J3 'Familv Residence With Attached Garaae)
P CluJe r
-r~poy'o.. ry
Address
DESIGN TEAI1
Phone
(address)
(name)
(lies. no.l
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(addr~ssl
nics. no.)
General
Plumbina
i Electrical ..
~'echan; ca 1
'I ~ ~(l.Ao, ~
b
17 <./ '1 /??tt.V7U
PLUIIBI NG
ELECTRICAL
NO, '
. FFF . rHARr.F 'lP
I ~~~ I r~~ NO
Each Single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
S.F. Residence
(J bath)
Duplex (l bath)
Additional bath
SERVICES
~ la-o-V
~~
(O,OOI/O,OD
I
I
I
I
I
I
I
I~
I
each
0"'- ~
~pora'"ry' ~~r~n
Change in existing
rps ; d_p~nr:p
multifamily, comm. or
Tndustri;il
Of amps.l
ICOMl'I./IND. FEEDERS
l'Install/alter/relocate
.dht.rj\1. fp~d.ers
IOf f,'J~ Z'::"'L:an,ps.1
I
I 'rio
I
~Iater service
Sewer
Storm Sewer
(exnires)
(ohone no."\
~
j~ .........
;~
V -"
(pxnirpc;.)
(ohonp nn.
7 Yh - ~ 21 ::'5
MECHANICAL
. i='i='~ . r...l::lAB.!iE.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~nAr:p hPAtpr And vpnt
Appliance vent
c;.f!oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I'
heatinq or A.C.
Mechanical exhaust
hood and dud.
Wood stove/heater
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
TOTAL CMARGES
.'J'.h~
.- TOTAL CHARGES
ISSUANCE OF PFRr1IT
that the El ectri ca 1 work be done by an. 'El ectri ca 1 Contractor, the e 1 ectri ca 1 portion of' thi s . pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~lINED 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, and that NO OCCUPAUCY 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
only subcontractors and employees who are in comoliance with ORS 7nl.055~used on this project.
NAlIE(please print) -n';'Of/llA<;. lJ L-Jll~GE _ SIGrIATURE~ ~4 ~ DATod..-9-8'3
FOr. OFFICE USE 0I1L y
S~, Ftg, Ilain
Sq. Ft9. Access
Sq, Ftg. Other
Zone
Tvpe/Canst.
Bedrooms
Units
Occy Load
Occy Group
Fi re Zone
Flaod Plain
Stories
BUILDING PER~IIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________~/Bldn Ppr ~I>e
Plan Ck. Res
30%/Blda Per Fee
I Fence
------------
1 Demo
_h__~J7~g--sidewalk
~ A/C Paving
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERr:1T
Cha rges and
Surcharges
MECHANICAL PERMIT
I Cha rges and
Surcharges
Curb Cut
, , TOTAL I~
x
Value
Value
Value
x
x
TOTAL VALUATION
Isystems Development
Charae tl.5~) "
IjJ~ ,20
I;,J;tO't9'/ g
I
I
I
I
.a-
1000
~
ITotal Comb. Permit
,: ~
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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
17 03 43
2, example- lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exampJe- waterheatertelectr;cal/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 permit information:
1. example - construct single family house with an
a ttached garage
2. examole - remodel existing garage into family room
3. examyle. 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 TEM~ 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. ---
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.
~;~~ bGO~B
V, FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name
signature
date
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