HomeMy WebLinkAboutPermit Electrical 1987-1-6
~.
::0....... .
INSPECTION LINE
1 726-3769
Job Address .5 -;:l';:<O'
legal Description
~......//")
q-: -0//d'
CITl Uf SPRINGfiELD
COMBltlATlON, APPlICATlON/PERHIT
ElIERGY SOURCES:
Heat
Water Heater
Ranqe_
ValuE of Work:
.
INfORltATlDN llN.
726-3753
Sq. Ftg, '.latn
!q. Ftg. Access.
Sq. Ftg, Other
New Add Alter ~ep,
-Fence Demo Change/Use
Other - -
~o<)
.....::J.
~,
0'
\~'
~
.
,
Owner A~L / r'AI ~.c::?;-ffil-
Address f/
Phone
"
BUilolno Permit Info: Describe Work(;;e.. Build Single
,Family,nesidence Hith Attached Garaoel
(JAIL nO",) r ./~d:,
Construction lender
Address
U.SltiN 1.A/1
(name)
PhClne
(address)
lUes. no.l
(@XOifPS )
'\
(phone no.)
Primary
(addrp~~ )
t:.. _ \~CleI
--t~ C, ti~\ I'
~-
", 'Ilie.. no.l
.,
,fiA
\ '(~
Structural
Electrical
Mechanical
CONTRAC TORS
(name)
i;;;;i~p,"i'_._.:'---, ~ne -nQL-
General
Plumbino
E1ectrical,~,;'d J
/bb?0/."~
~ ~-/?:?&
/~/r-;?
,
~'echanfcal
PlUflB IIIG
ELECTRICAL
MECHANICAL
SQ. FT.
r.. . r"~ .ll2....
furnace/burner to
BTU'.
, <eL.'.cHAR
NO. '
Each single fixture
. <EE 'CHARGE JIll
Residence of
...
Relocated building
(new fix. additional)
S,F, Residence
Il bath)
Duplex (1 b~t~) c3:h
/'
New circuits ~.
~._.",.s
"'"
1.5 .tC.1
Floor furnace
and vent
SERVICES
Recessed wall
Soace heater ."~ vant
Water service
Temporary Construction
Change in existing
l"PC; j ~P.r'cP
multifamily, comm. or
Indudrial
v\"\
Appliance vent
~~Dar~tp
Stationary evap.
r:noler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
MeChanical exhaust
hond ~nd dut":t
Wood stove/heater
Additional bath
Sewer
Stonn Sewer
Of
amps.
COI1J.1.{lND. FEEDERS
Install/alter/relocate
dic;trih. fppdpl"C;
Of
amps.
ISSUANCf OF PFRllIT
TOTAL CHARGES TOTAL CHARGES S'/ ..s: /D TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permi'
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Oivision
I HAVE CAREFUllY EXA/1INED 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 l^ws of the State of Oregori pertaining to the work described herein, and that UO OCCUPAIICY will be made
of any structure without the permission of the Building Division. J further certify that my registration with the Builder's
Board is in full farce and effect as required by DRS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontiaci;ors and employees who are in compiiance with ORS ]1')1.055 will b~ usedoli this project.
~
SIGMTURE
FOP. OFFICE JlSE 011 I U
~g. rlain "
Sq. Ftg, Access
Sq. Ftg. Other
;W1E(~lease print)~n ~(:';'7.7.;
OATr/-6'-7/
~
Zone
Ftre Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
x Value
x Value
. Value
TOTAL VALUATION
n
~lU'1BING PERHIT
Charges and
Surcharges
Plan Ck, Comm/lnd
651/Bldn P~r<..
Plan Ck. Res
301/Bldo Per Fee
Fence
Syste~s Development
Charoe tl,5~ '
BUilDING PERJ.1lT
tharges and
Surcharges
I:
Detno
ELECTRICAL PERtHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
___~_J,.:"l~ IJ1)
I(JO
Sidewalk
~'
AlC Paving
I Curb Cut'
---- -------J,
ToUl Comb., Permit
-
I
__I TOTAL
/ShO';'
~.t.- ~~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
1/ OJ 4j
2. exa~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
I. examole- heat/electrical ceiling/or forced air aas
2. example- waterheater/el~ctricaIJor solar
E. Square footage or valuation. etc. ------
1, example- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project. check-new.- 1f addition,
check 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. examole - convert single family residence into
restaurant (Change of use) ,
G. Value of,work as defined in Section 303 (a) of the
Structural Soecialty Code
H. DESIGN TEAf! AND CONTRACTORS
To avoid design or construction delays. Building
~ivision Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
11. 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
Z. 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 genera) contractor is.not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible, the initial apolicatlon 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 rees 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 SATISFIED BEFORE OCCUPANCY:
.
~
. .......
.
PERMIT VALIDATION
(
S~%f
, IA/~~
...
Permit Cl erk
cdDP,
I .
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
~ I
I
'.
date
. ., ...... ..,..",'.. ....,<-...... - .~" ~.~f!;::::. J
. " C~TY OF SPRINGFIELD .
. ' City Hall .
Sprlngftald, Orogon
. Department of Public Works .
OFFICIAL RECEIPT
. No.8 67644 .
DBte/-tl /'\ . ,S1
. Rec'd'Fro~ I{1WJ& ~ ,- .
Address ~ A1A..ll/
. , A =.
-
Raceived For: 7;1002-2- (lBYJf fIl
. .
. t-'_ V / ,C), tJt) .
. cL -fRO .
- 11../
. .
. .
. / -.
Amount Received 1-S:t.OI
. {It .
.~ .-.
AUTHORIZED SIGNATURE