HomeMy WebLinkAboutPermit Electrical 1983-4-1
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II IrISPECTION LINE.
-p26-3769
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Job Address 'f</~/1. (Yla...; n _~f. _
Legal Description ' \1. b2"5Z-6 \ ()I.o 6QL)
CITY Uf SPRINGFIELD
COMBliIATlON APPlICATlON/PERMlT
EilERGY SOURCES:
Heat
\'Jater Heater
,
u'
INFDRlIATlDN UNt I
726-37S3
Sq. Ftg. /.Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
--Fence Demo Change/Use
-Other - -
Owner
130 b ~eeJon
I.f<{ fJs mOo.. ,. 11
.s.o+,/d.
Range
Valu€ of Work:
Address
~f
"
,suilcline PennH Info: Describe WorklLe., Build Single
PhonqVl-(,/t Familv Residence Hith Attached Garaoe)
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Address
UDlliN TEA/1
{name)
Phone
(address)
(lies. no.l
\'0
(exoires) {ohooe no"\ ()<;)
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Construction lender
Primary
Structural
Electrical
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CONTRACTORS
(name)
(address)
(lic:c;. no.)
(pxoires)
(ahont! nn.)
General
Plumbina
Electrical
K:c\~ <( Co. ZIQ.Jr,'Q>
<gl(4 s. 38 ""'-~tO~lti.
'Lo-17 2c.-
12-3/-S3
7 'fT-8./(,,/
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PLUIIBIrIG
ELECTRICAL
MECHANICAL
NO. I
I FEE I CHARGE NO
I ~~F I rHARr.F Nn_
I 1=1=1= I r~AIH~1=
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
I
10.00
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
~n~cp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
~poaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and rlur:t.
Additional bath
Sewer
Temporary Construction
Change in existing
rp'l i rlJ'Jlcp
multifamily. corrm. or
Indu<;trial
Water service
COMH./IND. FEEDERS
Install/alter/relocate
di~trib. fppdpr~
Wood stove/h~ter
Of
amps.
410
lfO
ISSUANCE OF PFRliIT
TOTAL CHARGES TOTAL CHARGES IIJ. <I: 0 TOTAL CHARGES
, WHERE STATE L.'\~ REQUiRES that the Electhcal work be done by an,'Electrical contractor. the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
I HAVE CAREFULLY EXMllNED the completed application for permit. and do hereby certify that all infonnation hereon is true'
and correct. and I further certify that any and all work perfonned 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 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption ;s noted hereon. and that
only subcontractors and employees who are in comoliance with OP.S 7nI.055 W~l~ed on this project.
I~AlIE(please print) ~fJJ IC{P tl tJ 0 SIGIIATURE~.J/ ~ om
FO~ OEFICE USE onLY
sc(' Ftg. 11a i n
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
Fire Zone
Flood PlairJ
x
Stories
x
TOTAL VALUATION
BUILDING PER/lIT Plan Ck. Conm/lnd
Charges and ------------ 65%/Blda Ppr Fpp
Surcharges Plan Ck. Res
3D%/Bldo Per Fee
PLUMBING PERMIT Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PERI:IT _u__J9...:_Q9_ 'Sidewal k
Cha rges and
Surcharges . \fa A/C Pavi ng
MECHANICAL PERMIT Curb Cut
Cha rges and ------------
Surcharges
Systems Development
Charoe (1.5%)
Total Comb. Permit
TOTAL
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1
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100. Lane County Map Reference
17 03 43 \
2. exa~le- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ce;l;~Q/or forced air Qas
2. examyle- waterheater/electrical/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
attached garage
2. example - remodel existing garage into family room
3. exam~[e - 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 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-ln 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 "HE 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 ba 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 SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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~83
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/C;'ZY
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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