HomeMy WebLinkAboutPermit Electrical 1983-5-24
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I INSPECTION LINE.
726-3769
Job Address Lj L) JS }..,{(1..i-n Sb:
Lega I Oe;cript;on '"1 02~'l..3 \ QIlD'3CYJ
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CITY UF SPRINGFIELD
CDrlBIllATION APPLICATION/PERMrT
--
E!lERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork:
Owner.
n A-1 JfYl fl.AI'\ --:f-r a /I'LL
'l:1 01 S 'l-rCl/Yl riA 'n & ~one
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INFURlIATION LINt
726-37S3
Sq. Ftg. ',Ia;n
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Pep.
-Fence Demo Change/Use
Other- -
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Address
Builciina Permit Info: Describe Work(i..e., Build Single
Familv Residence With Attached GaraQe)
Construction Lender
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I HAVE CAREFULLY EXA~lINED the completed aprlication for permit. and do hereby certify that all information hereon ;s true
and correct. and I further certify that any and a'1 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 rm 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, compl,iance with OP..S 7nl.055 'i/~bjlJ;\ on~his 7ject.
IWIE(please print) 6'& l. rLRffibLYlC\ ~ ~lECrSIGIl^TURE ~~ot.. J DATE
FOP. OfFICE USE 'OIJL Y '-"
Sq. Ftg. riain
Sq. Ft9. Access
Sq, Ftg. Other
Address
UES I GIJ TEAl,'
(name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CDNTRACTORS
(name)
(address)
General
jJ
DCLUiJi ~ 'rlrl,
Plumbino
Electrical
~lechanical
PLUIIBING
ELECTRICAL
NO, ,
, FEE 'CHARGE NO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath)
Additional bath
SERVICES
each
Temporary Construction
Change in existing
rp<:; i q~.nce
multifamily, comm. or
Inrluc;tr;al
Water serv; ce
Sewer
Storm Sewer
Of
amps.
COMH./IND. FEEDERS
Install/alter/relocate
di<:;trib. fe..~d~r<;
"2.-0 0 amps.
Of
Zone
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
Fire Zone
Flood Plain
Stories
BUILDING PERI.IIT
Charges and
Surcharges
Plan Ck, Comm/Ind
65%/Bldo Per F~e
Plan Ck, Res
3D%lBl do Per Fee
Fence
PLUI1BING PERMIT
Charges and
Surcharges
I D~mo
r-UU I '
______2'='. 'Sidewalk
, , au I A/C Paving
I Curb Cut
I
ELECTRICAL PERil IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
(I ics. no, I
(1 ir:<:;. no. l
I HI=" 'rI--lARr,1=" NO_
I
I
I
I
I
I
I
1":;500
1
I
I
~'S,?O
(exoires)
,
(OhOM no.
.~
(pxnirps1 (ohonp no. )
MECHANICAL
'n"!=' I rHARr,!='
furnace/burner to
STU's
Floor furnace
and vent
Recessed wall
Soar.p hp~tpr ~nrl vpnt
Appliance vent
sp.oa ril tp
Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart
,heatinq or A.C.
I Mechanical exhaust
hood and dur.t.
I ~lood stove/heater
I
I
I
from
ISSUANCE OF PfRt1lT
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charqe (1.5~)
Total Comb. rermit
1
,
,
j
,
TOTAL -"""""
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~
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
11 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. examole- heat/electrical ceilinQ/or forced air Qas
2. examjle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1, exam~le- 1250 sq, foot house, 500 sq, foot garage
2. examole- if new project, check new - if addition,
chee K add, etc.
F. Building permit information:
1. example. construct single family house with an
attached garllge
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 303 (a) of the
Structural Specialty Code
H. OESIGN TEAM ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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
signa ture.
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 OFFIC~ USE ONLY
Permit C1 erk
~
I
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
signature
date
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./. /3/cjtfert# 6';2094-0
/7 1P~'-f /~? CITY OF SPRINGFIELD
V?/d-- . Electrical Stock Report
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FORMNAME-,-!3 -,I- 7 P/L.lmh~ vi- E/e...c.fr/c om 6-- 24 -0'3
NAME OF MANAGER J?" /; l' r t ,/3 P f' rI () t:L- ADORES' 4 -12 (;j Mri / 'n (9 if,
STOCKREPORTBV fJl!tIIA', !;jdJ.'-./pJ ~~'::~~>:.,:.:j?~t.ttO'ZOZd4-
-..<, IINSPECTOR)
QUANTITY
TYPE AND NAME OF ELECTRICAL PRODUCTISI
TYPE OR
MODEL NO.
MANUFACTURER'S NAME AND ADDRESS
F/e.ct-r/<,r-7/ ,r~C.) aOD;-O:/Pr/I:,.-; C~?j-P.
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