HomeMy WebLinkAboutPermit Electrical 1986-11-19
I INSPECTIon LINE
726-3769 .
Job Address
.
( ,<1-.t~
CITY Uf SPRHIGfIELD
C011BIiIATION APPLICATION/PERMIT
Legal Oe~cription
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E1IERGY SOURCES:
Heat
t'Jater Heater
Ran<1e
ValUE of Hark:
INFORltATIO:l Ui'it.
726-3753
Sq. Ftq. f.iain
~q. !='tg. Access.
So. Ftg. Other
flew' Add JI..1ter P.eD.
--Fence Demo Change/Use
Other - -
g
-:>0
J0
Address
(U ,':/7 /J I
~ /LlaA~
;;e-R~ /--1I/iA".L ~/
-:]-,1/ -I W~,c
Phone t?37
;?~5/
Builr:inQ Pennit Info: Describe ~Jorkli-.e.. Build Single
Familv nesidence l'lith ".ttached (;araoe)
Owner
Construction Lender
J1uw 1#700
--..
Address
Ut~ J Grl fl:.A1t
(name)
Phone
(address)
/~tlr
(1 ics. no.
(exo; res)
(ohone no. \
Primary
Structura 1
I~.
;
Electrical
11echanical
CONTRACTORS
InamE"'l
(addrp.s,,)
n il':<:;. no.)
(pxr);rpc;)
{nnnne nn.'
Genera 1
Plumbina
Electrical
{)wfLV(../
t.1echanical
PLUIIBI riG
ELECTRICAL
MECHANICAL
....J!JL..I I FFF I CHARr,F
Each single fixture
Relocated building
(new fix. additional)
I' S. F. Res i dence
II bath)
IOuPlex (1 bath) each
Additional bath
-.....llil.....1 i I=;:T i rliAflliE. ~Jn
I Residence of
SQ. FT.
New circuits alts.
or extensions
'!IL'
furnace/burner to
BTlI's
Floor furnace
and vent
SERVICES
Recessed wall
Sl'l~('tl kp~tt>.. ::Inri Ifpnt
Sewer
ITempOrary Construction
Change in existing
rpS; (tp~nr~
multifamily, comm. or
InrllJ<:.trial
Storm Sewer
Of
COMM./IND. FEEDERS
Install/alter/relocate
rli<:.rrih fpt>npr<:.
amps.
Appliance vent
saoa ra tp
Stationary evao.
rnoler" .
Vent fan wi th .
s;nole durt
Vent system apart from
heating or A.C.
j'lechanical exhaust
hood and dud
Wood stove/heater
-I
~Iater servi ce
Of
amps.
ISSUANCE OF PFRtHT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\I-I REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Surervisor 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 Oreqon oertaining to the work described herein, and that rw OCCUPAIKY 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 exemotion is noted hereon. and that
~:I::(:~::::t:::::~S ~;~yS :~~C::;:._~ith:::I~~e ~~ om 1I-(q-f&J
FOr. OFFICE USE OIIL Y
Sq. Ftg. riain
$Q. Ft!J. Access
Sq. Ftg. Other
Zone
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occ.y Group
x
Value
Val ue
Fi re Zone
x
Flood Plain
x
Value
v(o
TOTAL VALUATION
BUILDlIlG PERr.1!T
Charges anc
Surcharges
Plan Ck. Comm/Ind
Syste~s Development
Charoe 0.5%)
PLUt1BING PERMIT
Charges and
Surcha rges
____________ 65X1BldCl p_pr r",p
Plan Ck. Res
30%/Bldq P~r Fee
____________1 Fence
I O~mo
___~_.:?J_.~QI Sidewalk
.90 A/C Paving
Curb Cut I ~ I J<.
I f~c LabdJ
Total Comb. Permi t I
I TOTAL I ;) 3/bV
,
..ELECTRICP,L PERI~IT
Cha rges and
Surcharges
11ECHAN I CAL PERMIT
Charges and
Surcharges
.zn
;. -
.
.
'1
I
,
.,
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
1I oj 43
2. examole- Lot I. 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. examole- waterheater/electrlca(/or solar.
E. Square footage or valuation, etc. ------
1. examole- 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. examole - 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. DESIGN TE~l 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. ---
Ill. 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.
B01~~5
II ~ I q - f(P
V. FOR OFFICE USE ONLY
Permit Clerk
cc/
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,.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANC
Permit applicant exempt from registration with the Bunder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
J
,
name
signature
date
,
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