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HomeMy WebLinkAboutPermit Electrical 1990-7-26 ~ I INSPECTION LINE 726.3769 Job Address '~o..,.d-.- MI>-..\~ legal \e;c)iD~ ~~ ~ OOCrA- Owner' S0~. 'b1'=l>J \..;,,~N\=f'-- Address;:tgd ~ \\'\e) { Jt\-.::, PhO;;1,,-\<CS,~~ Construction end\r I. rt I (<Jt J Lf 14, X . CtTY OF SPRINGFIELD COMBIIIATION APPLICATION/PERMIT EilERGY SOURCES, ~ Heat ~ 'Ia~ Ran INFORllATlDN LINe 726-37S3 Sq. Ftg. 1,1ain ~q. Ftg. Access. Sq. Ftg. Other Hew Add Alter Rep. --Fence Demo Change/Use "VaIuf(\o?cx, ) . Other- - BUil~i~q Permit Info: Describe Work(i.e.. Build Single Familv Residence With Attached.GaraQel . ! ",,1/' Al . ffiQ flt v'cN'l.l ~ ~ \ -I " ~) Address DESIGN TEAI,1 (name) Phone (address) 11 i cs. n('l.) (plCnirpc; ) (nhnnP. no. J Primary. Structural -<< Electrical Mechanical CONTRACTORS (name) (addrpss) (lies.. no.) (pxnirpc;.)'" (nhnnp no.) Genera 1 Plumbina Electrical {::>.', =,:,~ EO, Er~c.. \~\r-. ~ ~", '?t-0,. se,. c... \o\,\'\() 1'-\\ - <>''0-('') ~1echan;cal PlUf1BING ElECTRtCAl MECHANICAL NO. FEE CHI1RQL .l'n FFF r"ARU[ _NO ~~1= n~llRGf.. Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent S.F. Residence (] bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~ce heatpr ~nd vpnt Storm Sewer Of amps. App 1 i ance. vent seoaratp. Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A. C. Mechanical exhaust hood ilnd dur:t Sewer Temporary Construction Change in existing rl?sJ rtence multifamlly, C01T1l1. or Tndustriil.l ~!ater service COMM./IND. FEEDERS Install/alter/relocate distrib, feeders Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE l'W REQUIRES shall not be vali1 until the TOTAL CHARGES ISSUANCE OF PFRtIlT TOTAL CHARGES that the.E1ectrical work be done by an Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 Derformed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPArKY 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 compliance with ORS 701.055 will be used on this project. IWIE(please print)G ~~ (i\'\.:..""=' DATE\~ Zone Type/Canst. Units Sq. Fi re Zone Bedrooms Occy load Sq. Flood Plain Stories Occy Group Sq. BUIlDWG PERfIIT Plan Ck. ConmlI nd Charges an~ 6S~/Rldo Ppr Fpp Surcharges ------------ Plan Ck. Res 30%/Blda Per Fee PlU'~BING PERMIT Fence Charges and ------------ Surcharges Demo ELECTRICAL PERr~tT \::')9U Sidewalk Cha rges and /~ i\ Surcha rges A/C Pavi ng MECHANtCAl PERMIT I Curb Cut Charges and ------------ Surcharges I S IGIIATURE, FO~ OFF I CE USE DillY Ftg. I'a; n Ft!J. Access Ftg, Other .. x Value Value Value x x TOTAL VALUATION Systems Development Charae (1.5~) Total Comb. Permit TOTAL I , \ -S,lS . '..'... .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference II U3 43 2. exam~le- Lot I. Block 3, 2nd Addition to Sprlogfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole. heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example. 1250 sq. foot house. 500 sq. foot garage 2. exa~le- if new project. check-new - if -addition, check 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 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 OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ . _.. I PERMIT VALIDATION :'=t (l(<;~ 1-c9&-Q() Permit Cl erk Mim) Permit applicant exempt from registration with the Builder's.Board because: Additional Project Information: PLANS REVIEWED BY: name signature date j