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