HomeMy WebLinkAboutPermit Electrical 1989-10-20
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Job Address 4 q L{ () fY/t0fr.
Legal Dmription J'7-67.. -:6'2..- t./ I.
CITY UF SPRINGFIELD .
CDMBINATION APPLICATION/PERMIT .
EIIERGY SOURCES:
Heat
DOt" eo I/ater Heater
Range
ValuE of Work:
IINSPECTIDN LINE
726-3769
Owner &h ~i7m
Addrcsst.{q '-/{) ~
Z> 1-4. d. t) r?- Q'7 L{ '7 7
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Construction Lender
INFDR/IATlON UNt
726-3753
Sq. Ftg. I,'a i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
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Q7/~~ ,~uilGinQ Permit Info: Describe Work(i.e., Build Single
Phonc01V':r/~ 4amilv nesidence I~ith Attached GaraQe\
Address
DESIGN TEAl1
(name)
Phone
(address 1
Primary
Structura 1
Electrical
11echanical
CONTRACTDRS
(namel
(address 1
Genera 1
Pl umbi no
~
--l~
-~
't...
(lies. no.) ~~(exoires)
(1ies.no.'
(OhOM no. I
(exnirp.s)
(ohane no.l
Electrical
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l{Z~ZZ-II1C/Gtn.'U~ HuJy. ~1fJ.
Ii' II Zo- Z 7 Z. /(;-/- 'd
gttu'-stj<jZ-
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amps. (~- I?~"
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~1echanical
PLUI1BING
ELECTRICAL
NO.
FEE CHARGE Nn
Each single fixture
Residence of
SQ. FT,
Relocated building
(new fix, additional)
~ New circuits alts.
or extensions ~
7 6A /7:>Nr'C"
SERVICES
5.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
r~$ j q~ncp'
Imultifamily, comm. or
, I ndu..~ \ri <!J
If 10f -I~ amps,
ICOW~./IND, FEEDERS
I Install/alter/relocate
dif;trib. f~~d~rf;
IOf/~
I
I
I
Water service
Sewer
Storm Sewer
6
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that tile Electrical 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
TOTAL CHARGES
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 performed 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 HD OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bu;lder1s
Board 1s in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 Wil~sed on this project.
IW.IE(please print)~ ~~f"e / SIGHATURE A:::. -8~ DATyb~~
FDR OFFICE USE DIlLY
Sq. Ftg.
Sq, Ftg.
Sq. Ftg.
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy.Group
BUILDING PERI-lIT Plan Ck, C011tn!l nd
Charges and ------------ 65%!Blda Pj'r Fpp
Surcharges Plan Ck. Res
3D%/Blda Per Fee
PLur~BING PERMIT Fence
Charges and ------------
Surcharges 0,",0
ELECTRICAL PERIHI 'Z t!?Z, ?" c:; 'Sidewalk
Cha rges and ------------
Surcharges I ~~ f3. A/C Pavin9
rlECHANICAL PERMIT I Curb C~t
Charges and ------------ I
Surcharges
FFLJ:IiARliE.-1IQ....
n.,5c.
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I
I
l';:?~,
r;.~ c.. ~
riain
Access
Other
MECHANICAL
'IL J:IiARliE.
furnace/burner to
BTUI s
Floor furnace
and vent
Recessed wall
Soace he~tp~ a~rl ~p~
Appliance vent
sena ra te
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood il:nd duct
Wood stove/heater
ISSUANCF OF PFR!IIT
x
Value
Value
Value
x
x
TOTAL V ALUA TI ml
Systems Development
Charqe tl.5~l .
I
I
I
ITotal Comb, Permit
I
I TOTAL
I
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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
'II OJ 4J
2. example- Lot I, Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I, exam~le- 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. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examyle - 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 TEM1 AND CONTRACTDRS
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. I f the item( s) to be ins ta 11 ed 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. ---
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
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
Permit Cl erk
..
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
L ~9.#c
l'l'6~6'?j'signature ~3.
,date /e::r <4' ~
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