HomeMy WebLinkAboutPermit Electrical 1990-8-21
I INSPECTION LINE
726-3769
Job Address uCt LjTJ
Legal Description
.
vVtlMV1 ,9,-
CITY U, SPRINGfIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Meat
I~ater Meater
Range
ValuE of flork:
.
I NFORlIATlDN LI NE
726-3753
Sq. Ftg, 1,1ain
~q. Ftg. ,Access.
Sq, Ft9. Other
New Add Alter Rep,
-Fence Demo Change/Use
Other- -
I
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o
V(I
owner,~ 'Bl)~ I-\7IJ~^'dtzrv'\
Address Po (hI)" 02..-
construc7:1~~~0 tld Q7c.j77
phone'14fo-
<i! 7.Y-I
Builrilnq Permit Info: Describe Work(i.e.. Build Single
Familv Residence flith Attached Garacel
E4fV1d Ode... ('J {rU If
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I
Address
DI:.:)IGN TeAM
(name)
Phone
{address'
(lics.no.'
(exoires)
'~.'
.,~
I
(ohane no.'
Primary
Structura 1
Electrical
Meehan; ca 1
, CONTRACTORS
Genera 1
{name}
{addres,,'
llics.no.'
(exnirl?s.~
(ohane no. \
Plumbino
Electrical fI6CCtdLWr1n {.,
h)~U'~?f-fiv~~
9~2. 77
t.f-1?J-1/
Q'-ll-7or%
Mechanical
PLUf.1BING
ELECTRICAL
MECHANICAL
Each single fixture
I FEE I CHARGE NO, I
Residence of
FF"- .cJJARf,F NO,
FFF rH.lIlGL
NO.1
5Q, FT.
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
1~(5l)
Floor furnace
and vent
S.F. Residence
(J bath 1
Duplex (1 bath) each
Add it I onal ba th
SERVICES
Recessed wall
Soaca haatar and vent
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Water service
Temporary Construction
Change in existing
re!ilclence
multifamily, comm. or
Tndustrial
Sewer
Storm Sewer
Of
COMM,/IND, FEEDERS
Install/alter/relocate
di~trih" fppdprs
Wood stove/heater
Of
amps.
ISSUANCE OF PFRlIIT
TOTAL CHARGES TOTAL CHARGES /r:;.c;O TOTAL CHARGES
.-" ".-- ..
WHERE STATE L\H Rl~UIIll~ tnat the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pen:1it
shall not be vali1 until the 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 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 UO OCCUPAI~CY 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 ons 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 Wil~ us~n this project. ~~<:()~~.
IIAllE(please prlnt)--D/}UIO A- {,1.41i6 SIGNATURE" ,~::/tl.1.../Jt- DATE{~/~;'
FOr. OEFICE USEOIIL Y /
Sq. Ftg. f1ain )( Value
Sq. Ftg. Access x Value
Sq, Ft9, Other x Value
Zo~e
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
Plan Ck, Comm/Ind
65%/Bldo Ppr Fpp
------------ Plan Ck, Res
30%lBl do Per Fee
Fence
'Systems, Development
Charae 0, 5~ "
PLU!~BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERIIIT
Charges and
Surcha rges
_LS:..c;!'0______ 'Sidewalk
175 A/e Paving
Curb Cut
Tota' Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
11~-1S
.
COMBINATION APPLICATION/PERMIT (CAPl
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, Lane County Map Reference
11 03 43
2. example- lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. ' Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examyle- waterheater/electrical/or ~
E. Squa~e footage or valuation, etc.
I, example- 1250 sq, foot house. 500 sq, foot garage
2. ,~- if new project. check new - if addition,
lcnecJ('add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
a ttached garage
2. exam~le - remodel existing garage into family room
3. examele - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (al of the
Structural Specialty Code
H, DESIGN 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 n~ed 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
o. 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:
.
PERMIT VALIDATION
~-23-%
pc!. cuSh
Redt 18/ 22-
Permit' Clerk ~/I/\ 0
-
Permit applicant exempt from registratlon with the Builder's Board because:
, ^
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date