HomeMy WebLinkAboutPermit Electrical 1989-10-20 (2)
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CITY UF SPRINGFIElD .
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
DO& eo Hater Heater
Ran~e
ValuE of Work:
INFURliATlON Lit'"
726-3753
Sq. Ftg. I'lain
!q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter Pep.
-Fence Demo Change/Use
-Other- -
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I INSPECTION LINE .
726-3769 '
Job Address t.fq I{ () 'fY/~
Legal Dmription 11-62. -.6'2..-1./ t ,
Ph U71_~_v~uiltiino Permit Info: Oescribe Work(i,e., Build Single
oncP1II"71'1'Cl'amilv Residence Ilith Attached Garaael
Address
UI:.~l(jN II:.Ar"
lname}
Phone
(address)
(1 ics.. no. 1
(exni r@sl
Cohone no. \
Primary
I\.. _
'~
Structural
Electrical
r~echanical
CONTRACTORS
(name)
(addressl
(l ire:. no. 1
(pxoirpc:l
(nhnnp nn_ 1
Genera 1
Plumbino
Electrical
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~1echanical
PLUliB I NG ELECTRICAL MECHANICAL
NO,I FEF r:IIMU~E Nn <rr r"~.Jlll... ~rL ..tltAImE.
Each single fi x ture Residence of furnace/burner to
SQ. FT. BTU's
Relocated building --- New circuits alt5. Fl oar furnace
(new fix. additional) or extensions G. n.5~. and vent
'7 ~A /hdf' .
S.F. Residence SERVICES Recessed wall
(] bathl ~n~rp hp~tp~ ~nrl Vlllnt
Duplex (1 bath) each
Additional bath Temporary Construction Appliance vent
s@oarilt...
Water servi ce Change in existing S'tationary evap.
rps j d.e]lcP cooler
Sewer multifamily, COnE. or Vent fan with
T nt1.u" triiJ.l sinolp duct
I ofL~ 5;r~. Vent system apart from
Storm Sewer I amps, ;:r...."._.. ~ hpatina or A.C.
COMfl. II NO, FEEDERS Mechanical exhaust
hnod and durf
Install/alter/relocate Wood stove/heater
di~trih_ fllllllrlpr..
6 Of/~ amps. (:)- ~..."
TOTAL CHARGES
WIIERE STATE L\l1 REQUIRES
shall not be vali~ until the
TOTAL ,CIIARGES
ISSUANCF or PFRrlIT
~ t7Z. 'SO TOTAL CHARGES
that the 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
I HAVE CAREFULLV 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 lID OCCUPAIlCV 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 OP.S 701.055 wi1~sed on this project.
1lAf.IE(please print) ~ r:;.-~fR / SIf,IIATURF. ~. ~~ OATyb....=~
FOP. OrFICE USE OIILV
Sq, Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Fire Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy.Group
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATIOII
BUILDING PERmT
Charges and
Surcharges
Plan Ck. Comm/Ind
65S/Bldo ~pr FiliP
Plan Ck. Res
30%/Bldo Per Fee
Fence
syste,ms Development
Charce (1.5%
PLUHBING PERMIT
Charges and
Surcharges
DOmo
_ _~~~.:2~Sldewalk
I tf!:1,- t:5 AlC Paving
Total Comb. Permit
ELECTRICAL PERmT
Charges and
Surcharges
HECIIANICAL PERHIT
Charges and
Surcharges
TOTAL
I
-::</'::? ,63
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Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
\,
l. Applicant to furnish
A. Job Address
B. Legal Description
1. examDle- Tax lot.IOO, Lane County Map Reference
II U3 43 '
2. examole. Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le. heat/electrical ceilinq/or forced air Qas
2. exa~le. waterheater/electrical/or ~ .
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.
etlee Ie. add. etc.
F. Building permit information:
1. examele - construct single family house with an
attached garage
2. examele - 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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonmation or jab 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 penmit fonm the schedules
have been abbreviated
2. If the item(s) to be 1nstalled are not covered on
the abbreviated SChedules you should consult the
fu 11 schedu I es
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 penmit 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 1s issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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CITY OF SPRINGFIELD
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City Hall
SprIngfield, Oragon
Development Services
OFFICIAL RECEIPT
15182
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Dale a:.:r::<t!?, 191119
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Received For: 'Q ~~I:77I!i"7/~
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Amount Received
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Frantler BUSINESS fOA....S. INC. (500)I).I;2-'1~'
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Pennit Cl erk
Pennit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
.
PLANS REVIEWED BY:
.
name L ~7./I#c ft6~6:;;rSignature
~ _date /o,<..,.,~,
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