HomeMy WebLinkAboutPermit Electrical 1989-1-9
v
I ItlSPECTIOtI LItlE .
726- 37 69
Job Addre\W"f~~,;6\\ ~ '\\\~\ tf\ \.~, .
le9al~5criPtionn\ l\n~rf>~4-\ ()() (Qrf'J
owner~\, ~ rei 01rlY\._ I
^dU~dri~7;14'}7 ~
Construct~(le)der J \~ ffi \( ,~n rf f )
Address Phone
UI:~lliN rE.Af~ lnameJ {address 1
CITY UF SPRltlGFIElO
COMBINATIOtl APPlICATIOtl/PERMIT
ENERGY SOURCES:
Heat
l~ater Heater
.
ItlFORllATIOtl LItlE
726-3753
Sq, FIg, 1,Iain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add Alter Pep,
--Fence Demo Change/Use
Other- -
J
Build Single
~
C::>
--S>
~
--J)
Ranqe
Valu, of W~: \~
Builliinq pc"rmh\InfO: Describe Work{;~e..
Familv l1esidence Hith J1.ttached GaraCle\
)
(1 ics. no.)
(exnires)
{ohane no. I
Primary
l1echanical
COtlTRACTORS
(name)
(address'
II ir:s. no.)
~
~,,~
(exoiresl (ohane no. \
Structural
Electrical
General
Plumbino
(CbJruiJ
Electrical
~lechan; ca 1
PlUllBltlG
ELECTRICAL
MECHAtllCAl
tlO,
FEF . r.HARGE .n
~~r. rH~Rr.F NO
H"C OIARr.r.
SQ, ry,
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(I bath)
Duplex (I bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp he~tpr ~nrl vprt
Storm Sewer
Of
COMfI,/ltlO, FEEDERS
Install/alter/relocate
distrib. feederc;
amps"
Appliance vent
seDarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood ~nd dur:t
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res'; rlenc{'
multifamily, comm. or
Industrial
~/ater service
Of
amps.
TOTAL CHARGES
WHERE STATE L\\~ REQUIRES
shall not be valiJ until the
TOTAL CHARGES
ISSUANCF OF PFRt1JT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical rortion of this permit
label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFUllY EXMlINED the comnleted application for f.lermit, 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 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration \'lith 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 emnloyees who are in compliance with OP.S 701.055 will be used on this nroject.
IUAI,IE(please pr~Oh
I
SlhIIATlIRE_.fld-l/;l't4>?'l/
FOr. OFFICE USE arlLt
DATE
Zone
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftf!. f1ain
So' Ftl]. Access
So' Ftg, Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUIlDltlG PER~IIT Plan Ck. Conm/l nd
Charges and ------------ 65%/Bldo Per Fee
Surcharges Plan Ck, R"es
30%lB1 do Per Fee
PlUI1BltlG PERMIT Fence
Cha rges and ------------
Surcha rges D~mo
ElECTR I CAl PERI~IT _l~._u.w S1dewalk
Cha rges and
Surcharges ,e::::., AIC Paving
l1ECHAtlICAl PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charge (1. 5n
I~~-'~
f
Total Comb. rermi t I
,
rJU
TOTAL
/s:qS
.
.
~~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
{~q 10
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Map Reference
11 oj 4j
2, examp]e- Lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin..Q/or forced air qas
2. exa~le- waterheaterjelectrlcal/or solar
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,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attaChed garage
2. examl?le - remodel existing garage into family room
3. exam~le - 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 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 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 flat authorized
to sign the electrical label.
111. 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
Clerk~
V
C1/JQ/P0
I '
Penni t
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date