HomeMy WebLinkAboutPermit Electrical 1985-2-19
,
I IrISPECTION LINE . CITY Of SPRINGfIElD
726-3769 COMBHIATION ~~~ATI~N'PERMIT
Job Address 405' () M lYI~ ~ ~~;~GY SOURCES:
legal Description \ ,[);l?> \4 \r:D?X"Y) ~:~:: Heater
I
Owner .::s: W Ho-o f c> h.
Address p. CJ. -eO >< ~ A) t, Phone4'X'</
/-::I.A.g~ 0 ~ 9'7r./o / O/)t/~
Construction lende~
.
INfORlIATlON l,Nl
726-3753
Sq. Ftq. Hain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter ~ep.
-Fence Demo Change/Use
Other- -
~
('-
valUEl{ Hork: A 1\
'-Ib L/OtJ. vv.
BUilGinQ Pernlit Info: Describe Work(i~e," Build Single
2:t:dl A;;ched~a:~~ ~
-
Address
DESIGN lEAf.!
(name)
Phone
(address)
C)
(....,
~
,
Meehan; ca 1
CONTRACTORS
(name)
(addrp.s<; )
(1 ics. no. ) (exo; rp.s) (ahoM no.
i,
~.::7
,""\
(lice;. no. ) (pxoirpc:;' .,. (i)hnnp onl
Primary
Structural
Electr;cal
Genera 1
Plumbina
PlUllBING
,l 3d' lfI:..
~ Pi. # Pr!. f))(l q 7Y' 7 7
, V '
ElECTRICAL
MECHANICAl
,.,
If dci' ~ l!:ii. 'R(j <I
Electrical
~'echanical
NO.
FFF CHARGF NO
~~L...cJ:lAflli[ NO.
SQ. FT.
furnace/burner to
BTU's
<E.L 1.LJlARIii .
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wa 11
~n~~p hp~tpr ~nrl vpnt
TOTAL CHARGES
II.~
I
I
l~
Appliance vent
c;,poari'ltp
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart
heatino or A.C.
I'Mechanical exhaust
hood and durt
I ~'lood stove/heater
I
I
I
from
Additional bath
Temporary Construction
Change in existing
rp'l j nJ'.n~p
multifamily, comm. or
Industrial
~Iater service
Sewer
Storm Sewer
Of
amps.
COMI.'. IINO. FEEDERS
l'Instal1/alter/relocate
rlic:trih fppnprc:
IOf
I 45u II Berle
I
I
amps.
TOTAl CHARGES
WHERE STATE L~H REQUIRES
shall not be vali~ until the
ISSUANCf OF PfRIIIT
TOTAl CHARGES
that the E1 ectrica 1 work be done by an 'El ectri ca 1 Contractor" the e 1 ectri ca 1 110rt i on of thi s pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 Oref)on pertaining to the work described herein" and that rw OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify tha my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that' exempt the basis or exemption is noted hereon" and that
only subcontr. s and employees who are in compliance with OP.S 5 will be used this project.
~. l~" 0'10 J __SIGIIATURE .l.:, ~ ~
fOR OFfICE USE
Sq.
OATE~ -"I ~ -~'
IIAHE(please
Zone
Fire Zone
flood Plain
Type/Canst.
Bedrooms
Stories
Units
Y
Ftg. f1ain
Ft(]. Access
Ftg. Other
,
Value
Value
Value
Occy load
Occy Group
Sq.
Sq.
x
x
TOTAl VAlUATION
BUIlDING PERIIIT
Charges and
Surcharges
//'1 /t /1 Plan Ck. Conmllnd
/V (/""'C..I 65%/Rldo Ppr Fpp
------------ Plan Ck. R.es
q 0 30%/Bl do Per Fee
Fence
Systems Oevelopment
Charoe (1.5~)
PluriBING PERMIT
Charges and
Surcharges
ElECTRICAl PERIHT
Cha rges and
Surcharges
IS. 0-0
---------bo-
Demo
Sidewalk I
A/C Paving I
I Curb Cut _ I
II; i!4IJdl ~ g ,p7.$
I
ITotal Comb. rermit
/1ECHANICAl PERMIT
Charges and
Surcharges
,d ()
I
I TOTAl
~-Gd .!;
.
.
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
1/ U3 43
2. exam~le- lot 1. Block 3, 2nd Addition to
~ sprnlgtield Estates .' '.
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrical/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.
cneck. add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remadel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structurai 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 Scheduies
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
8. 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
fuli schedules
C. BUIlDING DIVISION STAFF WIll FILl OUT All FEES AND
CHARGES ON TME SCHEDUlES
O. As noted on the CAP, the labei 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 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. ,I
'1 .\
;1. .'(p ~ ;). ro :J'
(id a/!9/H/
V. FOR OFFICE USE ONLY
Pennit Cl erk
1nI
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl fcant exempt from registration with Hie Builder's Board because:
1
1
Additional Project Infonnation:
PLANS REVIEWED BY:
~ j
name
signature
date
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