HomeMy WebLinkAboutPermit Electrical 1984-12-10
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I INSPECTION LINE
726-3769
Job Address ''-/ / 0 s7Yl t1.14G
Legal Description
LITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Nater Heater
Range,
ValuE of Work:
IHFORtlATION liNt
726-3753
Sq. Fto. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A I ter pep.
--Fence Demo Change/Use
Other -- --
ownertt; OJj 11) i ,J aJ I1J ~
d ~AI1' , h 0 " BUlld,no PenJllt Info: Descr.be Work(i.e..
A dres:~::pI,;~ru::1/ 7 ~ p oneaZ~~- y:j);:de7~i~h;,ttac~1ao~
Construct'on Lender 70 ~ J.11IY
I -
Build Single
I~
C)
~
C)
-::r
100
(ohone no.')
Address
Ul:.~ lliN TEAf~
(name)
Phone
(address)
a
i1 ics.
no. )
{exoiresl
Primary
~
Jw-
~
Mechanical ~
CONTRACTDR~~,~~.l ~ ~ ~ Jj,ddr~ss' Jlirs. no. ~ 1-"JpxQirp~'
r~~.../ol~MA //ljdJ1Ii_ #~n..ltk ~(" (t2. .s.L.JftIrr.jjq 97'117 7db-ll.//fA
Plumbina
Structural
Electrical
-
(ohnnp l"In 1
Electrical
~'echani ca 1
PLUI,IBING
ELECTRICAL
,
CJ:L..cJiARIi.E NO.
MECHANICAL
NO.
FFF r.HARGF Nn
Each single fixture
Residence of
""L..cI!AB.IiE.
SQ. FT.
furnace/burner to
SlU1s
Relocated building
(new fix. additional)
New circuits alts.
or extensions
F1 oar fu rnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~iP hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
c;.poaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dur't.
Wood stove/heater
~Ia ter servi ce
Temporary Construction
Change in existing
rpc;. i r1J'JliP
multifamily. comm. or
tnduc;.trial
Sewer
CO~~./IND. FEEDERS
I Install/alter/relocate
dic;.t.rih. fPPdprc;.
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l~ REQUIRES that the Electrical work be done by an'E1ectrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
IOf _ __ amps.
~/LP.IA.Iflt!J C!.vv.l. ..II/Dffl
I I
I I
10- rflJ
ISSUANCE OF PFRIIIT
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 OCCUPArlCY 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 ORS 7nl.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGIIATURE 1I!t1t;;:? J@lz~.LJ,
FOr. OFFICE USE DilLY
Sn. Ftg. 11ain
Sq. Ft9. Access
Sq. Ftg. Other
DATV.~~8~
, .
IlA~1E (p 1 ease pri nt)
;J; 1M f; ;ff C -I h. tJ. 'NL~
x
Value
Value
Value
,
x
TOTAL VALUATION
BUILDING PERNIT
Charges anC:
Surcharges
Plan Ck. Comm/lnd
65%/Bldo P~r Fpe
------------ Plan Ck. Res
30%/Bldo Per Fee
Fence
syste,ms Development
CharQe tI.5~) ,
PLU'1BING PERMIT
Charges and
Surcharges
D~RIO
ELECTRICAL PERlilT
Cha rges and
Surcharges
_ __u_ !Q_J!!!..Sldewa1k
. '-16 A/C Paving
I
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
ITotal Comb. Permit
I </D
I TOTAL /0 ~
l/o"'CjE
.
.
R40 967,
1.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I
1. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates ' .
C. Name. etc. of owner and construction lender
D. Energy Sources -
"I. example- heat/electrical ce;l;nq/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,
check add, etc,
F. Building permit information:
1. examele - construct single family house with an
attached garllge
2. example - 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. OESIGN TEN~ 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. BOILDING DIVISION STAFF WILL FILL OOT 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
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.
''12#- 0? 97<(
fJ IJ)o/{C!
V. FOR OFFICE USE ONLY
Permit Clerk
/0.;J
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
...