HomeMy WebLinkAboutPermit Electrical 1988-5-23
,
Job Address
"-llo~
JnCU n
CITY Of SPR1NGFIE~D
CDMBIIIATIDN APPLICATIDN/PERMIT
EilERGY SOURCES:
Heat
I~ater Heater
Ran~e
ValuE of Work:
.
I NFDRllATIDN ~WC
726-37S3
Sq. ftg. I"ain
~q. !Ctg. Access.
Sq. ftg. Other
~ew Add Alter ~ep.
--Fence Demo Change/Use
Other -- -
~
()
-F-
(jJ
Ilft
I IriSPECTIO~ LI~E
726-376g
Legal Description
lJahond-/ 4duerl-ls ,'n 4
Address /O/?/) ,-()h/ e..- PR6ne ~
Eva~~ OIC. q?'40~
Construction L6nder
Owner
BuilGlno Permit Info: Describe Work(i.e.~ Build Single
Familv rlesidence I~ith Attached Garaae)
cJ et:d-r-l 'C-c-P -m
~h---'-..d
Address
Uc~IGr~ TEAll
(nan:e)
Phone
(address) (1 ics. no. ) (exoi res) (ahoM no.
t..
JW aLl 1_ ' <. ?.,()O
~~ . - ~ vI
ifI- )' v I
(address) (1 ic<;.. nn. ) (exnirpc;.) (nhnnp M. )
Primary
Structural
Electrical
Mechanical
CDNTRACTORS
lnamel
General
Plumbina
Electrical
U1I1 &.LrJ- r;leG. ka . /.0. &,,-:(5 8;:U c::K) - B"l~
. €ltCj&1eJ D;C 97lC ~
ICY/Sff" 1/.05, ~5<;
~'echanical
I'tlJlll!llllG ELECTRICAL MECHANICAL
NO. ' ~ FEF ' nlARGF Nn . J:'J:'J:' . fI-lAD.G.F flO. cc, rlJAJlliE
Each single fixture Residence of furnace/burner to
SQ. FT. BTU's
Relocated buil~ing 1 New circuits alts. Floor furnace
(new fix. additional) or extensions and vent
S. F. P.esidern:l! I SERVICES Recessed wall
(J bath) "n;:l(,p t'tP;:ltp\'" .:Inrl Vl)nt
Duplex (1 bath) each I I
Additio..l bath I ITemporary Construction I Appliance vent
~poaratp
Water service I IChange in existing I S-tationary evap.
rp'S-jq~nrl) cooler
Sewer I Imultifamily, comm. or 1 Vent fan wi th
TnrllJ"trii'l.l sinole duct
I / 10f "Je:> amps.1 I=<<..so Vent system apart from I
Storm Sewer heatino or A.C.
I ICO~~./IND. fEEDERS I Mechanical exhaust
hood and du(':t
1 I Install/alter/relocate I Wood stove/heater
ni~t...ih fpprlp..c:
\ ,1,01 IOf amps.1 I
, I I I
0 I I I
I I I ISSUAflCf OF PFRIIIT
TOTAL CMARGES TOTAL CHARGES
WHERE STAn l'\ll REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
;;:::;:. S-",t> TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
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 J further certify that any and all work performed 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 flO OCCUPAHCY will be made
of any str~ture .ithout the permission of the Building Division. I further certify that my registration with the Builder's
Board is in f~ll fDrce 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 OPOS 7Ql.055 will be used on this project.
Zone
Fire Zone
Flood Plain
TlfpelConst.
Bedrooms
Stories
Units
SIGrlATURE~~
.'
,Or. OfFICE USE OIlL y .
Sq. ftg. 11ain
Sq. ftg. Access
Sq. Ftg. Other
*..Ad.- DATES...,::13-'8'8"
llAl-lE(please print) ~i 1;0 r. - S-hJ C'L
Occy Load
Occy Group
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILOING PERJoIlT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Per Fpe
------------""""Plan Ck. Res
30%/Blda Per fee
I Fence
syste.ms Development
Charae (1.5%)
PLur~BING PERMIT
Charges and
Surcharges
I DfIIl10
"'ZJ?-.9=> I Sidewalk
,,-_u-/~;:3>--1 A/C Paving
I Curb Cut
I
ITotal Comb. rermit
I
I TOTAL
"2 "3.tt:; ?,
ELECTRICAL PERI~IT
Cha rges and I \
Surcharges -,
MECHANICAL PERMIT
Charges and
Surcharges
=
.
,
"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I, example- Tax Lot 100, Lane County Map Reference
II oj 43
2, exa~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceil;nq/or forced air Qas
2. examole- waterheater/electr;cal/or solar
E. Square footage or valuation. etc. -
I. example- 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 s;ngl~ family house with an
attached garage
2. examole - remodel 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
Structural Specialty Code
H. OESIGN TEAM ANO 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
fu 11 schedu 1 es
C. BUILDING OIVISION 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.
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 actua.l: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
Permit Clerka_Q ~~
<1<-",. ~n+- P- I~
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
......~ r. ~
,
Permit applicant'exempt. from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
name
Signature
. .',
date
.,