HomeMy WebLinkAboutPermit Electrical 1983-8-12
'I INSPECTION LINE
726-3769
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CITY UF SPRIIIGFIELO
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
.
Address
~~
--P AO __ _ b
INFORllATION LINt
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
Range -Fence Denio Change/Use
ValuE of Hork: Other- -
-f~'Q~ '
1-- BuildinQ Permit Info: Describe Work(Le., Build Single
Phone :7""""'t9h ;:'lmil v nesidence I~ith Attached Garaae)
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Job Address "'f / ~ ~ "'77,,,, ,c.. , 1? JZ-:
Legal oe5criPtion\Jr'1~_~;::).::1~ (114CO
Construction lender
/fl, - ~ ~ 1 (l01ALc:ti.~
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r6
'::)
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t>o
Owner
Address
OESIG" TEAn
(namel
Phone
(address)
(lics. no.)
(exoi res)
(ohon€! no.
Primary
1~
~~
'if
Structural
Electrical
fiechanical
CONTRACTORS
(namel
(address'
(lies no.'
(pxoirfllc;.)
(onnnp nn_
Genera 1
Plumbinc1
Electrical
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"?A--,~, .y:.,-L-.-~___.." :LC> :'3<? G 7-/-8"9' 7"T7a6?r
r2 /3.s-:.&-~
~1echanical
PLUlIBI NG
ELECTRICAL
MECHANICAL
"0.1
Each single fixture
I HI=' I fH^Rr.F
Nn 1
Residence of
t't'L1...t.1:iARG..E. NO
I
I
furnace/burner to
BTU's
I J:'~LI.cHARGE
/
SQ. FT.
Relocated building
(new fix. additional)
x
New c;rcu~ts~
or extenslQn$ ~
:z. pl"\ JY7Pi'J ~
SERVICES
IS." ·
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.1
Appliance vent
!;pnar~tp
Stationary evap.
cooler
Vent fan with
s.inole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnt1 and durt
Sewer
Temporary Construction
Change in existing
rp5 j dJ'J1rp
multifamily. comm. or
Tnf'lllc:tr;~l
Water service
COMl'I./lNO. FEEDERS
Install/alter/relocate
rlic:trih fppf'lprc:
Wood stove/heater
Of
amps.j
ISSUANCE OF PFRrlIT
TOTAL CHARGES TOTAL CHARGES IS:- TOTAL CHARGES
WHERE STATE L\lj REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 OCCUPAIlCY 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IlAI-lE(please print).)?A LLJ /V . lilt c 0_ /:;:-
SIGrMTURE C;?~ t?'77~
DATE f?-/02-Ii'T'
FOr. OFFICE USE OIjL Y
Zone Tvpe/Canst. Units S~. Ftg. Hain
Fire Zone Bedrooms Occy Load Sq. Ftg. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILOIlIG PERfllT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Bldo P~r Fee
Plao Ck. Res
30%/Bldo Per Fee
Fence
Syste~s Development
Charqe (1.5~) .
PLUtiBING PERMIT
Cha rges and
Surcharges
Demo
_ _ j"S:,_ ~_ _ISidew. I k
"e> I AIC Paving
I Curb Cut
------------
I
t.;n1C'-.
'11:178&
.::a..o
ELECTR ICAL PERI~IT
Cha rges and
Surcharges
ITotal Comb. rermit
J
/lECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
/SBO
---
.
COMBINATION APPLICATIONIPERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Map Reference
II 03 43
2. examole- lot I. Block 3, 2nd Addition to,
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceil;nqlor 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,
check add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
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. 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 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 o.
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.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
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
lD( S35
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~
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P,mit Cl"c&,On !r#J
Permit appl icant exempt from registrati on with the Bui 1 der' s Board because,:
Additional Project Information:
PLANS REVI EWED BY:'
name
signature
.1
I
date
.
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