HomeMy WebLinkAboutPermit Electrical 1982-2-12
INSPECTION LINE
726-3769
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CITY OF SPRUtGi=IELb \,
COMBINATION APPLlCATION/pERMIT
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INFORMATION LINE
726-3753
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J.b Add,... .AI/.<, (; C?r?~ ~
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ENERGY SOURCES:
Sq. Ftg. Main
Sq. Ftg. Access.
Sq. Ftg. Other
_New_Add_Alter_Rep.
_~ence___D~ma_Change/ Use
_Othe-.'
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/<iO.a.
Heat
Water Heater
RanQe
Value of Work: 0<0
.5'CO ~
Building Pormit Info: Describe Work Ii.e., Build Single
Family Residence With Attached Garaqe)
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I own,,-{OU!2
I Address
:Z::C..F
Phone
Cnn.trutt;(ln lender
Address
DESIGN TEAM
Phone
(name)
(address)
(lics. no.)
(expires)
(phone no.)
Primary
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Structural
Electrical
Mechanical
CONTRACTORS
(nome)
(() fJ i"1'1,_./J'1.
(address)
(Iics. no.)
, (expires)
{phone no.'
r,...n..rn[
Plumbin1'1
Electrical
Mechanical
PLUMBING
ELECTRICAL MECHANICAL
FEE CHARGE NO. FEE I CHARGE NO. FEE I CHARGE
Residence of furnace/burner to I
s9. ft. GTU's
New circuits, alterations Appliance vent I
or extensions " separate
Stationary evap.
SERVICES cooler
Vent fan with
Temporary Construction single duct ,
Vent system apart from
Amps. heating or A.C.
Mechanical exhaust
hood and duet
Wood stove/heator
FEEDERS Heat Pump
Air handler to
Amas. 10.000 CfM
J /J~"~Q~' /G71:2 Air handler ovor
10,000 CFM
I&~'#~--c...
NO,
Each sin~le fixture
Relocated building
(new fix. additional)
S.F. Residence
f1 bath}
Duplex (1 bath) each
Additional bath
Wat.r Sllrvice
Sewer
Storm Sewer
ISSUANCE Of PERMIT
TOTAL CHARGES
TOTAL CHARGES
/ s: tJ/J TOTAL CHARGES
WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, tho electrical portion of this permit shall not be valid until a
label has b..n signod by an Eloctrical Contractor and attached to tho electrical panel.
I HAVE. CARfFULLY 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 performed shall be done in accordance with the Ordinances of the City of Springfillld and thll law. of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building .Divi.ion. I furthor
certlfy that my registration with the Builder's Board is in fvll force and effect as required by ORS 701.055, that if exempt the basis for exemption i. noted
heron, and that only subcantrac:tors and employees who are in campliance with ORS 701.055 will b. used an this project.
NAME (pl.... p,;n') ~-re:V f5 ftPJJOJ. ("')
SIGNATURE
FOR OFFICE USE ONLY
I~ _ Ai'~CJOATE /,e"; - 61-<(2..
Basis for Builder'. Board exemption.
Z.n. _AI) - ^
Type/Const.~- III
:!.edrooms
Ctorie.
Units
r"lccy Load
n..y GroupJ~-~
Sq. ftg. Main
c;,q. ftg. Access
Sq. Ftg. Other
,
Value
."alue
.'clue
;:::. h'/'/~
Fire Zone
Flood Plain
x
x
TOTAL VALUATION
BUILDING PERMIT ' s: {JO Plan Ck. Comm/lnd
Charges and 65%/ BldQ Per Fe.
Surcharges -----
I dO Plan Ck. Res
30%/ BldQ Per Fee
PLUMBING PERMIT
Charges and Fence
Surcharges
Demo
ELECTRICAL PERMIT /5":lJrJ
Charges and Sidewalk
Surcharges I (po
AI C Pcvina
MECHANICAL PERMIT
Charges and Curb Cut
Surcharges --------
~.1IliIi::
Systems Developmont
Charpe f 1.5%)
Total Comb. Permit
;1;; tJ, 8"iJ
TOTAL
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r COMBINATION APPLlCA TIO;N/PE~ (C;~;
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I. Applicantta furnish
A. Job Address
-'\. B. Legal Description " .
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example.Lot 1. Block 3, 2nd Addition to, Springfield Estates
C. Name, etc. of owner and con'struction lender
D. Energy Sources
1. example-heat/electrical ceiling/ar forced air gas
2. exomole-water heater/electrical/or solar.:, '. . '\
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foat 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. 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
01 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 abbrevi-
ated schedules you'should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
III. Applicant ta sign and date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, Building Division Slaff will
prepare a typewritten 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 pracessed until these fees are paid. All' "
ather fees and charges are due and payable when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY:
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c:;ignatur'"
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