HomeMy WebLinkAboutPermit Electrical 1985-12-9
Builriina Permit Info: Describe Work(i.e., Build Single
Familv ~esidence With Attached Garaae)
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I I ISSUANCE OF PFRllIT
TOTAL CHARGES TOTAL CHARGES /0 Lj{) I TOTAL CHARGES
WHERE STATE L'l/ REQUIRES that the Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to e Building Division
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CITY OF SPRiNGFIELD
Cor1BHIATlON APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
\~ater Heater
Range
ValuE of Work:
~l IrISPECTlON LIIIE
726,3769
. Job Address
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Legal Oe~cription
Owner I j A-c.-O
Address-
Phone
Construction Lender
Address Phone
Ul~luN flAIl (name) (address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS {name} (addr~ss)
Genera 1
Plumbino HMJ;JC4
Electrical rrA ,,--fAur/
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~'echanical
(lies. no. )
A.
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~
y (lire; no. )
PLUI1BING
ELECTRICAL
NO,
FEE I":HARr.F NO
~~~ r~ARU[ NO
Each single fixture
Residence of
SQ, FT,
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
(] bath \
I Duplex (1 bath)
IAdditional bath
I~Jater service
I Sewer
IStorm Sewer
SERVICES
each
ITempOrary Construction
IChange in existing
rp~5dJ?Ju'p
Imultifamily, COIllll. or
Tnrlue;trhl
IOf
amps.l
CO~1,/IND, FEEDERS
Install/alter/relocate
.rlie;trih f.,..,.rlpre;
IOf
l;;t&n ~--'"
. 'l%
amps.
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INFORllATlON L1Nl
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add Alter Rep,
--Fence Demo Change/Use
Other- -
I'~
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(~xoir~sl
(ohone no.)
(pxnirpe;)
(ohonp nn. )
MECHANICAL
~~~ r~AR.G.E..
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~rp np~tpr ~nrl ~pnt
Appliance vent
s.eoarat.e
Stationary evap.
cooler
Vent fan with
sinole duct
I'Vent system apart from I
heatina or A.C.
IMechanical exhaust
hnod and dud
I ~'Iood stove/heater
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I HAVE CAREFULLY EXAMINEO the completed application for permit. and do hereby certi~y t all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accor e with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the Sta te of Orel)on pertai n i ng to the work des i bed her n and that rw OCCUPAIICY wi 11 be made
of any structure without the permission of the Building Division. I further. ertify }~a my registration with the-aui~der's
Board is in full force and effect as required by ORS 701.055. that if exem the ba is or exemption i ereon, and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 i be us on t . .
IlAI,IE(please print)
JO~
flIRff,
S Ir,NATU E
FOr. OFFICE USE I'YV V
~Ftg, Ilain
//q, Ftg, Access
II Sq, Ftg, Other
V
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILOING PERmT
Charges and
Surcharges
Plan Ck, Comm/Ind
65%/Bld~ Ppr Fpp
Plan Ck, lies
30%/Bldo Per Fee
Fence
PLurlBING PERMIT
Charges and
Surcharges
I Oemo
(0,00 I S1dewalk
--------:-<10-, A/C Paving
I Curb Cut
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ELECTRICAL PERr~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
OATE 1,;z-9-Z'S
x Value
x Value
x Value
TOTAL VALUATION
syste.ms Development
Charoe (1,5~) '.
th/ /0 lu-R.
I 'Zi= /Jt!lf),r1
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ITotal Comb, Permit
,2.0
ID"~ot
I
I TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Adoress
B. legal Description
1. example- Tax Lot 100, lane County M?p Reference
II 03 43
2. examole- lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcalJor SOlar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage'
2. exampJe- if new project. check-new - if addition,
check add. etc.
F. .Building pemit information:
1. example - construct single family house with an
attached garage
2. example - 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, DESIGN TEN1 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 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:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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date
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