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HomeMy WebLinkAboutPermit Electrical 1985-12-9 Builriina Permit Info: Describe Work(i.e., Build Single Familv ~esidence With Attached Garaae) ~~r/,jj ~L-r I I I I I I I I I I I /(J11901 I 41) I 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 . . '~' CITY OF SPRiNGFIELD Cor1BHIATlON APPLICATION/PERMIT ElIERGY SOURCES: Heat \~ater Heater Range ValuE of Work: ~l IrISPECTlON LIIIE 726,3769 . Job Address !/oXJ ;;;. 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/ ~ ~'echanical (lies. no. ) A. ~ ~ 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. ~@ INFORllATlON L1Nl 726-3753 Sq. Ftg. 1,Iain ~q. Ftg. Access. Sq, Ftg, Other Ilew Add Alter Rep, --Fence Demo Change/Use Other- - I'~ ( ::::0. ~ (~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 I I I 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 I 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 I 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: III PERMIT VALIDATION , . JilDq A5 fl;; / 7d- \r s G . 6 Permit Clerk ~ rr/ ] Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . . . I date . J