HomeMy WebLinkAboutPermit Electrical 1985-4-29
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I HISPECTION LINE CITY OF SPRINGFIELD
726-3769 COMBINATION APPLICATION/PERMIT
Job Address Li ~ ;). 3 m~ ~ ~~;~r,Y SOURCES:
legal Description ??t~ ./)A..-- ~~ !~ater Heater
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Owner fp 7'"p fJ" '" rJ
Ranqe
ValuE of [-Jor":
INFORlIATlON llNl
726-3753
Sq. Ftg. I.lain
~q, Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other - -
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Address ) "t J.
WI, ." }??Ol""
,6/Y)^ , -~=ly'. p A)
constructior!lender(JI I
1)12
X Ph~eJ7
<( 7'0,'1 ~ru
Buildina Permit Info: Describe Work. ( Le, I Build Single
Familv nesidence IHth JI..ttached Garaae)
~'/ (II.!. ~ '~JP
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Address
DES I GN rlAt~
(name)
Phone
(address)
nics. no.)
(exnires)
(ohone no.
Primary
Mechanical
CONTRACTORS
(name)
(addrflSS)
(lies. no.)
*
(pxnirps)~ (ohonp no. )
Structural
Electrical
Genera 1
Plumbino
Electrical {~ ~.u;. ..L
~[).()e
'<.,<'9.1./1./.
-gr rl3oh~
~'echanical
PLUIIBING
ELECTRICAL
r4ARGJJ:lo....l
MECHANICAL
...l!Q.,.
FFE
CHARGF
~n
FFF
SQ. FT.
furnace/burner to
BTU's
I.EFF
I
I
v.'lL1
I
1
Ir~~
Each single fixture
Residence of
Relocated building
(new fix, additional)
IS.F. Residence
11 bath 1
IDuplex (1 bath)
IAdditional bath
I \oIa ter serv; ce
I Sewer
IStorm Sewer
New circuits aIts.
or extensions
Floor furnace
and vent
each
ISERVICES
I
Recessed wall
'\r'I"",.D h~~tpl'" :tnrt
Of
ICOW1./IND. FEEDERS
1 Install/alter/relocate
rti~tr;h fppnpr~
10f amps.1
I
I
I
amps.1
I' Appl lance vent
spoaratp
I Stationary evap,
coolar
I Vent fan with
sinole duct
I Vent system apart
heatino or A.C.
I Mechanical exhaust
hond :tnd du("t.
I Hood stove/heater
I
I
I
from
!Temporary Construction
Change in existing
rp",jd~.nce
multifamily, comm, or
lndu"trinl
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LW REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
I SSUANCF OF PFR!1lT
I TOTAL CHARGES
'Electrical Contractor. the electrical portion of this penmit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED the completed aprlication 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 rID OCCUPAIKY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7Ql,055 will be used on this project.
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IIAt.IE(please print) f), )'0"';' / tu ~
SIr.rIATURE A ),~''1'',,_
FO~ OFFiCE USE miL Y
Sq. Ftg. lloin
Sq. Ft!], Access
Sq. Ft9. Other
~.,~
OATE <1/19'/1( <j
.A(#?'\..,
Zone
Fi re Zone
Flood Plain
TvpelConst,
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERIIIT
Charges anC:
Surcharges
Plan Ck. Comm/lnd
65%/BldC1 Pj'r Fpp
Plan n. Res
30%/Bldo Per Fee
Fence
1-f2~ .~
Systems Development
Charoe (1.5;) ,
?tJ.lL. .JU,.J
I r.).?;'7/ f_
I
,'2-0
PLU'1BING PERMIT
Charges and
Surcharges
Demo
I S1dewalk
lAIC Payi n9
I Curb Cut
------------1
Total Comb, rermit
I
..!T. ._ /
' 16~Coo
ELECTRICAL PERr~IT
Cha rges and
Surcharges
_J.9:...~_C2.____
.<(D
11ECHANICAL PERMIT
Charges and
Surcharges
I TOTAL
<...
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II
11
COMBINATION APPLICATION/PERMIT (CAP)
II
I. Applicant to furnish
A. Job Address
B. legal Description
1, example- Tax Lot 100. Lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Spnngtield Estates
C. Name, etc, of owner and construction lender
0, Energy Sources
1, example- heat/electrical ceiling/or forced air Qas
2, examole- waterheater/electrical/or solar
E, Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project, check new - if addition.
cheCK add. etc.
F, Building pennit information:
1, example - construct single family house with an
attached garage
2, exam~le - remodel existing garage into family room
3. exam~le - 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 ,TEAll 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 ava'ilable 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'l abbreviated schedules you should consul t the
fu 111 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES'ION 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:1 the electrical label. -
III. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet:lonly. 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. II
IV. Fees and Charges
Plan check fees are due and payable at the time of the
appl ication': 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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III
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PERMIT VALIDATION
o
~d
;) -Iv l, ~ <7^- 1
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Permit Clerk
ju
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Permit appl,icant exempt from registration with the Buil der I s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
date
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