HomeMy WebLinkAboutPermit Electrical 1990-2-6
\ INSPECTION LINE
726-3769
Job Address 4. ~ Q 0- i\'rrq (\ stIIQn t
Legal Description J)0 O<)~ ~81)(q()( )
TY SPR NG IELD
COMBINATION APPLICATION/PERMIT
EIIERr,y SOURCES:
Heat
I~ater Heater
.
N RllAT ON
726-3753
Sq. Ftg. Main
~q. Ftg. Access.
Sq. Ftg. Other
.lIew Add Alter Pep.
-FenCe Demo Change/Use
Other- -
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Range
Dwne~' ~\\\~[~QO~l ~ U.-YlLoM~valuE K Wr(\ -) " '.
- Builoina -p~1t Info: Descr1be Workli.e.,
Address \) - Phone Familv ~esidence \-lith Attached Garaae'
-
Build Single
o
~
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(name)
Phone
(address'
\ ilirt ~ \ ~~~ 51'\\;'1 , l'\l \ ~ .
flies. no. \ (excires) (ohone no.\
Construction lender
Address
DE~lI.lN ItAr~
,
Primary
..
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y......
Structural
Electrical'
'~echani ca 1
CONTRACTORS
{namel
(address \
{1 ic:<;.. 00. \
(e"oil"'es)
(ohone no. )
~~nerf.ll
Plumbino \ 1_
Electrica..A~.?
r Uof'J7lJ fl)
~lechani ca 1
PLUIIBING
ELECTRICAL
MECHANICAL
NO. .
FEE . CH~RGE Nn
::FF r"AJlliE. .Jlll
~~~ . ru.lRG.E..
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
f\.... Jiew circuits alts,
,)/ or extensions
Floor furnace
and vent
S,F. Residence
(j bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~~~r~ "~~t~~ ~"rl W~"t
Storm Sewer
Of
amps.
Appliance vent
seoarate
S'tationary evap,
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rpsj4~ncp
multifamily. COIl1Tl. or
lndrstrial
Water service
COflfl./INO. FEEDERS
Install/alter/relocate
rti<:trih. fpprlpr<:
Of
amps.
I SSUANCf OF PFRllIT
TOTAL CHARGES \ TOTAL CHARGES c)!) .f=)C), TOTAL CHARGES
WIlERE STATE L\W REQUIRES that the Electrical work be done by an,'Electrical Contractor. the electrical portion of this pemit
shall not be vali~ 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 110 OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further 'certify that my registration \'/ith 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 ~~hO are in compliance with ORS 701.055 will be used on this project.
IWIE(please pri~ ~ ~C.?f~GIlATURE DATE
FOP. OFFICE USE OIlLY
Sq. Ftg. l1ain
Sq. Ftg, Access
Sq. Ftg. Other
Fi re Zone
Flood Plain
x
Value
Value
Value
Stories
Units
Occy Load
Occy Group
x
Zone
Type/Const.
Bedrooms
x
TOTAL VALUATION
BUILDING PERfIIT
Charges and
Surcharges
, Plan Ck. COl1111/1nd
65%/Bldo P~r Fpp
------------ Plan Ck. lies
30t/Bldo Per Fee
Fence
'Systems, Development I
Charqe tJ. 5% ' '. ".
PLU!~BING PERMIT
Charges and
Surcha rges
ELECTR I CAL PERIIIT
Charges and
Surcharges
jJ'd.:. c;;J)
\. \0
IO~
'Sidewalk
A/C Paving
Total Comb. rermit
!lECIlANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
j~5,b3
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant toj!furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Reference'
'II oj 43
2. example- Lot I. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1. examDle- 1250 sq. foot house, 500 sq. foot garage
2, example- if new project. check-new - if addition,
chee k add. ete.
F. Building,:pennit information: .
1, exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3, exam~le. convert single family residence into
restaurant (change of use)
G. Value ofiwork as defined in Section 303 (a) of the
Structur~l 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 w~ere 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
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 tollsign and date
Whenever possible, the initial application will be used as
a worksheet only, Where possible, Building Division Staff
will prepare)ia 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
II
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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.
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Permit Clerk
.
PERMIT VALIDATION
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
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name
signature
date
1-