Loading...
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- - I i I. I I' " I' 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 ~ ~ (name) Phone (address' \ ilirt ~ \ ~~~ 51'\\;'1 , l'\l \ ~ . flies. no. \ (excires) (ohone no.\ Construction lender Address DE~lI.lN ItAr~ , Primary .. ~ 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 _.__-11__________ ii . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I' . "I Permit Clerk . PERMIT VALIDATION \c(\o ~\ ~C\'\~ #\ . 1 '- ;\(Dc0 v " Permit applicant exempt from registration with the Builder's Board because: ': Additional Project Information: PLANS REVIEWED BY: " name signature date 1-