HomeMy WebLinkAboutPermit Electrical 1985-8-26
I INSPECTION LINE
726-3769
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BuiloinQ Permit Info: Describe Work(i.e.. Build Sin91e I ~
Family nesidence With Attached Garaael \J'j
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726-3753
Sq. Ftq. I"ain.
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Pep.
Fence_Demo _Change/Use
_Other
Job Address
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#8
Owner
Address
Phone
Construction Lender
Address
UtS 1 uN TlAf-1
(name)
Phone
(address)
(lies. no.)
(exoi res)
lohone no.\
Primary
Structura 1
Mechanical
CONTRACTORS
(name)
(address)
(l ;l".<;. no.)
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(~xnill)
(ohnnp no_ )
Electrical
Genera 1
Plumbina
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Electrical
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Mechanical
PLUI1BI NG
ELECTRICAL
I
! F" I J:I!ARG.E. NO ,
MECHANICAL
NO.
FEE CHARGF NO
Each Single fixture
Residence of
~n' rlJAR.G.E
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
New circuits alts~~
or extensions rSJ(
SERVICES
/5 tJ'tI
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Sewer
ITemporary Construction
IChange in existing
rps i ct.p~nI"'P
Imultifamily, comm. or
Inclll<:tri~l
10f amps.1
ICO~1./INO. FEEDERS I
IInstall/alter/relocate I
c1idrih. fppdprc;;,
IOf amp~1
I
I
I
Appliance vent
<:eoarate
Stationary evap.
cooler
Vent fan wi th
sinflle duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood ~nd du..t
from
Water servi ce
Storm Sewer
Wood stove/heater
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/5. Cov
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ISSUANCE OF PFRIIIT
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 UO OCCUPAllCY 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 O~S 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 7~1.055 Will,~~ O~iS~,'r~Oje~ct
IWIE(please print) KA r2L ttUI<.S\ SIr,N^TURE)(~/~ ~~~ 2{
FO~ OFFICE USE DIlLY
Sa. Ftg.
Sq. Ft9.
Sq. Ftg.
,.-
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I
Zone
Type/Const.
Bedrooms
Units
Occy Load
Occy Group
f1ain
Access
Other
x
Value
Value
Value
Fi re Zone
x
Flood Plain
Stories
x
TOTAL VALUATION
ELECTRICAL PERI~IT
Cha rges and
Surcharges
/5, 0-0
------------
(dD
Plan Ck. Comm/Ind
____________ 65%18Jda P.l'r Fpe
Plan Ck. Res
30%/BldQ Ppr Fee
Fence I
D~A1O I
'Sidewalk I
AIC Paving I
I Curb Cut I
I 02te-/tt-W 197'57~
syste,rns Development
Charae (1.5%) .
BUILDING PER~1lT
Charges and
Surcharges
PLUI~BING PERMIT
Charges and
Surcharges
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
,20
TOTAL
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COMBINATION APPlICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Oescription
1. example- Tax lot 100. lane County Map Reference
17 oj 43
'2. exam~le- lot I. Block 3, 2nd Addition to
, Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. example - 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 TEAM 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
full schedules
C. BUIlOING OIVISION STAFF WILL FIll OUT All FEES ANO
CHARGES ON THE SCHEOUlES
O. 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.
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V. FOR OFFICE USE ONLY
Permit Cl erk ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
PLANS REVIEWED BY:
name
signature
date