HomeMy WebLinkAboutPermit Electrical 1988-4-4
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j I~~PECTION LINE
j 726-37 69
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CITY UF SPRINGFIELD
COM8INATIDN APPLICATION/PERMIT
EIIERGY SOURCES:
Heat p~
I~ater Heater
.
INFORl1ATlON LINt
726-3753
Sq, Ftg. l'lain 'ftD
~q. Ftg, Access.
Sq. Ftg, Other
~lew_Add IAlter-Yep.
_Fence_D~_Change/Use
_Other
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Jeb Address '7".2.2 7 A MAl/.! S7
Legal Descriptien 11tJ -2.1.;).1.;1
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Address
Ut~ lliN fl:.At1 I name 1
Primary ~1'/'iIL
Phone
faddress\
Ran!le
ValUE of Werk:
't~tPc>. -
BUilGino Permit Info: Describe Work(i.e., Build Single
Family nesidence With Attached Garaae)
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, Owner L.<!ssoe.. " IJ.,,; ~c- ..II... AIl-.. ~I.,A.s vP ,:-",,,;"''''1
Address ~ _ Ill..,. I. A '/.~" /. Phene
~raty .v;,"':, ~r.J.' , ,J I<",-,~ ~(o-76'1 J~~t
2i2flu. c.":.?7'tt'" l4-~ W'A,9Q/2I/.Jl.<;.,-
Construction lender
(lies. no.l
(exniresl
(ohone no.
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73'11 E...:J,.... dl2. &;1</d/ ('"~1l11 7~
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Structural
Electrical
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Mechanical
CONTRACTORS Inamel
General 4....,i!A....~N"'.s~t.fc/,~
(addrpc;,s l
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no. l
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Plumbina
Electrical L.I/. J11~II' S
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~1echanical
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
I FEF I fHARr.F 'ill. I I FFF I rlWUif. .11O~ I
Residence of furnace/burner to
SQ. FT. BTU's
I r:.E.L I .cl!ARliE
Relocated building
(new fix. addftienal)
~ New circu~ts alts.
or extenSlons
':2 ~JIIJ,~C"
?2.'5C
Floor furnace
and vent
S.F. Residence
(l bathl
Duplex (1 bath) each
Additienal bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
amps.
Appliance vent
5~oaratp
Stationary evap.
cooler
Vent fan with
sinole duet
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnnd ;lnd cturt
I-
I
I
Sewer- ..,
Temporary Construction
Change in existing
rp~ j cir.nrp
multifamily, COItl!l. or
I ndw: tr; a 1
Water service
Storm Sewer
Of
,-
CDMM./IND. FEEDERS
Install/alter/relecate
rlic:trih_ fl>l>/'ip,."
Wood stove/heater
Of
amps.
ISSUANCE OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES -:z :/.~ TOTAL CHARGES
WHERE STATE L,'\~ REQUIRES that the Electrical work be dene by an,'Electrical Contractor, the electrical pertion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
[ HAVE CAREFULLY EXMflNED the cempleted applicatien fer permit, and de hereby certify that all infermatien hereen 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
ef Springfield and the Laws ef the State of Oregon pertaining te the work described herein, and that 110 OCCUPAIICY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
IlAf.lE(please printl_d'v....... (::L,.'..e~..:., aLl,;' Ji/'_qIGII^TURE ~L ~
FOr. IlI"FICE USE OIIL Y 4'
Zene~/:. Type/Censt.~.h' Units Sq. Ftg. Ilain 9.60 foI
Fire Zone Bedrooms Occy load Sq. Ft~. Access
Fleed Plain Steries / Occy Greup 15~.:z Sq. Ftg, Other
1\) r:; -cj-~!
Plan Ck. Cerrrn/lnd ~ II,JUI Systems Develepment
65%/Bldo p.pr Fpp :/:#,93' 7710 Charpe (1.5%) .
Plan Ck. Res
30%lBlde Per Fee
DATE 1/- Y-6'g
x
Y~.-
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERmT
Charges and
Surcharges
~
___f'~@'___
.~.23
//-A,
PLur~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PER~1 T
Charges and
Surcharges .
MECHANICAL PERMIT
Charges and
Surcharges
D_
':<'4'-.5"<='Sldewal k
------------
/. /:3 A/C Paving
Curb Cut
I
ITotal Cemb, rermit ,
I
I TOTAL
7~%
,
.
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIT VALIDATION
1, Applicant to furnish
A. Jeb Address
B. Legal Oescriptien
1, example- Tax Let 100, Lane Ceunty Map Reference
17 03 43
2. example- Let 1. Bleck 3, 2nd Additien te
Sprlngfield Estates
C. Name, etc. of owner and construction lender
0, Energy Seurces
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examp_le- waterheater/electrlca (lor solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. feet heuse, 500 sq. feet garage
2. example- if new project. check-new - if addition,
CheCK add, etc.
F. Building pennit information:
1. examele - construct Single family house with an
attached garage
2, examEle - remedel existing garage inte family reom
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) ef the
Structural Specialty Cede
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.
11. 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 en1y the Ne. Boxes adjacent
te the apprepriate item(s) te 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) te be installed are net cevered en
the abbreviated schedules yeu sheuld censult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, As noted en the CAP, the label must be delivered to the
electrical contractor for Signature by his electrical
supervisor. The general contractor is .not authorized
te sign the electrical label, ---
Ill. 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
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.1
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c1 GD., L
/ / 5 .;z.d
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~.RHe: ;z:'~~c.<:"
signatur~~~
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