HomeMy WebLinkAboutPermit Electrical 1983-1-16
Range
Value: of ['lork:
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BUlldlnq Permit Info: Describe Work(i.e., Build Single
Family nesidence With Attached Garaqe)
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(lies. no.) (exnires)
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I INSPECTION LINE.
726-3769
Job Address ~'3tl$"" 'l'v\~~~
Legal Dmription \\(')~ ~ \?-, \
CITY UF SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Ha ter Hea ter
("h\rY)
Owner, U.~. ~."'L_
Address
Phone
Construction lender
Address
DESIGN TEAf~
{name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
(address)
(1 ;C5. no.'
Genera 1
Plumbina
INFORllATION liNt
726-3753
Sq. Ftg. f,lain
:q. Ftg. Access.
Sq, Ftg. Other
Ilew Add A Her Rep.
--Fence Demo Change/Use
Other - -
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(ohone no .'\
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(exoiresl
(OhOM no.)
Electrical
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,.!)J),f).7) TOTAL CHARGES
, WHERE STATE L'H REQUIRES that the Electrical work be done by an,'Electrical Contractor. the electrical portion'of this pemit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
~lechanical
PLUIIBIIIG
ELECTRICAL
NO. '
, FFF '[HARC,F NO.
, FEE . CHARGF NO
Each single fixture
Residence of
SQ. FT.
IRelocated building
(new fix. additional)
IS.F. Residence
(1 hath)
IDuplex (1 bath) each
IAdditional bath
New circuits alts.
or extensions
SERVICES
Temporary Construction
Change in existing
residl?J1ce
multifamily, comm. or
Industrirll
~Iater service
Sewer
Storm Sewer
Of
il.mps.
COMfI./IND. FEEDERS
Install/alter/relocate
rHc:.trih fpprlprc:.
Of
amps.
1)n I . \c"\o J\.J ,
J)/J()Q N't'I.p~
~ /.f &Iff)
TOTAL CHARGES
TOTAL CHARGES
MECHANICAL
'FFF '[HARGF
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa11
Snace he~tpr and vpnt
Appliance vent
spoarrltp
Stationary evap.
cooler
Vent fan with
sina1e duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood and duct
from
Wood stove/heater
ISSUANCE OF PFR!lIT
I HAVE CAREFULLY EXM1INED 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 rw OCCUPAHCY 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 701.055 will be used on this project.
rW,IE(please print) L\..lj.JN 1) VlAOf>D t;..
SIGflATURE ~ ~ ~ ~J\Jo..ll
FOP. OFFICE USE OI~L V II
DATE
1/lroJR3
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. riain
Sq. Ft/]. Access
Sq. Ftg. Other
BUILDING PER/lIT
Charges and
Surcharges
Plan Ck, Comm/Ind
____________ 65%/Bldo PM Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
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PLUf1BING PERMIT
Charges and
Surcharges
D~mo
.....
_ W,U-J
Sidewalk
I A/e Paving
I Curb Cut
I
ELECTRICAL PERI:IT
Charges and
Surcharges
riECHAIIICAL PERMIT
Charges and
Surcharges
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charqe (1. 5%) ,
Total Comb. Permit
~
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TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
"
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I. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100, lane County Map Reference
17 OJ 4J
2, example- Lot I. Block 3, 2nd Addition to
Spr,ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinG/or forced air Gas
2. example- waterheater/electrica(/or ~
. E. Square footage or valuation, etc.
1. 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. example ~ construct single family house with an
attached garage
2. examyle - 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, 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 ~ite
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 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
fu 11 schedu 1 es
C. BUILDING OIVISION STAFF WILL FILL OOT 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.
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 Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
, Permit applicant exempt from registration with the Builder's ,Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
name
signature
date
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