HomeMy WebLinkAboutPermit Electrical 1985-8-22
I INSPECTION LINE
726-3769
-
CITY UF SPRINGFIELD
COMBIIIATION APPlICATION/PERMIT
EilERGY SOURCES:
Heat
t~ater Heater
Range
Val u€ of I-lark:
-
~
INFDRtlATION LINe
726-3753
Sq. Ftg. 1.la i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo ChangelUse
Other- -
Job Address :3 &::, (" If rYnfJ.ivu
Legal Description 17 0 O!. c ~ I L/?
#-1
04701
Owner () AtYI P !tJ j. (p fA ~ {J!I ft-{if Xi (/1
Address Co /.p '3 W. toAl U 11\~a 0 Phone 74 h-
()::3 <;So
BuiltiinQ Permit Info: Describe Work(i.e.,
Family ~esidence With Attached Garaae)
,
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Build Single
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Construction Lender
Address
UtS I GN TEAf1
(name)
Phone
(address)
(lies. no.)
(exo;res)
(ohane no:~ --~
Primary
Mechanical
CONTRACTORS
(name)
(address)
flics. no.)
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~d
.
(ohnl"lp fin
Structural
Electrical
Genera 1
Plumbino
Electrical rO./LQ ~1\
~'echan;cal
PLUflB I NG
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ELECTRICAL "-EL J:JJARIiE' Nn MECHANICAL
FF' r\.lllr:u;r 'll' "-EL J:I!AIlli.E.
Residence of furnace/burner to
SQ. FT. BTU's
New circuits a1t5. Floor furnace
or extensions and vent
SERVICES Recessed wall
~nn~P hp~tpr nnrl vpnt
NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from ,.
heatino or A.C.
Mechanical exhaust
hnorl "nil rll1~t
Sewer
Temporary Construction
Change in existing
rps i rl_p..n~P
multifamily. comm. or
Industrial
~rater service
COffi1./IND. FEEOERS
Install/alter/relocate
ilidrih. fppdprc;;
Wood stove/heater
Of amps.
P"'Orl:.A, S,U_'-.
.(
fAI J 1'1 n >o"""J
t/ "j 0
10 00
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ISSUANC, OF PFR!1IT
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 NO 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 ORS 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 7Ql.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
I
v,,) rrn"ltt ..__SIGNATURE ~~j~/~
. FO~ OFFICE USE OfILY
Sq. Ftg. rialn
Sq. Ftg. Access
Sq. Ftg. Other
DA Tii8' -2 :;2.'6'5
1lAf,IE(please print)
..){ Jlox.n I d
Units
Occy Load
Occy Group
x
Value
Value
Value
x
x
TOT^L VALUATION
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Blda Ppr Fpe
Plan Ck. Res
30%/Blda Per Fep
Fence
Isystems Development
Charqe O.5~) .
PLUI1BING PERMIT
Charges and
Surcharges
I D_
f 0.00 ISidewalk
------ --,-<70-1 AIC Paving
I Curb Cut I
1~.It k6(Jo?'I5-b, ~
..I, , r
Total Comb. Permit
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
QlO I TOTAL
fel. ~O
,
-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examo'le- waterheater/etectrica(/or solar
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. examele - construct single family house with an
attached garllge
2. examyle - remodel existing garage into family room
3. examFle - 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. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
tt
PERMIT VALIDATION
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PAlO
/
Permit Clerk
1 V (L/
tb/O
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.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date