HomeMy WebLinkAboutPermit Electrical 1984-8-28
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I INSPECTION LINE
726.376g
Job Address ~ t, c; 0 Ain J.:-w I
Legal Description \\ (J"L ~\42
Owner ,~mulk..o U~J)
CITY Uf SPRtNGFIELO
COMBIIIATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
('')~_~ \ Water Heater
Range
ValUE. of I-Jark:
INFORllATION LJNt
., 726-3753
Sq, Ftg'. 1,la;n '
S:q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A 1ter Rep.
-Fence Demo Change/Use
-Other- -
'i>
'-
."s)
o
~
~
Address
Phone
BuilriinQ Permit Info: Describe Work{i.e.. Build Single
Familv nesidence With Attached Garaqe)
$2 h.p--J2AL-r-j - ~;';.A'7/..d'.flUf/ fJ<J..." I
. ~ r 0 .
Ohu---"'f' -<l
Construction Lender
Address
Ut~lliN TI:.Ar~
(name)
Phone
(address)
(lies. noe)
(exnirpo;)
(ohnn!'> "0
, Primary
Structural
Electrical (()/?--RfIlY 'El'd::t-.... d 'l, 70 1)), ..., ~/2fl. c.. 9J1.....o '2:>2'00/ 9(;<;Ia:--
7(t~~~!:f.!..Cfl 1\ girl /;J ~~ C).hu.dl...u'.'u.(n<a.-E-I./-t.--I 'o~x~T 1bJ.j.!~ ":3<d I~-f/
CONTRACTORS ~nam~ (aflc&ess) I fl,cs no.) (pxo;res) (ohMP I1n,)
Genera 1 '" .J
~ Plumb;nq +
I Electrical
~lechan;cal
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO.
FEE r.HARr,F NO
~~~ rHARr.~ NO
~~~ rHlIIU::~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
y
New circuits alts.
or extensions
10"....,. ~o-t;
I SERVICES
I
ITemporary Construction
IChange in existing
rP'i j d_p.nC'{'
Imultifamily, comm. or
Tndu<;.trial
IOf amps.
ICOMM./IND. FEEDERS
IInstall/alter/relocate
rtic:trit'L fppdprc:
IOf amps.
I
I
I
~ ..g<J
/-:, 1)-
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Addit;onal bath
Recessed wall
Snarp hp~tpr ~nn vpnt
~Ia ter servi ce
Appliance vent
c:el)arilt.f3
Stationary evap.
cooler
Vent fan with
sinole duct.
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood ilnn rlwt
Sewer
Storm Sewer
Wood stove/heater
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRtllT
TOTAL CHARGES
.Electrical Contractor, the electrical portion of this permit
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 Spri ngfi e 1 d and the laws of the Sta te of Oregon perta i n i ng to the work descri bed herei n, and that 1m OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 701.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Group
SIGIIATURE Jl(7W~ p,) '-< )(:--y u.-./-:-,
For orFICE USE OIIL Y
Sq. Ftg. r1ain
Sq. Ft9. Access
Sq. Ftg, Other
DATt% - ;if -Jr/
IlAI'lE(please print) ,1'J (J'1 n /_-/ Il/ r".../.p~...
x
Value
Value
Value
x
x
TOTAL V ALUA TI ON
BUILDING PERfllT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Blrlo Ppr F~e
------------ Plan Ck. R-es
30%/Bldq Per Fee
I Fence
I DtIAlo
,I~; o--u I-Sidewalk
-------~-~~I-I A/C Paving
I Curb Cut
I
Systems Development
Charqe t1.5~) ,
PLU!1BING PERMIT
Charges and
SurCharges
_ e,.i..R.1.JF ';U b 9 e...
,do
ELECTRICAL PERI~IT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Cha rges and
Surcharges
Total Comb. rermit
TOTAL
/s-.~
~
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example~ Tax Lot 100. Lane County Map Reference
II U'3 43
2. examele- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examDle- heat/electrical ceilinq/or forced air Qas
2. exampJe- waterheater/electrlcal/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. example - construct single family house with an
attached gar~ge
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, DESIGN TEM4 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 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 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 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:
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I
PERMIT VALIDATION
R ti-- b '3 ~ (( J"
OJ! '}s/~!s/8;y
Permit Clerk 1\), dCJ<-~
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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,
date