HomeMy WebLinkAboutPermit Electrical 1990-7-31
CITY UF SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
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BUilG:nd ~erm;t Info: Describe Work(i.e., Build Single
Familv Oesidence With Attached Garaoel
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INSPECTION LINE
/26-3769
Legal De~cr;ption
Owner ~ '\5\...\..Q ~ 0 C\
Addr.ss4h\~ ~() 'Ll\ -5<t phon.,_)
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Address
Ul>luN flAH
(name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
{address1
Genera 1
Plumbina I~ _
Electrical't' iri V Od 1 1\ r'Lbrl
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~lechan; ca 1
PLUI1BI NG
NO,
FFF r.HARf,F
N~ rrr
Residence of
ISERVICES
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I
or I
Each single fixture
Relocated building
(new fix. additional)
0:\
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
ELECTRICAL
SQ. FT.
Sewer
IChange in existing
resjcjepce
Imultifamily, camm.
Indus.trial
Water service
IOf amps.1
ICO~1./IND_ FEEDERS I
Install/alter/relocate I
rli~t~th_ f~prlpr~
Of IJrxl amps.1
Storm Sewer
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L."~ REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Fire Zone
Flood Plain
BUILDING PERfIIT
Charges an':
Surcharges
Plan Ck. Comm/lnd
____________....Q.2!/Blda P,.E'r I="pp
Plan Ck. Res
30%/BIdo Per Fee
Fence
PLUI~BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERI~IT
Cha rges and
SurchiJrges
-J~~6~
Sidewalk
A/C Pavi ng
11ECHANICAL PE.RMIT
Charges and
Surcharges
Curb Cut
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INFDRlIATlON L1Nl
726-3753
Sq. Ftq. "\a i n
~q. Ftg. Access. ~
Sq. Ftg. Other,;'
Ilew Add !ter Rep_
--Fenc- emo Change/Use
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no. )
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.~r
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(pxoirpc,)
(ollonp no. \
Lo~q~
MECHANICAL
-EEL .CIlARG.E.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
Appl iance- vent
s.eoa ra tp
Stationary evap.
cooler
Vent fan with
s.inole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood il.nd du~t
Hood stove/heater
\
ISSUANCF OF PFRlllT
,_ TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
f1ain
Access
Other
D~.TE
,
.
Value
Value
Value
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 OCCUPAIKY will be made
of any structure without the permission of the Building Division. I furt er certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exe pt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 ill be used on this .proje .
IlAl.IE(pIease print)~AI'Y\~ ~. ~u Io.LP.u!\kL::
FOr. OFFIC_ USE
. S.
Sq.
Sq. Ftg.
x
x
TOTAL VALUATION
Systems Development
Charqe (1.5~)
Total Comb. rermit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 D3 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrical/or solar
E. Square foota'ge or valuation, etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check-new - if addition,
cneckadd, etc.
F. Building permit information:
1. example - construct Single family house with an
attached garage
2. example - 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 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 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 fonm 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 penmit 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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PERMIT VALIDATION
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Pennit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
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.
" II
date