HomeMy WebLinkAboutPermit Electrical 1986-9-12
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CJS35
Range
ValuE of Work:
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726-3753
Sq. Ftg, 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
-Fence Oemo Change/Use
, Other- -
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jlNSPECTtON LINE
726-3769
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Job Address
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CITY Uf SPRINGflElO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Ilater Heater
legal Description
Address Po ~,<VV
,
C1'A Hi / /Y> {) -
Construction lend~ .
BuiltiinQ Permit Info: Descrlbe Workli~e," Build Single
Family Residence With Attached GaraQe)
0l-MJ [, C;;tR- r.lh1(2 ~ h
Address
DES t uN TEAl1
(name)
Phone
(address)
(lies. no.)
(exoires)
{ohone no. I
Primary
Mechanical
CONTRACTORS
(name)
(addri='ssl
flies. no.)
'~
(eXOire~ (ohone no,)
Structura 1
Electrical
General
Plumbino
Electrical
(A/l./U/h7
w~
tf35 - 70;l,b
~lechanica'
PLUI,IBING
ELECTRICAL
MECHANICAL
NO.
FEF CHARr.F N"
ccc rH~ N"
ccc rH~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
S~~~P ~p~tpr ~nn upnt
Storm Sewer
Of
amps.
Appliance vent
~eDarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino nr A.r..
Mechanical exhaust
hood and du~t
Sewer
Temporary Construction
Change in existing
rp~ j 1pnrp
multifamily. comm. or
Inc1ustr;al
,later service
COMI,I. /lNO. FEEOERS
Install/alter/relocate
di~trih. fpeder~
Wood stove/heater
Of
amps.
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I SSUANCE 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 performed 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 un OCCUPAUCY 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 sis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will us d on this project.
OATE CJ-I2.-5K"
IW,IE(please print)~#IA1/~ F7A2AL~LL SIGNATURE
FO~ OFFICE USE OfILY
Zone Type/Const. Units Sq. Ftg.
Fi re Zone Bed rooms Ocey Load Sq. Ftl].
Flood Plain Stories Occy Group Sq. Ftg.
r1ain
Access
Other
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERmT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________~/Bldo Per Fee
Plan Ck. R'es
30%/Bldo Per Fee
Fence
Systems Development
Cha rqe (1. 5~) ,
PLUl1BING PERMIT
Charges and
Surcha rges
De_o,
JkC' ~ 'Sidewalk
_____L-:='...!____
,&'t:> A/C Paving
Total Comb. Permit
ELECTRICAL PERliIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
d/i()5C-
.20
~ L.bJ.
TOTAL
(5, S:O
r
,
- I
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address '
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check-new - if addition,
CheCk add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyle - 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 TE~1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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 ~ivision
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.
f3 ~ 70G ~
q-[2 - tb
V. FOR OFFICE USE ONLY
t"c
Permit Cl erk
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date