HomeMy WebLinkAboutPermit Electrical 1985-7-1
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IIISPECTION LINE
i 726-376g
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CITY Uf SPRINGFIE~D
COMBINATION APP~ICATIONfPERMIT
EIlERGY SOURCES:
Heat
Ilater Meater
Ranqe
ValuE of Hork:
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BuildlnQ Permit Info:
Familv ~esidence Hith
.
1 NFORltA TI ON L. Nt
726-3753
SQ, Ftg. "lain
~Q. Ftg. Access.
5Q. Ftg. Other
flew Add Alter Rep.
-Fence Demo ChangefUse
Other - -
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Job Address /.2!/;; ,/?'/#/# S~ /A./_:2?
Legal Description /7-<7'$-'5>6-'%/ tJ~~e>t!:)
Address
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7tI~.'1'-9r
Describe Work(i~e" Build Single
Attached Garaae 1
Owner
Address
DESIGN TEM
(name)
Phone
( address ,
FtI1E:- "P/f--""! h":, ~ J7~~/R
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_~ / .H-:'-riY~.
- (1;c5.no.\. (p)lnires\ (ohOl'l~no
Construction lender
Primary
Mechanical
CONTRACTORS
(name)
(addresc; )
,1.
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Structural
Electrical
(lir:e; M \
(px~irpc' '~hn~p ~n \
General
n~AIe:~
:, Plumbina
Electrical
~'echanical
PLUI1B I NG
ELECTRICAL
MECHANICA~
NO.
FH CHARhF NO
Each single fixture
Residence of
~I CHARGFj N~
furnace/burner to
BTU's
~I.tIlAllli.E.
SQ. FT.'
,,'
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Relocated building
(new fix. additional)
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New circuits alts.
~)~s
SERVICES
(5-
Floor furnace
and vent
fj.-.
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S.F. Residence
11 bath 1
Duplex (1 bath) each
Additional bath
Recessed wall
~n~~~ h~~tp~ ~n~ ~~nt
Sewer
ITempor~ry Construction
IChange in existing
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Imultifamily. comm. or
lndllc:.trial
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I~QIC> I TOTAL
Appliance vent
c:.goi)r:ittp
Stationary evap.
cooler
V"ent fan wi th
sinole duct
1 Vent system apart from 1
hea t i no or A" C"
I' Mechan i ca 1 exhaust
hnnd and rlurt
I Hood stove/heater
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1
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Water service
. ~.
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Storm Sewer
10f
ICOMH,f1ND. FEEDER5
Ilnstall/alter/relocate
dic:.trih. fppdprc:.
10f
I
amps.1
_amps.
TOTA~ CHARGES TOTAL CHARGES
WHERE STATE L,\ll REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
ISSUANCF OF PFR,m
CHARGES
Electrical Contractor. the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM11NED 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 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 OP.S 7~1.055 will be used on this project.
NN1E(please print)
Zone .c:=. C
Fire Zone
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Flood Plain
TyoefConst. .:;"-N.
Bedrooms
Stories /
Units
Occy load
Dccy Group~-/
SIGUATURE
FO~ OFFICE USE OIIL Y
50. Ftg. r1ain x Value
Sq. Ft9. Access x Value
SQ. Ftg, Otherr.d"TF l:i}6T>J'C:.~ Value$.a::.::?-
TOT A~ V ALUA Tl Otl
DATF
BUILDING PERMIT
Charges an~
Surcharges
, -L-. _ 'Plan Ck,
___~_~,:___'_ 65%1Bldn
/...,... Plan Ck,
~....::-O 30%lBldo
Fence
Conrnfl nd
P.fr Fpp
Res
Per Fee
,~.
.Systems Development
Charoe tJ.5~)
#4.
PLU'1BING PERMIT
Charges and
Surcharges
DC/lI1O
____/'$_":.':.-' Sidewalk
. <!.O ,I AfC Paving
"'. 1 Curb Cut '.
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ELECTRICAL PERr:IT
Charges and
Surcharges
ITotal Comb, rermit
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I TOTAL
f/c8:'B$
MECHANICAL PERMIT
Charges and
Surcharges
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.TV OF SPRINGFIELD
CIty Hall
Springfield, Oregon
Department 01 Public Worka
.....,~,........ .'''' ....".."t:..., OF;:ICiAL'RE'CEIPT"~1:\::'\:"\!'lI.~~t'!"~'lJl':~~ 1
. .,; No. B 64920l
Dale ./O'-'t' I,. 19 ~
( Roc'd From ffl,YtP ~.,-cN'
Address atl7 .M~ ~
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R~ceived For: rJ.,t!'!: F~o II '.:> /
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COMBINATION APPLICATION/PERMIT (CAP)
,
III.
I. Applicant to furnish
A. Job Address
B, Legal Description
1. example- Tax Lot 100,
/I 03 43-
2. example- Lot 1. Block 3, 2nd Addition to
" ~prlngtield Estates '.',' "..,
C. \Name. etc. of owner and construction lender
D. Energy'Sources "',", ~ + .. '. .... .
1. " exam~ I e- hea tIe 1 ectrical ceil i nqfor forced air ~
2. .exa~le- waterneater/electrical/or SOlar
E. Square footage or valuation, etc. ------
I. examOle. 1250 sq, foot house. 500 sq. foot garag
2. examp.le- if new project, check-new - if addition
cneck add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family ro (
3. examole - 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 TEN4 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 adjace C
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 penmit-form the schedul
have been abbreviated
2. If the item(s) to be 'installed are not covered c
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES ,.... , '.
O. 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 w;"ll 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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Lane County Map Reference
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Amount Received
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V. FOR OFFICE USE ONLY
Pennit Clerk
PROJECT CONDITIONS TO BE SAiisFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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'Additional Project Infonnation:
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PLANS REVIEWED BY:
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name
~#G" ~E"~Signature. ~$''-'~ date
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