HomeMy WebLinkAboutPermit Electrical 1990-1-30
\ INSPECTION LINE
726-3769
Job Address \ I\~l) t\'{\ ~'(\ ~
Legal Description f1Q.38lo3 r 6I/..o()()
Ow\er ~ h J,J. O.
~ CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
.
INFORI1ATlON LINE
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other.
lIew Add Alter Rep.
-Fence Demo Change/Use
Other - -
.J)
EIIERGY SOURCES:
Heat
l~ater Heater
lJ j. tri I) OC)
.J\ f aJ-- Phonf~\()\ In
f , U.:-V\\I
,1.11'1-
Range _
valu,\\f\r\j .
BUlltiina~ermlt Info: Oeser be Work{i.e., Build Single
Familv R s;dence W~1h_ A~ta:~ed Garaael
l:' \ )U.Jy.J$1flf1d1rfYmp
\ (I) f) (1});n::;-
Construct
v
Address
DESIGN rEM
(name)
Phone
(address'
(l its. no. \
{exniresl {ohone no.
Primar.v
~~
~
Structura 1
Electrical
11echan;cal
CONTRACTORS
(namel
{address \
(lies. no, \
(pxnir~s\ (ohane n~. 1
Genera 1
Pll,lm~ino
Electrical.
G-0,( ,G.lo. \I'\~. EloJltnl"C' "
PLUMBING ELECTRICAL
7)lo~ 1.I.)gct1 hB 4-"K '5-2b~
(~RLP()rT ) I IfJVq J
,
MECHANICAL
~'echanical
NO. .
FEE CH~RGE NO
"FF . CH'lRliE. NO.
FFF rH~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
f\\' .New circuits alts.
('j or extensions
r ~QsJ
Floor furnace
and vent
S.F. Residence
(j bath'
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp "PAtpr And vp~t
amps.
Appliance vent
~t:o~r;:'l~,p
Stationary evap.
conl@r
Vent fan wi th
sin91e duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hnl'Jd and dud.
Sewer
Temporary Construction
Change in existing
reos j <te.nee
multifamlly, corran. or
lndustl"'ial
Water service
Storm Sewer
Of
COMfI./lND. FEEDERS
Install/alter/relocate
di~trib. frpder~
o~mps.
Wood stove/heater
()!J.~
TOTAL CHARGES
WIlEnE STATE LAII REQUIRES
shall not be vali1 until the
\ TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
I SSUANCF OF PFRIlIT
~f)CJ, TOTAL CHARGES
Electrical Contractor, the electrical rartlon of this penmit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work nerformed 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 HO OCCUPArlCY 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 sUbcontraci~l~~~ Wi~S 7~1.DS " 1 be use on this project.
~nt) SI~UR
FOP. orFICE USE'EfOl~ '
Zone Tvpe/Canst. Units SI1. J . l-\ain
Fire Zone Bedrooms Occy load Sq. tlJ. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
DATE
.
Value
Value
.
x
Value
TOTAL VALUATION
BUILDING PERfIlT
Charges and
Surcharges
Plan Ck, Comm/lnd
____________ ~'Rldo P.l'r Fpp
Plan Ck. Res
3D~'Bldo Per Fee
Fence
'syste.r.1s Development I
Charoe (1. 5~ '"
PLU'~BING PERMIT
Charges and
Surcha rges
D~o
__~S-"C!?___ 'Sldewalk
A .!1 ~ A/C Paving
Curb Cut
Tota' Comb. Permit
EL[CTR I CAL PERIH T
Cha rges and
Surcharges
IIECHANICAL PERHIT
Charges and
Sure ha rge s
TOTAL
~'l ~Q~
I
~
,~
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
11 oj 4J
2, example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole. heat/electrical ceilinQ/or forced air Qas
2. examyle- waterheaterjelectrical/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. examole - construct single family house with an
attached garage
2. exa~le - remodel existing garage into family room
3. examjple - 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. B~;lding
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc. ' , t
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
0, 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 b~ 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:
.
.
..
PERMIT VALIDATION
"
I cfJ-YrJ
Permi t Cl erk
ciD~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
,
signature
date