HomeMy WebLinkAboutPermit Electrical 1989-11-29
INFORtIATlON LINE
126,3753
SQ. Ftg. 1,Iain
~q. Ftg. Access.
SQ. Ftg. Other
lIew Add Alter Rep.
--Fence Demo Change/Use
Other -- --
J
Job Address
.
(~L/ Lf fYI/11M ~'tr.f.p J-
Legal Description 17~ () '3-3{P - tJ:2."(v 001tJ{)
Lf.YU5tQ... IttLV'\ (,' jW'f%JL_L#'/1~.:,1 Ranqe
ValuE. of Hark:
(rJ/ /YLL. Jup p I (fWW/I OJ., uf, )
Address "-"" Phone BulldinQ Permit Info: Deser be Work( i ".e.. Build Single
I Family ~esidence With Attached GaraQe\
CITY F SPR NGFIELO
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
I INSPECTION LINE
726-3769
Address
Do~I~N loAr1
(name I
Phone
(address 1
.f- un fJ. .t iJ-U-rt'c.tV.- ()&(r ~
~ X-fhIM fAh..-.M \~
~IjDqA.. v.--x:cx\ ,~I of ....I)\('~ I
rrl (lies. no.) (exOlres) (ohane no. \
~
~
---
I~
Owner'
Construction lender.
Hechanical
CONTRACTORS
(name'
faddrl:l'ss \
flies. no. \
-*
(px~irps) (ohnnp nn. \
Primary
Structura 1
Electrical
Genera 1
C)W
l/
Plumbino
Electrical
~lechan; ca 1
PLUI.1BING
ELECTRICAL
MECHANICAL
....llih
FEE CII~Rr.F Nn
~~~ r~ -1W
FF"- J:JJAlllif..
SQ. FT,
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix, additional)
S.F, Residence
11 bath)
Duplex.(l ba~h) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
scoaratp.
Stationary evap.
cooler
Vent fan with
sin~:l1e duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood .lnd duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
fpsirlence
multifamily, camm. or
Inrlustr;al
~Iater service
COMl". /I NO. FEEDERS
Install/alter/relocate
r1ic:trHL fpprlprc:
Of
amps.
I SSUANCF OF PFR/IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CI~RGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be val;~ until the label has been signed by an Electrical 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 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 hr.rcin. and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my re~istration with the Guilder's
Goard 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 ORS 7~1.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Units
Occy Load
Occy Group
SI"IlATURF.
FOP. OrrICE USE OIlLY
Sq. Ftq,
SQ, Ftq,
Sq. Ftg.
~vJ) ? UI~rz-
DATE I (-:<efe- 8C('
IWIE(please printl-.L P ()O(fd
J-b\f S.
Type/Const,
Bedrooms
Stories
f1ain
Access
Other
x
.x
Value
Value
Value
x
TOTAL VALUATIOIl
BUILDING PER~\lT Plan Ck. COIll11/1 nd
Charges ant: ------------ 65%fBldo Ppr Fpp
Surcharges Plan Ck. R'es
30%/Bldo Per Fee
PLU!1BING PERMIT Fence
Charges and ------------
Surcha rges DtjIllo
ELECTRICAL PERIIlT _J5..fJ_rlun Sidewalk
Cha rges and '1g3t .16 A/C Pavin9
Surcha rges
/lECIIAN I CAL PERMIT Curb Cut
Charges and ------------
Surcharges
'Systems Development
Charae (I.5~) ,
Total Comb. rermit
TOTAL
/5;1~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description ,
1. example- Tax Lot lOa. lane County Map Reference
17 oj 43
2, example- Lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction Tender
D. Energy Sources 0,
1. example- heat/electrical ceiling/or forced air gas
2. examjJle- waterheater/elcctr'ical/or solar.
E. Squa re footage or va 1 ua t i on. elc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition.
check. add, ete.
F. Building penna information:
1. examele - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family room
3. examJlle. 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 TEAll ANa 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.nQ! 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
[
v
t4- 1606/
~ '
Permit Clerk
fJAJL
.
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
name
. ,
signature
I
lJate
I
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