HomeMy WebLinkAboutPermit Electrical 1985-10-10
IIIISPECTION L1IIE
726-3769
,
Address
U<,!(;rI I<Al1
(name)
Phone
(address)
I
:or
~
..Q
Bullciino Pennit Info: Desc~ibe Work(Le.. Build Single .L~
~~::h~tta~~d/ ~fr~~
ftM flLdlt,;" O(1~
1/. ~ / I~ 11ft
nics. no.l
t
v~
Job Address ',,>JO-{)[) MJ1A'~J
Le9a I Deseri pt i on / '7 0 3 :;;' I/J
-.er-
L./;;Z
CITY OF SPRIrlGFIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
o ,::)'1tJL lIater Heater
Range
ValuE of Work:
INFORlIATION UrI<
726-3753
Sq, Ft9, 1.lain
~q. Ftg. Access.
S9, Ftg. Other
New Add Alter Pep,
-Fence Demo Change/Use
Other - -
Owner /~ YJ ,-1.tt/J'h ~
Address 1,:),t:;"oq flI/j,,:U/ . '\ PhonetJ4b
/ ~.(P".Btk/)70M ) 8'1//
tanstruction Len~r 7%,) - 3 0:2:f1/
{~xo;resl
(ohone no. \
Primary
*-
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(address)
(1 ire:. no.l
(pxoirpc:.\
(ohnnp nn, \
General
Plll:nh;,,~
(WIJI7P h)
Electrical
Hechanical
PLUlIBlIlG
ELECTRICAL
r'lARGE l-'L
MECHANICAL
NO.
I FFF
fHARhF
rip
I i=n
SQ, FT.
furnace/burner to
BTU's
1-EEL.cJJA&li.E.
I i
Each single fixture
Residence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bat.hl
Ouplex (1 bath) each I
IAdditional bath I
Iwater service I
I Sewer I
IStorm Sewer I
-I I
I I
I I
I
I
I
SERVICES
Recessed wall
Sn~h~~~~~ ~~d vpnt
I-I
I I
I I
I I
I
I
I
I
I
I
TOTAL CHARGES
WHERE STATE L~II REQUIRES
shall not be valiJ until the
I
I
I
10f amps.1 I
I~~('/I II)I
I~ Laf:ui)~ I I I
I 0K9513 I I 2D I
TOTAL CHARGES 1; rh , "7V I TOTAL CHARGES r
that the Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the BUilding Oivision
10f
-ICO~1,/IND, FEEDERS
IInstall/alter/relocate I
rl;~trih fpprlpr~
amps.1
I Appliance vent
~poarM,p
I Stationary evap.
cooler
I Vent fan with
5.inale duct
Vent system apart from I
heatina or A.C.
- Mechanical exhaust
hood and rlur:t
Il~OOd stove/heater
Temporary Construction
Change in existing
rp~ i 1p~n'-e
multifamily, corrm. or
, Inctlldri~l
I SSUANCr OF PFR!IIT
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 Derformed 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 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 subcontractors and employees who are in compliance with OPS 701.05S w~sed on this project, ,
HAlIE(please print) G~E i~OLlCc,1-\ V SIGH^T~~~~TE(O -(0 ~~ c:;-
FOr. OFFICE USE OrlL Y ,-
Sq, Ftg, 'ialn
Sq. Ftt]. Access
Sq. Ftg, Other
Type/Cons t,
Bedrooms
Units
Occy ~oad
Occy Group
x
1f:7/ Value
,
Zone
Fi re Zone
x
Value
Value
TOT^L VALUATION
Flood Plain
Stories
x
BUILDIIIG PER/lIT
Charges an~
Surcharges
Plan Ck,
65%/Bldo
------------ "Piiin Ck.
30%lBl do
I Fence
I D~mo
(0.00 I Sidewalk
---------;7;;::::.
. ~U lAIC Pavi ng
I Curb Cut
------------1
Conm/Ind
Ppr Fpp
Res
Per Fee
syste,ms Development
Charoe O.5~) ,
PLUI1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
I TOTAL
IV~ fo
~
..
.'
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
II oj 43
2, example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
1. examole- heat/electrical ceilinq/or forced air QdS
2. examole- waterheater/electrica)/or solar
E. Square footage or valuation, etc. -
1. examole~ 1250 sq. foot house. 500 sq. foot garage
2. exampJe- if new project. check-new - if addition,
cneck add. etc.
F. ,Building pennit information:
1. examole - construct single family house with an
a ttached garage
2. examole ~ remodel existing garage into family room
3. exam~le - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (aJ of the
Structural Specialty Code
H, DESIGN TEAM ANO 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. ~xcept 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
Z. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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 be used as
a worksheet only, Where possible, Building Oivision 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.
, ~
~iP~
f81D rg<;
lfY \
V. FOR OFFICE USE ONLY
Permit Clerk
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Informati9n:
;'
'-
PLANS REVIEWED BY:
name
signature
date
,
,
.