HomeMy WebLinkAboutPermit Electrical 1990-5-30
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legal De,cription I ( . ~':J 7--11 \ ! i'''(") Hater Heater Sq. Ftg. Other
\ '---^- ., \.. Ji '-'\\ I Ilew Add Alter Pep.
Range_ -Fence Demo Change/Use
owner~' . rt (\j\\\ \)(\b ()}~d111\.O.t)u< of \"or~'~) Other-
\~)' tnn f-i/mlfl t v\ } \ BU11Gina Penuit Ilfo: Describe Work{;..e., Build Single
Addres~ Ii I ~(.-J .A/l 0-14;, Fam~Y Residence lith AttaCohed Ga~aoe). . \
Constructi~n l~nJer I '. ,l ~ H:1::iUJ'Ot UIU nili,
Address Phone \
UI:.::dI.:iN TE.Af1 (name) (addressl (lics. 'no.l (exoirps) {ohane no.
n
o
~
o
Primary
.~
Al
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address 1
(1;c~.no_)
(e.xn;rl;'<;)
(nhone no.)
Genera 1
Pl umb; na
Electrica) (~\\~~. r U Q H
,.Qf\~ V11~ urn Oil }:~. ~ \.D ~ld-{f) ~ ll.4p \ ~I~
- r\ ~los4S. 1-4\ ~6)~~ In
~1echanical
Plur,iBING
ELECTRICAL
MECHANICAL
NO.
FEE . CHARGE 'fll
.....E.E.L JJiA&liE. Nn
~~I=' rUllRGf
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building .
(new fix. additional)
I \
New circuits alts.
or extensions
\'S.~1\6<f)
Floor furnace
and vent
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tp~ ~nrl vpnt
Storm Sewer
Of
amps.
Appl iance- vent
~po~riltp
Stationaryevap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilod duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re!jidencp'
multifamily, COITm. or
Indus.trial
Water service
CO~1./IND. FEEDERS
Install/alter/relocate
distrib. fppdl"rc;.
Of
amps.:
TOTAL CHARGES
WHERE STATE lAH REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANCF nF PFRrilT
~ o'S Cf:. TOTAL CHARGES
that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pernit
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 oerfonmed 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 NO OCCUPAIlCY 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 'ORS 7Ql.055 will be used on this project. ,
UAt1E(please print) ~o;,""'4 G i1. II leI< SIGUATVRE ~.~
..
FOr. OFFICE USE OULY ( I
Zonl;' Type/Canst. Uni ts Sq. Ftg. r1ain
Fi re Zone Bed rooms Occy Load Sq. Ft~. Access
Flood Plain Stories. Occ,Y Group Sq. Ftg. Other
.h~
DATES--30-'lO
x
Value
Value.
Value
x
x
TOTAL VAlUATlOII
BUILDING PWlIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65'-'/Bldo Ppr Fpe
------------ Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Char~e (!.5~)
PlUt1BIrlG PERMIT
Charges and
Surcharges
D~mo
jLlQ.'~~ Sidewalk
"?<- ,QS . A/C Pavi ng
Total Comb. Permit
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
I 13.d5
.
\
,
"
.. .
I....! I
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALI~ATION
I. Applicant. to furnish
A. Job Address
B. legal Description I
1. example- Tax lot 100, Lane County Map Reference
Jl oj 43
2. example- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources ' :
'I. example- heat/electrical ce;l;n~/or forced air qas
2. examyle~ waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
.2. example- if new project. check:mew - if addition.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examEle - remodel existing garage into family room
3. examjJle - 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. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
~ivision 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 be~n 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.
/7:200
S -<n-7Q
V. FOR OFFICE USE ONLY
Cl"k&~_
./
Permit
PROJECT CONOITIONS TO BE SATISFIED 8EFORE OCCUPANCY:
I
Permit applicant exempt.from registration with the Builder's Board because:
Additional Project Information:
,
PLANS REVIEWED BY:
'-
name
signature
date