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HomeMy WebLinkAboutPermit Electrical 1990-5-30 1 m~~mON L1r1E , COMBlllm6NU~p~m~m~7~ERI:ri ~ ~ ~~~~~;IO!i LWt J;;'b Address 1()L1>'~ IDLf {Q n~' ..i.A -= ~~~~GY SOURCES:\-J ;~:~~~: ~~~~ss. 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