HomeMy WebLinkAboutPermit Electrical 1984-1-5
I. IrISPECTION LINE
)726-3769
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CITY UF SPRINGFIELD
COMBltIATION APPLICATION/PERMIT
I E!IERGY SOURCES:
Heat
I t-later Heater
, Ran~e
~ ValuE of Hark:
?"'V BuilriinQ Pennit Info: Describe Work(Le..
Phone 1f><f,...1?K' ~Fami1v l1es;dence Hith JI..ttached Garaael
?~;.J} rR~-
~ 0 ,., ~-~r -
Legal
Ilii ~
OescriPtionh ()~?--, Cft-\
Job Address
~\2, ' ,,- -
Owner ~vy....,LL..
Address \.2 l <6 tU,
~~tf
1'<. "...... .sA
Construction lender
Address
Ut)lliN IE:.Ar.,
(name)
Phone
(address)
Primary
Structural
Electr;clll
Mechanical
CONTRACTORS
(name)
(addrp~~)
Genera 1
Plumbino
Electrical -- ~ -
~1echanical
PLUIIBING
ELECTRICAL
NO. I
I FFF I r.HARr.f ~n I
Each single fixture
Residence of
SQ, FT.
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
SERVICES
ITemporary Construction
IChange in existing
fPsirlJ'J'Irp
Imultifamily, COITlTl. or
Tndud.r;al
10f amps,l
ICOMM./IND, FEEDERS
I Install/alter/relocate
d;dr;h. fppdpr<;.
Of ~~ amp~1
~Iater service
Sewer
Storm Sewer
<f--!b
(lies. no.)
(lit'<;., nn.)
1 ~n' . rl-1J1RG.E. NO
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INFOR/IATION LINt .1
726-37S3
Sq, Ftg, 1,Iain
:q. Ftg. Access.
Sq, Ftg, Other
Ilew Add A Iter Rep,
--Fence Demo Change/Use
,I Other-- --
C)()
-t:::.
CJ
CJ
CJ
oQ.
Build Single
..]o.l~-" .
v
(exoires) (ohane no.,
wL
-~
(exn;re~) (ohnnp nn~)
MECHANICAL
I ~J:"~ I rl-lliR.G.E
furnace/burner to
BTU1 s
l
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nd vpnt
Appliance vent
<;.pn~rtltp
Stationary evap.
cooler
Vent fan with
sinol/'! dur:t.
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood tlnd riur:t
Wood stove/heater
ISSUANCE OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES 15. feD TOTAL CHARGES
WHERE STATE L,\\/ REQUIRES that the Electrical work be done by an,-Electrical Contractor, the electrical portion of this pemit
shall not be valiJ 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 oerformed 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 OCCUPAIKY 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 OP.S 701.055 will be used on this project.
IW1E(please print) W Jl.J..mWl C H cESWI A,N SIGIIATURE pct~.. ..
FOr. OFFICE USE DilLY
Zone Tvoe/Const, Units Sq. Ft~. f1ain
Fi re Zone Bedrooms Occy Load Sq, Ftg, Access
Flood Plain Stories Occy Group Sq. Ftg, Other
BUILDING PERMIT
Charges and
Surcharges
Plan Ck, Comm/lnd
65%/Rldn Per Fpp
------------ Plan Ck, Res
30%/Bldo Per Fee
Fence
PLUtiBING PERMIT
Charges and
Surcharges
Demo
'Sidew.l k
I AIC Paving
I Curb Cut
I
ELECTRICAL PERIHT
Cha rges and
Surcharges
_ __1 ?_._~.?___
,&0
11ECHAN I CAL PERMIT
Charges and
Surcharges
d.-.
DATE
/~s-8Y
,
x
Value
Value
Value
x
TOTAL V ALUA TI orl
Systems Development
Charoe (J.5~) ,
Ofl1 , .J...L 0
~O~..,'j B
''20
I
ITota'
I
I TOTAL
Comb. Permit
..$( -
I ::::., 2S"O
.
,
.
COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
11 oj 43
2. example- Lot I, Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house. 500 sq, foot garage
2. examp'le- if new project. check:ruew - if addition,
chee k add. etc.
F. Building permit information:
1. example - construct Single family house with an
attaChed garage
2. exam~le - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (chan'ge 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, 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 OIVISION 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. ---
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 penmit is issued.
t
III.
V, FOR OFFICE USE ONLY
PROJECT ,CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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.
P,mit CliiiflM!Jt;
1
Permit appl icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date