HomeMy WebLinkAboutPermit Electrical 1982-12-13
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BuilolnQ Permit Info: Descr1be \~ork{1.e" Build Single I
Family l1esidence \Jith Attached Garaoe)
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726- 37 69
CITY OF SPRIIIGFIELD
COMBInATIOII APPLlCATIOlI/PERMn
EIIERGY SOURCES:
Heat
Hater Heater
Job Address //'6 'i5 M A ) A.I <; ?"c.t=>
I.egal Description n ~h&"\ ~ ()lJ!rrf)f)O
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Range
ValuE of Hork:
INFORlIATION LINt
726-37S3
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add A I ter Pep.
-Fence Demo Change/Use
-Other - -
Owner E P B r /1/ AI ~ r r
Address$5,;?o.sv.N'..5 G"T S'PFD
Phone _~;'
~ Y." '" ",0
E,Lec..T
Construction Lender
Address
DtSIGN ItAf1
(name)
Phone
f address 1
(l ics. no.)
(exo; res)
(ohone no. J
Primary
-~L
AT-
.,
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no. \
(pxo;rec;.)
(ohane no.)
Genera 1
Plumbino
Electrical < 1/ /\/ L n 7> DEL G" c. r-
;; b.J L (; V... L 5P"cEj dO -/..0..2 C.
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7.ilit i'f!:OO
~lechan; ca 1
PLUIIBING
ELECTRICAL
MECHANICAL
NO.1
lEaCh single fixture
IRelocated building
(new fix. additional)
IS. F. Res i dence
(1 bath)
IDuplex (1 bath) each
IAdditional bath
~Iater service
I FEf7 I f.HARt;F
Nn '
I r:n- I rI-lAR~J: NO. I
I r:r:r I nlAR~r
Residence of
SQ. FT.
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
';'J:
Recessed wall
Snn~p hPntpr nnd vpnt
Sewer
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TOTAL CHARGES _2 In. l!)'U TOTAL CHARGES
that the Electrical work be done by an.-[lectrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Iremporary Construction
I'Change in existing
rP5- i r!pnrp .
Imultifamily, comm. or
Indu"trial
Storm Sewer
10f
ICOf~1./IND. FEEDERS
I Install/alter/relocate
rlic:.trih fpprlprc:.
10f
I
I
I
amps.
Appliance vent
"FlOaratp
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart
heatinq or A.C.
Mechanical exhaust
hnnd and dud
from
Wood stove/heater
amps.
ISSUANCE OF PFR!IIT
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be val;~ until the
I HAVE CAREFUllY EXM11NED the completed aprl;cation for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work performed 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 OCCUPAHCY 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 7Ql.055 will be used on this project.
I~AI.\E(please print) R .. 10-'1.. r" k
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SIGIIATURE?~cr/'/
om /'L/J'<k."-
FO~ OFFICE USE OI~L Y
Zone Tyoe/Const. Units Sq. Ftg. 11ain
Fire Zone Bedrooms Occy Load Sq. Ftg. Access
Flood Plain Stories Dcc.y Group Sq_ Ftg. Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________....Q.2!/Bldo Per Fee
Plan Ck. Res
30%lBlda Per Fee
Fence
Systems Development
Charae (1.5%)
PLU'1BING PERMIT
Charges and
Surcharges
Demo
I
I
I
ITotal Comb. Permit
I
I TOTAL
c%o~
ELECTRICAL PERI~IT
Cha rges and
Surcharges
_ -.d_S_,~ _?._ ___Sidewalk
1.00 I A/C Paving
Curb Cut
f1ECHAN I CAL PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. lega 1 Oeser; pt i on
1. example. Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheaterielectrical/or solar
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyle - 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 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 DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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. ---
Ill. 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.
V. FOR OFFICE USE ONLY
Permit Clerk
.
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
PLANS REVIEWED BY:
name
signature
. date
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