HomeMy WebLinkAboutPermit Electrical 1986-6-13
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----crrV OF SPRfNGFiELO
COHBINATION APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
Water Heater
Ranqe
ValuE of Work:
/t)oo-""-
Buildina Permit Info: Oeser.be Work(;~e., Build Single
Familv-nesidence With Attached Ctaraael
INfOR/lATlO" loiN. ~
726-3753
Sq. Ftg. Hain_
~q. Ftg. . Access. .
Sq. Ftg. OtI1er
new Add Alter Rep.
-Fence Demo Change/Use
Other- -
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, INSPECTION LINE
! 726-3769
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Job Address 11'95"" M~..;",..sr.'
Legal Description I? oJ :J$' ~.. /'
Owner. /111. . M(I('.'N~1.,J
Addre.. ~8'
[ c,y,...t,
E 10"-4
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c:l v..
Phone.
<; ?~t)/
r<l...t:(! ..T cC;
< ._~~of'1;
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I'D"'" ,AJf!...:I (. ",Jc.~~.,.<<
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Construction lender
Address
U.~IGN IEAli
.\'. Primary
(name)
Phone
f"ttdressl
J'"" :;';'Pr~ h'(~ w~I.It":-'
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. ~--I . ~_c, /Q..c.rc_.'
tlies. nn , fpxoirp~'
c:.rS'V~,- c...V'~...+
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(t')h~"~ "'"
Structural
Electrical
Af.
'~bl
_~P-
Hechanical
CONTRACTORS
(namel
faddrpsc:;l
(lire:., nn
(pvnirpc:.l fnhnnp nn
G......] D.utt. !; -f-JJ
'10..> N....... 91 IV ~"..,_ ~""'o,
6~')":<'JJ
Plumbina
A./ tJ....., <..
Electrical c.r-S t: fe~,
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C-3o-8'?
3~~.z::zJC
~techan1cal
PLUflBING
ELECTRICAL
HECHANICAL
~I
Each Single fixture
I HI=' I rHARr"F ~n . nr . r1:iAB!iE. ..l[l
Residence of furnace/burner to
SQ. FT. BTU's
t't't' ru~
..
Relocated building
(new fi.. additional)
S.F. Residence
(1 hathl
Duple. (1 bath) each
Additional bath
-'" New circuits alts.
O~~Sions .
SERVICES
ISee
Floor furnace
and vent
Recessed wa 11
~~~rp ~patpp aft~ UPftt
Storm Sewer
O~
amps,
Appliance vent
SPl)aratp
S-tationary evap.
cooler
iient fan wi th
o;:inole duct
Vent system apart
heatlno or A.C.
Mechanlcal exhaust
hnnd ..nd rtur:t
from
Hater servi ce
Sewer
Temporary Construction
Change in existing
rps- j dj"Ju'p
multifamily, camm. or
rnrtuc:.trbl
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be vali1 until the
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I ISSUANCE OF PFRllIT
TOTAL CHARGES /5': alJ TOTAL CHARGES M/N. /,.:'5: -
that the Electrical work be done by an..Electrical Contractor. the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building qivision
COHM./IND. FEEDERS
Install/alter/relocate
rli~tr;h fpp~prc
Wood stove/heater
Of
amps.
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1lv"A4:k ~ ~@ ~
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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 Derfonmed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore~on pertaining to the work described herein, and that 110 OCCUPAIICV will be made
of any structure without the permission of the Building Division. [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 ORS 701.055 will ~ used on this project.
IIAl.tE(please print) j(~,R~r.-<. ~ <.as
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SIGNATURE d~-:::~;L
OATrb -)3 -~I
Zone L:.C
Fire Zone
Flood Plain
hpe/Const.
Bedrooms
Stories
~N
Units
Occy Load
Occy Group
F0~ OfFICE n~~ 01lLV
Sq. Ftg. !lain . Value
Sq. Ftg. Access 2t!!Jt:>"". Value /~, 00
Sq. Ftg. Other . Value
, ... TOTAL VALUATION
tl.-;;;t~. '':'''?i~s Uevelopment 01'/ A
'i1 "i2~?' Cha....e t1.5~) . /?f ".. .
ELECTRICAL PERlm
Charges and
Surcharges
HECHANICAL PERHlr
Charges and
Surcharges
'/99'0
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BUILDING PER/otlT
Charges and
Surcharges
L1? ~O Plan Ck.. Conm/lnd
___ '1.:~~__ 65'.C{~1r'':' P".r ~A.
"?o Plan Ck. Res
. ~, ~~~/Bldo P~r ~~~
Fence
PLUMBING PERMIT
Charges and
Surcha rges
Dotno
____Is: ~'ISideWa1k
.60 lAIc Pavin9
_.;.._L~_~_I Curb Cut.
,00 I .
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ITotal Comb.. Permit
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIT VALIDATION
"f".'J
I. Applicant to furnish ". _'00'.< "
A. Job Address .. ,
B. Legal Description
1. examp.le- Tax Lot 100, Lane County Map Reference
II UJ 4J
2. examele- Lot I. Block 3. 2nd Addition to
5prlngtleld Estates
Cv Name. etcv of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electricalJor solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500'sq. foot garage
2. example- if new project, check~.- if addition,
cneck add, etc.
F. Building penmit information: ,
1. examole - construct Single family house with an
attached garage . ,'.
2. examole - remodel existing garag~ into family room
3. examole - 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 infonmation 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 fonm 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 0lV1SION STAFF WILL FILL OUT ALL FEES AND .
CHARGES ON THE SCHEDULES
O. 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. ---
111. 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.
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V. FOR OFFICE USE ONLY
Pennit Cl erk .
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PROJECT CONDITIONS. TO BE SATISFIED BEFORE OCCUPANCY:
Pennit applicant exempt from registration with the Builder's Board because:
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Additional. Project Infonnation:
PLANS REVIEWED BY:'
name..L-t:::'fl~~ "12:::.z:::/T signature" &
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date b,:2 5"~
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