HomeMy WebLinkAboutPermit Electrical 1990-5-16
CITY Uf SPRINGFIElD
COMBINATION APPlICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range_
ValuE of Work: ", (1 r$.//
~&:'''''''. -~ if ./ .
BuiloinQ Permit Info: Describe Work(i.e..
Family nesidence With Attached Garaae)
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(lies. no.) (exoiresl
jlNSPECTION lINE
726-3769
-
-
Job Address 1001 rot) j'rI\.j .$,."
legal Oescription \V)D~~l6?i\ [)4?{Y)
Owner.. ~~, ~l~~ I
Address 31() ~" I'h.o.i iY\.J YYl ort LrArl J
u
Phone
Construction lender
Address
DESIGN IEAH
Phone
(address)
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addres!d
(lin. no.)
General
d~2)
INFORllATION liNt
726-3753
Sq. Ftg. flain
~q. Ftg. Access.
Sq. Ft9. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other- -
~
~
N
I\JJ
6uild Single
(ahone no. J
*-
(exoire~) (ohnnp nn. \
Plumbina
Electrical c.t~ P~lr~1/~/4--..Jo.1Hj.\JI..J.p.~.q.'1417 1-D-,4Q, ID-l-QO
~'echani ca 1
PlUllBI NG
ElECTRICAl
FEE .. CHARGE Nn 'TI- J:IlARli[ NO"
Residence of
SQ. FT.
New circuits alts.
..--- or extensions
-:> d>~ ~./J'e ~<;;:>
SERVICEd 4J\o"~ ~ \
I .... ~J.~ S) ~
To #00 ~A4'
Temporary Construction
Change in existing
re~jq~.nce
multifamily, COITl'n. or
Tnrtllc;.tria1
Of amps,
COMH./IND. FEEDERS
Install/alter/relocate
di~trib. fppdpr~
).. Of ~() amps. J>~ 30<;'-
NO.
Each single fixture
Relocated building ~
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
1t./.U?.3fD
MECHANICAl
..EEL J:IlARli[
furnace/burner to
6TU's
Floor furnace
and vent
Recessed wall
S~~rp hp~tpr ~nrl vpnt
Appliance vent
~eoarat2
Stationary evap.
cooler
Vent fan with
5ino12 duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnod and duct
Wood stove/heater
TOTAl CHARGES
WHERE STATE l~W REQUIRES
shall not be vali1 until the
TOTAl CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRllIT
/C'5:.~6 TOTAl CHARGES
'Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all ~nformation 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 UO OCCUPAr~CY 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 ORS 7Q1.055 will be used on this project.
SIGIIATUR/;::) ~~
FOR OFFICE USEf~ J'
Sq. Ftg. Hair. "l(
Sq. Ftg. Access x
Sq. Ftg. Other x
IW1E(please print)Oy-v/I{~
! Tty.v
Zone
Tyoe/Const.
Bedrooms
Stories.
Units
Occy load
Occy Group
Fire Zone
Flood Plain
6UIlDING PERMIT
Charges and
Surcharges
. Plan Ck. Conm/Ind
65%/Blda Ppr Fpp
------------ Plan Ck. R-es
30X/BldQ Per Fee
Fence
PlUt~BING PERMIT
Charges and
Surcha rges
Demo
_ _~(~:E::::'_Sjd"walk
1-1 5 '::?S A/C Paving
ElECTRICAl PERInI
Charges and
Surcha rges
MECHANICAl PERMIT
Charges and
Surcharges
Curb Cut
DATE ~/;(I9'tI
,
Value
Value.
Value
TOTAl VAlUATION
.Systems Development ,.
Charoe (I.5~)
Total Comb. Permit
TOTAl
(/0, ;:..s--
-
,
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I
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
Ill.
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
spr1ngtield Estates
C. -Name, etc:'of owner and construction lender'
D. . Energy. Sou,fees " .'
1. exam~le. heat/electrical ceilinqlor forced air gas
2. examy Ie., waterheater/etectrlca liar ~
E. Square footage or valuation. etc. .
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. exam~le- if new project. check-new - if addition,
Check add. etc.
F. Building pennit infonnation:
1. example - construct single family house with an
attached garage .
2. example - remodel existing garage into family room
3. exam)>le - 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
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 penmit 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. BUILOING OIVISION 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. ---
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 penmit 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 Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.Pennit applicant exempt from registration with the Build~r's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date