HomeMy WebLinkAboutPermit Electrical 1990-2-23
, ,
I INSPECTION LINE
726-3769
.
Job Address /4f)q Mt/1hV SOJd. ,.
Legal Description l!./()~~~-VlJ :::~,A)(J11Ol-
CITY Uf SPRiNGfIELD
COMBINATION APPLICATiON/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
-
v,J,oO
, '0"
INfORllATION liNe I
726-3753 . ~
Sq. ftg. '-lain - .
~q. Ftg. Access. 8
Sq. Ftg. Other
-.!le,,_Add_Al ter -!qep.
__Fence_Demo_Change/Use r-\~
_Other l.L/
6
Owner A I ~e-vvV'-
Address ~
ValuE of Hork:
Phone
BuilGinQ Permit Info: Describe Work{i~e.. Build Single
Familv nesidence With Attached Garaael
Address
Ot.~lljN TEAl1
(name)
Phone
(address)
IJ ~ Qt~;~ I tC~
~
"~
(ohone no.'\
Construction lender
Primary
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(address)
(1;1""- nn.1
(p'l(l)irpc::;\
(I)hnnp no. \
Genera 1
Electrical
~~/fnW / Plu' /,'V)$
, ,
a/7.0 Ke~c::M..; I.a.M..L-
E..I et;;!v i c,.... :?){) -I '"FI e-
If) !&t 0
fdtZ ItJ 1(,)
Plumbina
~1echani ca 1
PLUilBI NG
ELECTRICAL
r"A.r.rl NO
MECHANICAL
NO.
FEF CHARGF NO
rrr
For I r"A'lG.E..
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU'S
Relocated building
(new fix. additional)
New circuits alts.
Il!:OO ,"1'"
or extensions '1-.._ . + v ,(/
, I c.\fl.U. .
SERVICES
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance- vent
seoarilt~
Stationary evap.
cool~r
Vent fan with
sinale duct
Veni system apart from
heatina or A.C.
Mechanical exhaust
hood and durt.
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp~ j riPpre
multifamily, camm. or
lnrluc;trial
Water service
CO~1./IND. FEEDERS
Install/alter/relocate
rlic::trih_ fpprlpro::
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\l/ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
. ~ I.....~ ISSUANCf OF PFRfllT
l"!~:;) TOTAL CHARGES
Ele' ntractor, the electrical portion of this
Supervisor and returned to the Building Division
permit
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 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 rf!in, and..... t uo OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further eel'" . y t~at my/regi ation with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt t basi,'for/exe 9 is noted hereon, and t~at
only subcontractors ~.~~p:ees~: a;~n_~:Pliance with ORS 701.055 will e ,us~ ?:~ /JJect.
IlAl'iE(please print) Vf.A Vtu "/171.. SIGrIATURE_~' /4- ~ DATE
, FOR OFFICE USEO~ I'
Tyoe/Const. Units Sa. Ftg. rlafn
Bedrooms Occy load Sq. Ft~. Access
Stories Occy Group Sq. Ftg. Other
Zone
x
Value
Value
Value
Fire Zone
Flood Plain
x
x
TOTAL V ALUA TI ON
BUILDIIIG PERflIT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fee
------------ Plan Ck. R-es
30%/Bld. Per Fee
Fence
Systems Development
Charae (1.5~)
PLU'~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
_15~~
"S
DeAlO
Sidewalk
A/C Paving
I Curb Cut
I
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
.'\D'~'
-
.- -:. ...
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. exam)'le- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examDl~- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater{electrical/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house, SOD sq. foot garage
2. examjple- if new project, check-nfw - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. example - 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 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
-
PERMIT VALIDATION
"d3'9Q
tr,l \Dw
(f}1)
Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
. date