HomeMy WebLinkAboutPermit Electrical 1988-11-14
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jINSPECTION liNE CITY UF SPRINGFIELD ~., INFOID1ATION LINt
',. 726-3769 COMBINATION APPLICATION/PERMIT 726-3753
--:JOb Address 1'17/3 /Jt,.,A _~t;..<t>Qr I ~~;~GY SOURCES: ~~: ~;~: ~~~~ss.
legal Oe,cription "'_<" ~A'....l._ / _ ~_~_ ~~-kHater Heater Sq. Ftg. Other
I--'V.., "h.T>= "-A_~T.7-r Ilew Add Alter Pep.
<": ' /2. /.' ~ /'ll Range_ - Fence_Oemo_Change/Use
'~....,~...... 41.' (./~'7:'iI* I ValuE of Hork: _Other
Owner ...~ Ah.,.liah!!,d
- D ':t BUllciina Penmt Info: Describe Work{l.e.. Build Single
Address 1.1{ !?..i8'.s.tIJ.d:..~"n....M_" p onetbzo_/'C ~Fami1v Re,idence \~ith Attached Garaae)
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k~.../J$"'e.j" I"J....... 9'Yf.) .5"
Construction Lender
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Address
Ut~ll.iN ItAr~
(name)
Phone
(address)
flies. no.)
(exnirec;)
(ohOl'H~ no.
Il
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Primary
Electrical
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Structura 1
Mechanical
CONTRACTORS
{name}
(address)
f1 ir:<:.. nn.)
(pYn;rtl~'
(nhnn,. nn \
General
Plumbina
Electrical~'r _<;'i!2;-the..-e Be.c:....
~1echanical
NO.
FEF fHARGE NO
'h!!.YAJ,E. /22AJ R---r"'..eI. O~. 9U...rO~9'-"7~ D
. $-/55c...... /oj~/B-f
ElECTRICAtID6t1.1'l,3 MECHANICAL
~n' rl-l.o\RGf. ~ ct"~
Residence of
PlUl1B I NG
Each Single fixture
SQ. FT.
furnace/burner to
BTU' 5
Relocated building
(new fix. additional)
New circuits alts.
.QJ; e~ten~ons l?~
7,./-,0 ~~
,
SERVICES
/(
t!>C
-
Floor furnace
and vent
S.F. Residence
(1 bath)
IOuPlex (1 bath)
IAdditional bath
\ola ter serv; ce
Recessed wall
~D~~P hPntpr nnrl vpnt
each
Storm Sewer
I
I
I
I
I
I
Of
amps.
Appliance vent
o;.eOnr"ltp
Stationary evap.
(':('lnlpl"
Vent' fan with
sino 1 educt
Vent system apart from I
hP.:'ltil1q or A.C.
I Mechanical exhaust
hood and dud
Sewer
Temporary Construction
Change in existing
rp$.irip}lrp
Imultifamily, comm. or
Tndllc:trial
COMI.I./lNO. FEEDERS
I Install/alter/relocate
riic:,tl"ih.. fp""'1"'''c:
10f
I
I
I
Wood stove/heater
amps.
ISSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I
WHERE STATE L'\H REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this peliilit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 herein, and that UO OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 complian~e with OP.S 7nl.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Tvpe/Canst.
Bedrooms
Stories
[1,,-I'-;:>eMt~_ ..H_SI"IIATURE~-~"4""'~~
FOr. OFF I CE USE Grll Y r/
Sq. Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
Units
Occy load
Occy Group
DATE Ilb'l/8~'
-. ~
IWIE(please print)~u
,
x
Value
Value
Value
x
x
TOTAL VALUATION
BUilDING PERIIIT Plan Ck. COIllll/l nd
Charges and 65%1Bldo PJ'r F~~
Surcharges ------------ Plan Ck. Res
30%/Bldo Per Fee
PlU!~B ING PERMIT Fence
Char:ges and....... ------------
Surcha rges O~mo
ELECTRICAL PERIHT --hJ.{_~__ Sidewalk
Charges and '-'\
Surcharges . 'If' _ A/C Paving
<- MECHANICAL PERMIT ---
Curb Cut
Charges and ------------
Surcharges 'I ---' /II!
syste.ms Development
CharQe tl.5~) .
I
I
I
!Total Comb. Permit
I
I TOTAL
/5.t!J'7S"
.
.
'~
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example. Tax Lot 100. Lane County Map Reference
17 03 43 ,
2. exa~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ{or forced air Qas
2. examole- waterheater/electrica (lor 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 gar~ge
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 Oivision
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 .
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. ---
Ill. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building ~ivision 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
,
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.,
'. .
\ d-6'lf
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Permit Cl erk
(J f/
Permit appl i cant exempt .from reg.istrati on with the Bu'i.l der' s Board because:
Additional Project Information:
'.
PLANS REVIEWED BY:
. name
signature
date