HomeMy WebLinkAboutPermit Electrical 1988-1-7
INFORl1ATlON liNt
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Job Address I Lf <-I 'X )Yt 1 f':'" ~ll f .
Legal Description <:::t-i 4. ,i;) if A .~,
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I INSPECTION LINE
726-3769
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
l~ater Heater
Range
Value of Work:
-JJ I. '500
Builcilnq Pennit Info: Describe Work{i..e.,
Familv Residence With Attached Garaael
Owner lC1~ U).')/D/V1~
Address ']~7U? ~ i-.r
Construction renYer
Phone
I-j'fl- 084~
Address
DESIGN TEAr.,
(name)
Phone
(address)
i Primary
Structural
/1., I - I' '1 O~I
C-'-l~, jJ .....
Electrical
Mechanical
CONTRACTORS
\/1 I
(name)
(addr~ss)
(1 ir<o.. no.)
(pxnires1
Genera 1
Plumbina
Electrical
(y~ rPn~
"';>"'3 ~ ! J/c.
44ct9~(J 4'*t
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TOTAL CHARGES TOTAL CHARGES .:3 7. .,-0 ~ TOTAL CHARGES
WHERE STATE l;\l<l REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of "this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
~1echanical
PlUf.lBING
ELECTRICAL
MECHANICAL
NO.
FEE
FHARr,E
Il(L
>>>
r~M.G..E. Nn
Each single fixture
Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated buildin9
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath)
jAdditional bath
I ~Iater service
I Sewer
SERVICES
Recessed wall
SI'l,:lf"P nPiltp.,. ;lr'lrl 1fpnt
each
lTemporary Construction
IChange in existing
rps j d.;::nrp'
Imultifamily. comm. or
, Tnrlllc:trial
Appliance vent
spn"r;ttp
Stationary evap.
cooler
Vent fan wi th
5 i nn 1 P rlllct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood and dud
Storm Sewer
IDf
ICD~1./IND. FEEDERS
l'Install/alter/relocate
rtic;t_rih. fpprlprc:
IOf ~ 0 n
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ISSUANCE OF PFRrlIT
amps.1
'--\7\
amps.
~.
Wood stove/heater
.~
,
(ohnnp nn.)
1.H.L..GllAIlliE.
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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 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 NO 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 701.055 will be used on this project.
IlA/o1E(please print)./../.4",~<.. L- ~~(
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SIGNATURE ~.~. _
FOr. OFFICE USE OIIL Y /
Sq. Ftg. t1ain
Sq. Ftg. Access
Sq. Ftg. Other
x
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy load
Occy Graup
x
x
Value
Value
Value
TOTAL VALUATION
BUilDING PERfllT
Charges and
Surcharges
. Plan Ck.
____________ 65%/Bldo
Plan Ck.
30%/Bldo
I Fence
I D~mo
_ __..3..1..?.Q. ___ISidewillk
) . ~g I A/C Paving
j Curb Cut
I
syste.rns Development
Charoe (1.5~) .
COll111/1nd
Ppr Fpp
R"es
Per Fee
Plur~BING PERMIT
Charges and
Surcharges
/ /
ELECTRICAL PERrllT
Charges and , .\
Surcharges v
eL. LLJ . '2.0
4t.- /0"1/ C-
Total Comb. Permit I
f.lECHANICAl PERMIT
Charges and
Surcharges
I TOTAL 39. 52S
.
r-~
=
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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. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinCl/or forced air Qas
2. exam~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check-nfw - if addition,
check. add, etc.
f. Building permit information:
1. examele - construct single family house with an
attached garage
2. example - 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
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. ---
III. Applicant to sign and date
Whenever possible, the initial application will b~ 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:
..
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PERMIT VALIDATION
Permit C1 erk
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O1fo1
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date