HomeMy WebLinkAboutPermit Electrical 1989-11-28
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I INSPECTION LINE
726-3769
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COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of Hork:
.
I NFDRlIATlDN LI No
726-3763
Sq, Ftg. Main
~q. Ftg. "Access.
Sq. Ftg. Other
Ilew Add Alter P.ep.
-Fence Oemo Change/Use
Other- -
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Job Address
Owner
Address
Phone
BuildinQ Permit Info: Oeser be Work(i.e.. Build Single
Familv nesidence With Attached Gara~e~
--rj J'ViI,O, .Ill /J ./l hj (U.J-. ('// fJ..u ).
vJ15Y Y-mt<.r mL JOt-,
Cons truct i on lender '. .
Address
OESI~N TEAl1
(namel
Phone
(address 1
,
(lies. no.)
(exoiresl (Dhone no.
*
~
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address'
(l in.. no.'
(pxnirp~'
(nhoop on. ,
Pl umbi no
;If) .:b
Genera 1
Electrical
~'echani ca 1
PlUlm 1 NG
ELECTRICAL
MECHANICAL
NO.
FEE JdjARGF Nn
r~~ 'r~~Qr.~ NO
HI=' rl-l~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of.
Relocated bui1din9
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Residence
11 bath \
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
<;I);U'P hp;lotpr ;lo,lri ....pnt
Storm Sewer
Of
amps.
Appliance vent
s~oarate
Stationary evap.
cooler
Vent fan wi th
sin~:lle duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood tlnd dud
Wood stove/heater
Sewer
Temporary Construction
Change in existing
r~ll j dr_nc~
multifamily. comm. or
Tndustri.11
Wa ter servi ce
CO~1./INO. FEEDERS
Install/alter/relocate
dishib. feedPrs
Of
amps.
ISSIJANCF OF PFR!IIT
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be va1i1 until the
TOTAL CHARGES TOTAL CHARGES
,
that tile Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
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 UO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration \'lith 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 7nl.055 will be used on this project.
IWIE(please print) -:v k iR.i..l-cl-
/-I.....c../cJ-,Ud..r SIGIIATURE A e;\ H.trjl'-f-l.~~r OATE_Ll!.'?I!tll
FOP. OffICE USE DIlLY' I j
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
Sq. Ftg. t1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
TOTAL V AlUA TI ON
-S~stems Deve10pment ,
C arge (1. 5~ .
BU I lO I NG PERI-lIT
Charges and
Surcharges
. Plan Ck. Conm/lnd
____________ ~/81da Per Fpp
Plan Ck. lies
30X'B1dQ Per Fee
Fence
PlUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlm
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
/5,00
---6O'j{) ,16
O~o.
.Sldewa 1 k
A/C Pavin9
Curb Cut
Total Comb. rermit
TOTAL
/67fJ
I'
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COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exa~le- heat/electrical ceil inn/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examDle- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building pennit information:
1. examole - 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. DESIGN TEAN AND CONTRACTORS
To avoid design or construction de1uys. 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
8. 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
.0. 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
S i goa ture.
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. FDR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additianal Project Information:
PLANS REVIEWED BY:
name
signature
date