HomeMy WebLinkAboutPermit Electrical 1988-12-9
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63 t;tB <II
. CITY OF SPRINGFIELD
COtIBIIIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
t~a ter Hea ler
.
INFORI1ATION LINt
726-3753
Sq. Ftg. '.Iain
~q. Ft9. Access.
Sq. Ftg. Other
lie" Add A Her P.ep.
-Fence Demo Change/Use
Other - -
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(]
I INSPECTION LINE
726-3769
Job Address;J .1, 03
Legal Description 1'7
..s+.
DI / 0 6
Ran!"]e
ValUE of Hark:
IiwnerT",.x N "-.7') J). ,_..4-
Address ~~ J/ t() .:'iT h/s;T~ ,$
~tJ, ()f2 '77,;)./,
Phone
BuildinQ Permit Info: Describe Wor~:.(i.e.. Build Single
Family nesidence l'Ii th P.ttached r.araqe)
10 /7.eW eI ec..-h- /C:e' Q -
&('~~
Construction lender
Address
DESIGN TEA11
(nameJ
I'hone
{address \
Hechanical
CONTRACTORS
(namel
(addrl~SS ,
.
fl ics. no. \ (exnires) (nhonP. no. l
// I? I /l"- _ CI., 'D C
11/ IJ - I -, ..>
(1 i cs. no. ) (exoiresl (ohane no. \
Primary
Structural
Electrical
Genera 1
PlumbinQ
Electrical
? ;::;- ~ I' /)
PDEoy }/5'{~q Ol>~""r{ ~b-..6,g)(c..
;;} 5< ;5;>-'7 :>:0.. \
~lechanical
PLUI1BlNG
ELECTRICAL
FEF cllARGF ~n
Residence of
SQ. FT.
.b New circuits alts.
or extensions
SERVICES
MECIlANICAL
NO.1
-----lEach single fixture
Relocated building
(new fix, additional)
S,F. Residence
(1 bath1
Duplex (1 bath) each
FFF 1..c.HARliE.-1IP.
FeF
nJARGJ:
furnace/burner to
BTlI's
dB
Floor furnace
and vent
Reces sed wa 11
~n~rp hp~tpr ~nrl vpnt
\)V'\
Temporary Construction
IChange in existing
rP."J rl!i:nce
Imultifamily, ConIn, or
TnrllJ"tri~l
I Of amps.
ICOffij./IND. FEEDERS
I Install/alter/relocate
rli"trio^ fpprlpr"
fOf amps.
I
Appliance vent
"po~ r~ te
Sta'tionaryevap.
cooler
Vent fan with
sinnle duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ~nd r1urt
Additional bath
~/ater service
Sewer
Storm Sewer
Vood stove/heater
ISSUANCF nF PFRlHT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l/ REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor. the electrical portion of this pe~it
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 nerformed shall be done in accordance with the Ordinances of the City
of Spri ng fie 1 d and the Laws of the Sta te of Oregon pe rta i n i n9 to the work descri bed herei n. and tha t He OCCUPAUCY wi 11 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 OP.S 7111.055 will be used on this rro,ject.
H~(~::;r:t~ 1--<1.1--01 "-"'- --s- Fk..sL 01';J,^. SIGI1ATlIRE.a.._~..-..:>~-- ll~.!EL2.':::3- '6 R
FOr. OFFICE USE bilLY l./
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occ,v Group
Sf!. Ftg. riain
Sq, Ft9, Access
Sq, Ftg, Other
x
Value
Value
Value
,
x
TOTAL VALUATIOtI
BUILDING PERfIIT
Charges anc
Surcharges
Plan Ck. Comm/lnd
65t/Rldo Ppr Fpp
------------ Plan Ck. R'es
30t/Bldn Per Fee
Fence
Syste~s Development
Cha rQe (1. 5%)
PLU'1BING PERMIT
Charges and
Surcharges
Demo
___X.:.Sit:.~_Sldewalk
/. 13 A/C Paving
Total Comb. Permit
ELECTR I CAL PERIHT
Charges and
Surcharges '-'\
/lECIlANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
cQ3. Go3
1---.
.
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Legal Description
1, example~ Tax Lot 100, Lane County Map Reference
11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or 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 garage
2. examele - 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 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.
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. ---
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.
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.
II.
I I I.
IV.
V,
FOR OFFICE USE ONLY
.
~
III
~
PERMIT VALIDATION
";'.'
...-E,ermi t Cl erk
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d- r:J.J~ lA.
f~q~l' 1Z.-/3-~-r;
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
DAVE KIMMEL
PRES/OENT
PLANS REVIEWED BY:
name
signature
PERMIT CONSULTING SERVICES INC.
122 S.E. 27111
Portland. OR 97214
(503) 236-6000
date