HomeMy WebLinkAboutPermit Electrical 1985-7-26
I- INSPECTION LIIIE ~ f, *. CITY OF SPRINGFIELD
1726-3769 (':%1 () /!J-V ~., fL" COMBIIIATION APPLICATION/PERMIT
Job Address _?/'~ /1 //.. . EnERGY SOURCES:
~"T v",... . _ ~ ,~\."5' Heat
Legal Description\)) l eGw. TY=.'Prv~ . llater Heater
Ranqe
ValuE. of Hark:
.
!
(? VA_
Owner <;p -fd.. ~/-/L>
Address f'/f)/I?/Ven t'1
~ t:. 12'-f/..J aE 0 L ,.u71 "I? C/
Construction Lender . ,. \1 '
<ILL .11
??fer>
BuilGinQ Permit Info: Describe Work{i.e'1 Build Single
Phone :?tIt..!~ Familv nesidence IHth A.ttached Garaoe)
INFORltATION L1N!:.
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other- -
(}.
~
In
a
1.1)
60
Address
OESIGNIEAI1
jO-Q ~ .{J!-An..u'~ /o-,u p~
~ ~ <( f~~ rj..t7).~
- flies. no.) ,(.exnireslj'5: r (ohone no.
Phone
(address)
Primary
(name)
/'l/o .;V e..,./
/Y"d I1/' e-/
1'.../1'1' J//ew
v
ei't /, 0
#.4Jj/Jj.",,", ect Z~-//J'c. 6-.:i~ .rf'(,
h/-/z,9.~
Structura 1
c-~e-D;L
Electrical
Mechanical
CONTRACTORS
(name)
(addrpss)
Genera 1
/V" /.1 /V -e..
;V 0 tv' -e....>
Plumbina
Electrical
~'echan; ca 1
/Ytl /V e.-
PLUflBING
ELECTRICAL
NO. .
FFF 1...Q!^Rr.F "n~
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
11 bath \
Duplex (1 bath)
New circuits alts.
or extensions
ISERVICES
each
Additional bath
I \4a tel'" servi ce
Sewer
ITemporary Construction
Change in existing
rp'i i dj"nl"'P
multifamily, comm. or
Industrial
Storm Sewer
IDf
ICO~1./IND. FEEDERS
I Install/alter/relocate
di~trih fppdpr~
IDf amps.1
I
I
I
100
amps.l
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\IJ REQUIRES that the Electrical work be done by an
shall not be va1ij until the label has been signed by an Electrical
n iC':~ nn.)
1O.EL1J:.liARG.E. _'In
J~.oC
I
I
I
I
1':5.~
I I
I
I
I
I
I I
3o.cvl
(plCoirp,,)
(I)hnnp nn \
MECHANICAL
furnace/burner to
BTU's
n~ ru~
Floor furnace
and vent
Recessed wall
Sn~l"'P hp~tpr ~nrl wpnt
Appliance vent
S@l)ijratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hond and dlJrt
Wood stove/heater
I SSUANCF OF PFR111T
TOTAL CHARGES
Electrical Contractor. the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1lNED 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 rlO 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 7Ql.055 will be used on this project.
.::"r //~fj-.Eh SIf,IIATUR~~~
FO~ OFFICE USE miL Y
Sn. Ftg. 11ain
Sq. Ft9. Access
Sq. Ftg. Other
f1Af.IE(please print) ?~t.P~
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILDING PWlIT
Charges anC:
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
------------ Plan Ck. Res
30%/Bl do Per Fee
Fence
PLU'1BING PERMIT
Charges and
Surcharges
I Demo
I Sidewalk
I A/C Paving
I Curb Cut
I
ELECTRICAL PERlm
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
__,,3.0./'10
J. ~o
DATEr~zi.-P.s- .
-
.
Value
Value
Value
.
x
TOTAL V ALUA TI ON
Systems Development
Charqe (1.5~)
ITotal Comb. rermit
I
I TOTAL
3 \.26
.
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. examele- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. exa~le- 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. exam~le - 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 (al of the
Structural Specialty Code
H. OESIGN TEAfl AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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(sl 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:
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PERMIT VALIDATION
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Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
date