HomeMy WebLinkAboutPermit Electrical 1989-7-21
m~~mON LINE ~,.,.. COMBIN~TnN APPr~C,~Tlm~ERMlT ,
Job Address r!} f\.nG \1\ ll(l"'f\ f\\ r) _ ~~;~GY SOURCES:______
legal DescriPtion \ () (_J" ~ Q l'b4.' OOOO() j :;c::
./ ValUE of \\~!J ~ /
Buildino Permi~ lnf~Descrbe Work(i.e.. Build Single
Familv Residente With Attached Garaoel
171{)?)o{f\A I ~ ~ 0 o@nf't ~l1\L~ ~
$ti? 1)( ~. U j{\,('i [ rC(u\dI
I... d Q 1'*' ~
(lies. no. \ (expires) {ohone no.
'- N RJiAT ON
"- 726-3753
Sq. Ftg. "Mo.in
~q: Ftg. AccOH,.
Sq. Ftg. Other "-,
flew Add A Her Rl!)>,.,
-Fence Demo Change/U$"e..
Other- -
.
Owner ~ 11"'"A 1, ~ ~ ~~'\~
Address /j:::l 'A ~\~ ~ \ \
~ -.' Rt\J C{l:fJl
Construct; n ~ende .
Phone
~
o
...:J
Address
Ul~jbll IlAl1
(namel
Phone
(addressl
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrpss \
(1 ics. no. \
(exoiresl
(ohnnp nro. )
Genera 1
Plumbino r.\\., -
Electricat _ Vi\'l ~ U 1 ~~
~'echan; ca 1
'rJl Q I'1\1 ~ r
)
PlUllBING
ELECTRICAL
MECHANICAL
NO.
FEE
CH~RGE
Nn I
Residence of
SQ. FT.
'New circuits alts.
or extensions
H,
rH.\.B.IiL Nn.
~H
rHWiE.
Each single fixture
furnace/burner to
BTU's
Relocated building
(new fix, additional)
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p he~tpr ~nd vpnt
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ~nd duct
Sewer
Temporary Construction
Change in existing
re$ i d~Jlce
multifamily, comm. or
Industrial
Water service
Storm Sewer
Of
CO~1,/IND. FEEDERS
Install/alter/relocate
di~trib. fe~A~~~
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
ISSUANCF OF PFRIHT
, TOTAL CHARGES . TOTAL CHARGES
that the Electrical work b. done by an,-Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and re~urned 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 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 here;n, and that un OCCUPAI~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 ;s 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 OPOS 701.055 will be used on this project.
IWiE(please print) 6{;tj.t!"'6 ,(.1 P.dLILGC SIGIlATURE ~..fiSl..-L4/7 /~ ~f!I1J-t
FOr. orFICE USE DIllY v
Sq. Ftg. flain
Sq. Ft~. Access
Sq. Ftg. Other
DATE
7b/k
1
Zone
Type/Const.
Bedrooms
S tori es
Units
Occy load
Occy Group
x
Value
Value
Value
Fire Zone
Flood Plain
x
x
TOTAL VALUATION
BUILDING PERmT ' Plan Ck, Conm/l nd
Charges anc ------------ 65%/Bldo Ppr Fpp
Surcharges Plan Ck. Res
30%/Bldo Per Fee
PlUI1BING PERMIT Fence
Charges and ------------
Surcharges D/jRlo
ELECTRICAL PERIHT -nJ-n--'- 'Sldewalk
Charges and
Surcharges AIC Pavi ng
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
ISystems Development I
Cha rqe tl. 5% '
Tota' Comb. Permit
TOTAL
I\\D{~
""
.
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
11 uj 4,
2. example. Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin9/or forced air Qas
2. examele- waterneater/electrlcal/or ~
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, SOD sq. foot garage
2. examp.le- if new project,'check new - if addition,
cheCK add, etc. .
F. Building pennit infonnation:
1. example - construct single family house with an
attac-hed 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
I. To conserve space on the permit fonn 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:
.
PERMIT VALIDATION
1/t
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V
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Permit
c:....
mJ
.
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date