HomeMy WebLinkAboutPermit Electrical 1990-6-7
I IrISPECTlON LINE . CITY Of SPR1Nr,fTELO
726-3769 COMBIIIATlON APPLICATlON/PERNlT
Job Address 2- If' ~ , } a.e ""'. ft-& ' I ~~;~GY SOURCES:
Legal Description 'II 0 'J.. ~c6txJ 0:)000 I. Hater Meater
I
YYv" (')-,~o ~ vY\k
Phone 6
INfORlIATlON UNt
726-3753
Sq. Ftg. 1'lain
~q. , ftg. Access.
Sq. Ft9. Other
New Add Alter Pep.
Range -Fence Den;, Change/U,e
ValuE of l'lork: Other- -
B '1' Np' !At J- f 'b ' B 'ld S' I
Ul G1nQ erml no: Ueserl e Workll~e.. Ul log e
Family Residence With Attached GaraQe\
ClV"
.
Owner li~rp', h"",
Address
~
o
o
J\
V
~ JP('~
s::; :~
Construction lender
Address
DESJGN TEAr~
lnarne)
Phone
(address)
flies. no.}
(exoires)
(ohone no.'
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrpssl
(1 ics. no. \
(p'Il'n;rpc:,'
(flhnnl> no \
Genera 1
Electrical
Y'v\..oove- c; he-
'X '" I 2., c., G 0'Sf:=,\ p v Q,{), 12 l.( ('
o
t:t~~
to/elf
'::XiM? c.
7'-/; -Ci-,i i
Plumbina
~'echanical
PLurlBI NG
ELECTRJCAL
MECHANICAL
NO, '
FEF rHARr.F NO
~n' '__CHARGF Nn
t:'n rl-/1RG.E.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building .
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
1
S.F. Residence
(] bath 1
Duplex (1 bath) each
SERVJCES
Recessed wa 11
~n~~p hp~tp- ~nrl vpnt
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
rli~trih. f~~d~r~
amps,
Appliance- vent
Cj;~oari'l.tp
S-tationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Hater service
Temporary Construction
Change in existing
res j Q~.nce
multifamily, comm. or
Tndtl~trial
Additional bath
Sewer
Wood stovelheater
Of amps.
~Ie(" .LlVS"T
/Sou
TOTAL CHARGES
WHERE STATE L'H REQUIRES
shall not be vali1 until the
, TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFR11JT
I TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the complete~ 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 Sprin9field and the Laws of the State of Oregon pertainin9 to the work described herein, and that 110 OCCUPAIlCY 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 OP.S 7Q1.055 will be used on this project.
IWIE(ple~se prinOf", L{J 121 ,4 J'''{6 0 fT,7:_ SJGIlATURE~t??/,:-_ t?7PZ"I'7fhI<? DATE 6-';>. g(}
FO~ OFFJCE USE orlLY
Sq. Ft9, 11ain
Sq. FtlJ. Access
Sq. Ft9. Other
Stories'
Units
Occy load
Occy Group
,
Value
Value.
Value
Fi re Zone
Flood Plain
TvpE:/Collst.
Bedrooms
x
Zone
x
TOTAL VALUATION
PLU!lBJNG PERMJT
Charges and
Surcharges
. Plan Ck. Co,,"/lnd
65~/Blda Per Fee
------------ Plan Ck, Res
30%/BldQ Per Fee
Fence
.Syster:lS Development ~
CharQe (1. 5~)
BUJLDING PER~IJT
Charges and
Surcharges
Demo
ELECTRJCAL PERI\lT
Charges and
Surcharges
__L5-00
---r-,
Sidewalk
A/C Pavin9
Total Comb. Permit
HECHANICAL PERMJT
Charges and
Surcharges
Curb Cut
TOTAL
~IS-15
-
e
,"
h.. _
If
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map P.eference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. example- waterheater/electrlcal/or ~
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,
checl< add. etc.
F. Building pennit information:
1. exam2'e - 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
fu 11 schedu 1 es
C. BOILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOOLES
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 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,
Pel. ci
():l-(P~
[\Jfl:-
V. FOR OFFICE USE ONLY
Permit Clerk
lGB.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date