HomeMy WebLinkAboutMiscellaneous Electrical 1989-8-29
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ELECTRICAL INS"ALLATION RECORD
Job Address: ~ ,/).t r'/hP.,L. C
Tenant:
Property Owner:
Owner's Aadress:
Electrical Contractor: SA"''- -CJ/V F/"",~ r. Label # ,r)",<:::,nn_'<c
Address:
~<:1S L./ ~ ash
~upervlslng tlectrician
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Description of Work: /1/'1""'-<./200 ~ v? Yr-PvJ<r- :;:17,56
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h-,-./~ ,.e 6- "- ( fi ~."-' / tpO ~//') (' / i", c9 0
Inspection Results .~dJ2h 5..c;h-A/ ~-r.c'/Jd/C"',o.
Electrical Fee $ ,~~C)
Surcharge
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$ =~~~L~=
Total
#451
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lnsper- s flgnafurp
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rtmnc1'J/. Ill, LBuilfiinq Penuit Info: Deser be I~ork(i..e"
_ '1l./"t,.t'" :;IFamilv nesidence Hith Attached Garaoe\
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Build Single
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I INSPECTION LINE
726-3769
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Job Address ~Z 6 VI Y(VlPI L-
Legal Description n /' D2- ~ 5D--.gl-/
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(11m' Tat VuA~
Address 3~g S Q{l/1YYlPI '-L-
u
(tTY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
.
INFORltATION LINE
726-3753
SQ. Ftg, '.lain
~Cl. Ftg. Access.
SQ. Ftg. Other
Ilew Add A Iter Pep.
-Fence Demo Change/Use
Other- --
Ranlle
ValUE of I-lark:
Owner
Construction Lender
^durCS5
DESIGN IEAI1
(name)
Phone
(addressl
(l ics. no. \
(exoi res)
(ohone no. I
Primary
Struc tura 1
Electrical
/1echanical
CONTRACTORS
(name)
(addre$s'
11 ;r:". no.)
(eX'lires \
(ohone no.'
Genera 1
PlumbinQ
I {)lffYl.J.V 1
\.... ,I
Electrical
~lechani ca 1
PLUI1BIIIG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO
FFF CHI\RGE. NO
J:'J:'~.c.uARG.E..
SQ. fT.
furnace/burner to
BTll's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
I SOilrp hpo'ltpr <inti vpnt
amps.1
Appliance vent
sp.oa ra te
Stationary evap.
cooler
Vent fan wi th
sin9le duct
Vent system apart from
hei't.ino or A,r.
Mechanical exhaust
hord i\nd nurt
Sewer
Temporary Construction
Change in existing
rpc;.iqence
multifamily, con111. or
Induc;.tri.ll
~!ater service
Storm Sewer
Of
COMI.I./I NO. FEEDERS
Install/alter/relocate
di,trib. feenpr,
Wood stove/heater
Of
amps.
1
I SSlJANCF OF PFRtH T
TOTAL CHARGES
WIIERE STATE L.\I~ REQUIRES
shall not be valiJ until the
TOTAL CHARGES
TOTAL CIIARGES
that tile Electrical work be done by an Electricill Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREfUllY EXNlINED the completed appl ication for permit, and do hcreb.v certify that all infonnation 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 herein, and that 110 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 is in full force and effe a qu red by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and empl e ho ar in compliance with Or.S 7~1.055 will be used on this project.
DATE
g;2J'-f1
flAt-IE(please print) SI(,IIATURE
I ./ FO~ OFFICE USE OIlLY
Zone Type/Const. .r Units Sq. Ft~,
Fire Zone Bedrooms Occy load SQ. Ft!).
Flood Plain Stories Dcc.y Group Sq. Ftg,
x
Value
Value
Value
f1ain
Access
Other
x
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________ ~/Bldo Ppr Fpp
Plan CIc.. Res
30%/BldQ Per Fee
__Jz'_QQ____ Fence
, 16 D~mo
Systems Development
CharQe (1.5~)
PLUt~BING PERMIT
Cha rges and
Surcha rges
ELECTR I CAL PERI:I T
Charges and --------
Surcharges
r1ECIIANICAL PERMIT
Charges and
Surchar!]es
Sidewalk
A/C Paving
Total Comb. Permit
TOTAL
t5.1L7"
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
J. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. lane County Map Reference
11 D3 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examjle- waterheatertelectrlcafior 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,
chee k. add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garllge
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 (aJ of the
Structural SpeCialty Code
H. OESIGN TEM~ ANa 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(sJ 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.
Ill. 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
v
'* \1-16(1,
Permit Clerk
AA i J /
.
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date