HomeMy WebLinkAboutPermit Electrical 1988-10-24
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; INSPECTION LINE
,726-3769
Job Address '5 S....:;:) h
Legal Description
.
CITY Of SPRINGfIELO
COHBINATION APPLICATION/PERMIT
S'~ EIIERGY SOURCES:
k- '7 ". Heat
Water Heater
Ranoe
ValuE of Work:
.
INfOR/tATlOM LINt
726-3753
Sq. Fto. l-lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
Other- -
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C>~//:/1 /))
'0 (7
Owner;... )/);. ~o
Address
J ~<---d,)
Construction Lender
BU11tilnQ Permlt Info: Describe Work(l.e., Build Single
Familv nes;dence H;t~ Attar.~p~ r.araoe\
.& OT/~.-, ~-it:r~I)- 'l's( ji-y;:;" '/.' . ~;:,
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Phone
Address
Ut~lGN ftAM
(namel
Phone
(address)
nics. no.l
(exn;r@sl
Primary
Structural
Electrical
V;4S l 1"
JO~ 1, {.:.
Hechanical
c..OtfIKAc..1 UK~
(n~,~l
(addressT-------h-.-- Clics. -no. 1
- fexorres 1
',..
-~ l(lnp nn_ll
Genera 1
Plumbino
~ L"
Electrical~~ L/K I
Ldn. cf.
/P6YU/~ 0..5!-
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4"0
:1 '/:J-?I./f/J..:::J
~fechani ca 1
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
Each single fixture
F f F r"IlJ!llL..lID....... I:I.L J:IlAIlGf.' IIn I
Residence of furnace/burner to
SQ. FT. BTU's
Ii
Relocated building
(new fix. additional)
New circuits alts.
or extensions
~.ot:
Floor furnace
and vent
S.F. Residence
Cl bath \
Duplex (1 bath) each
SERVICES
Recessed wall
C\'l"f"P "'P::'''/3'' ,,",.I \.t,Q"t'
ITemporary Construction
I'Change in existing
rP'ij"pflre
I' Imultifamily, comm. or
Tnril,c:t.ri..l
I 10f
I ICOMfI./IND. FEEDERS J-I~ I
I Ilnstall/alter/relocate I' I
rli~trih_ fpprlpr~
I 10f amps.1 I
A I I
'~\"Il I I I
I I I ? ~ :5 JI- ISSUANCf OF PFrollT
TOTAL CHARGES TOTAL CHARGES ::5 9_ '? ~TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be val11 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Stonn Sewer
amps.
Appliance vent
~!:oari\t,p
Stationary evap.
c::ooler
Vent fan wi th
~inol@ duc::t.
I Vent system apart
heatina or A.C.
I Mechanical exh~ust
hnod and du..t
I ~Jood stove/heater
I
I
I
from
Additional bath
IWater service
Sewer
Zone
Fire Zone
Flood Plain
I HAVE CAREFULLY EXAHINED 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 herein, and that 110 OCCUPAIICY 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 s~ibcontractors and employees wt.o are in compliance with ORS 701.055 will b~ used on this project.
1IA1-1E(please print), :.)~..... A/"r1Y zrz-: SIGNATURE w~.L:
FOP. OfFICE UiE OrllY
-----
Sq. Ftg. Hain
Sq. Ftg. Access
Sq. Ftg. Other
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
;..Jo
DA~r7'~#
,
.
Value
Value
Value
x
TOTAL VALUATIOII
BUILDING PERf.1lT
Charges an~
Surcharges
Plan Ck. Comn/lnd
65%/Bldo P~r Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charoe tl.5~\ .
PLUMBING PERMIT
Charges and
Surcharges
ELECTR I CAL PERIHT
Charges and \
Surcharges V
HECHANICAL PERHIT
Charges and
Surcharges
_____2J~~~_
{.~
0,..,
I 'Sidewalk
I A/C Pavi ng
I Curb Cut.
I
ITotal Comb. rermit
I
1 TOTAL
>938'
"
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2. exa~le- Lot 1. Block 3. 2nd Addition to
~prln9tield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam21e- heat/electrical ceilinqlor forced air Qas
2. examyle- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check-new.- if addition,
cneck add. etc.
F. Building pennit information: ,
1. example - construct single family house with an
attached. garage
2. example - remodel existing garage into family foom
3. examOle - convert single family residence into
'rern'urant (change of use) ,
G. Value of work as defined in Section 303 (aJ 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 descrip~ion
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
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
signCltur'e.
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.
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(6 ~ d- ~~f(
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V. FOR OFFICE USE ONLY
Permit Clerk
Cc--
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
~ I
'.
name
signature
date
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