HomeMy WebLinkAboutPermit Electrical 1983-11-23
,
'I INSPECTION LINE
726-3769
Job Address :5 S 2& ~, j -r .
Legal Oescr; pt i on 1-r.A?i)C() \ Q0l4
CITY UF SPRINGFIELD
COMBIiIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
Val UE of I~ork:
Rcd::L~'Y\.....p
(,,>-l~, I >,t.
Pu.. ~ C) e.
Construction(l~nder
Owner ~ <~ M
Address /8 CO D
, )(#02050
~o/ 1fI=
INFORltATION LINt
726-3753
Sq. Ftg. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A iter Pep.
-Fence Demo Change/Use
Other- -
00
VJ
N
N
(/\
VJ
Phory~",,, . '1~::~
BuilciinQ Permit Info: Describe Work(i~e.. Build Single
Familv ~esidence With Attached Garaael
.VI), I) . _'I ]
LJ~Lc l) ~{ ~Uv .J..0>< <,c.,^<YU><.~ {)
LUG~i, r:;ft~ ~L...fh..-- :.\
IJ (Bies. no.l fexniresl (ahoM no.'1
ITempOrary Construction
IChange in existing
rps j d_p.nt'P
Imultifamily, camm. or
lnnudri;d
IOf amps.1
ICOMfI./IND. FEEDERS I
IInstall/alter/relocate I
rlidrih fpprfpro:::
IOf amps.1
I
I
I I ISSUANCe OF PFRllIT
TOTAL CHARGES TOTAL CHARGES /0. '10 I TOTAL CHARGES
WHERE STATE L"/ REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this pemit
shall not be valfj until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 NO OCCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 701.055 Will_~O: this project.
IIAHE(please print) (J)..,?/C/;{" )1 14:7;'1(' SIG11ATURE /~ ~ ~ DATE /1~2.';)-n
tJ FO~ OFFICE USE OIILY ./'
Tvpe/Const. Units Sq. Ftg. riain
Bedrooms Occy load Sq. Ftg. Access
Stories Occy Group Sq. Ftg. Other
Address
U~~I~N IlAI,'
(namel
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrE"ss'
flics_ nn_'
General
Plumbina
~d. ,~,,---tovaJ ~. 4~'~'j j" () j){!, M if.
(\
ruARG.l:! Nn
Electrical
~lechanical
PLUttBI NG
ELECTRICAL
NO.
FFF rH~ ~n
>>>
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
dO.()O
I .'10
I
I
I
I
I
I
S.F. Residence
(1 bath)
Ouplex (1 bath)
SERVICES
each
"i'I.
Additional bath
IWater service
I Sewer
lstorm Sewer
I
I
I
I
ZonE'
Fire Zone
Flood Plain
BUILDING PWIIT
Charges and
Surcharges
PI an Ck.
____________ 65%/Bldo
Plan Ck.
30%/Bldo
I Fence
I Demo
Lb, 0 D I Sidewalk
--- -~qo----I A/C Paving
I Curb Cut n .J
------------12-0.(. PA..-L2~~c,
.'10
COIl111/lnd
Ppr FE"E"
lies
Per Fee
PLUI~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIUT
Cha rges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcharges
(PXlJirpc:;\
(I)nnrtp "n 1
fu#ZO-20SC
MECHANICAL
>>>
r'lARll[
furnace/burner to
BTU's
,
Floor furnace
and vent
Recessed wall
~o~rp nPAtpr ~nrl vpnt
Appliance vent
c;,~ofll"'atp
Stationary evap.
cooler
Vent fan with
5inole duct.
Vent system apart from I
heatinq or A.(..
IMeChanical exhaust
hnnd ~nd rlur-t
I ~Jood stove/heater
I
I
I
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charge (J.5~)
Total Comb. rermit
J
TOTAL
)b.~D
.
I
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
11 oj 43
2. example- lot 1. Block 3, 2nd Addition to
sprlngfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinqjor forced air qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation. etc.
1. examele- 1250 sq. foot house, 500 sq. foot garage
2. example- 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. example. remodel existing garage into family room
3. example - convert single family res.idence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aj of the
Structural Specialty Code
H. DESIGN TEM4 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
correct i ens. 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
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. ---
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
signa ture.
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.
i I-A3-<i3
li{)O~-O
,
V. FOR OFFICE USE ONLY
Permit
Cl"kMr~fJ J,
~ I '/-nv
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