HomeMy WebLinkAboutPermit Electrical 1990-3-28
'1
I INSPECTION LINE
. 726-3769
Job Address I~'i
Legal Description
Pi ON~..n 1WI,1r......... €
.
/7-G>~.~~ ,,,~~
,
. CITY OF SPRINGFIELD
. COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Owner J) A; 'K.Y o.~.
Address
Phone
INFORl1ATlON UNE
726-3753
Sq. Ftg. I.iain
~q. Ftg. Access. ."D
Sq. Ftg. Other g
flew Add A Iter Rep.
Range Fence_Demo_Change/Use I
ValUE of HO!,k:735S~ _Other "~
BuilainQ Permit Info: Descr,be Work(i.e" Build Single
Familv Residence Hith Attached Garaoel
-
Construction lender.
IZArP" 'f-:zNS77'lu.") ~ 7YP€.r~.re-
HOO~ FANS.
Address
DESIGN 1tAf~
(name)
Phone
(address'
(lics.no.'
(Hnires)
(ChOM no.
Primary
Structural
Electrical
Mechanicalpk.'~;( ,~~MLo;c:;
CONTRACTORS lna~e~
:j)iWO. D\IL. 9.SbQ 5.L.1
{address'
~_ ~ll 1"~ 0I2E 97062
(lies. no. \ (pxnires\
(gjj&f/-ZS'II'
(ohonp nn_'
Genera 1
Plumbino
Electrical
Mechani~aI4c;'f"c SrA/N' ~r ~r;v/
PLUI1BING
ELECTRICAL
MECHANICAL
--'iQ..,.
FFF (H1BGL Nn
'" (~, Nn.
," I DJARliE.
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
S.F. Residence
(1 bathl
Duplex (1 bath) each
SERVICES
Recessed wa 11
~n;l("_p hp;ltpr ~nrl VM_t
amps.
Appliance vent
"~Daratp
Stationary evap.
cool~r
Vent fan with
sinale duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hond "nd dUl".t
Sewer
Temporary Construction
Change in existing
rf'<;' j qe.ncp
multifamily, corrm. or
Indu<;.trial
Additional bath
Water service
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
.rli<;.trih. fppdpr<;.
'}
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
ISSUANCF nF PFR!IlT
\ TOTAL CHARGES ; TOTAL CHARGES .h?/.A/. ~-
that tile Electrical work be done by an"Electrical Contractor, the electrical [lortion of this perlilit
label has been signed by an Electrical Supervisor and returned 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 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, ahd that UO OCCUPAHCY 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
O~~b~.o:~trll~:':-~~~~ ...... _" 1...-' ~..~~t"A In jOmpllance wi th OP.S ]l')1.055 will be used on this project.
rWoIE(please print)(:AR.l lO.shclMAN SIGIIATURFC~ ~ _0
FOr. OFFICE USE DIlLY
Sq. Ftg. Ilain
So. Ft~.
Sq. Ftg.
3-J1fW-YO
.......DATE -~
Zone c::. c...
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
S tori es
::;?' /l?
/
Units
Occy Load
Dccy Group A-?
x Value
~
Access x Val ue
Oth.".....:::;-~,A:_..... ~ Va,lu. ~,~
TOTAL VALUATION
PLUIIBING PERMIT
Charges and
Surcharges
. Plan Ck. Conm/lnd
____________~/Rlda Ppr Fpp
Plan Ck. lies
30%/Bldo Per Fee
Fence
'Systems. Development I
Charoe O,5~) .
BUILDING PERfllT
Charges and
Surcharges
Dgmo
ELECTRICAL PERIiIT .Sidewalk
Charges and ------------
Surcharges A/C Pavi ng
Total Comb. Permit
IIECHANICAL PERMIT
Charges and
Surcharges
__ _ _I.S; _~ _ Curb Cut
.-7,r
TOTAL
, .15: "/6
I
e
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. exa~le- Tax Lot 100, Lane County Map Reference
II 03 43
2. examele- Lot I. Block 3, 2nd Addition to
sprlngtield Estates. .
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. example- waterheaterjelectrlcal/or solar
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 permit information:
1. exam~le - construct single family house with an
a ttached garage
2. examele - remodel existing garage into family room
3. examyle - 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. OESIGN 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,'Mechanica], and Electrical Schedules
are available at the Building Division
1. To conser~e 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. BOILOING OIVISION STAFF WILL FILL OOT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted en the CAP, the label mU5t be delive~cd to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant tu 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. r
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 penmit is issued.
V. FOR OFFICE OSE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
.
..
J
I
PERMIT VALIDATION
\'
Q-c98~qO
lloCOalo
Permi t
Clock ~:m )
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Permit appl i cant exempt from regi strati on wi th the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
/ ---:,~~;C::~___~~ignature~----~ ~,__.." date /-23-7'0
,., .,P'
name