HomeMy WebLinkAboutPermit Electrical 1989-12-7
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jINSPECTlON LINE . CITY OF SPRINGF I ELD . INF0R11ATlON LINt
726-3769 ~ COMBIN~TlON APPLICATION/PERMIT 726-3753
Job Address I X( ).c\., f.), l Onl2.Y J) lLUC'.. ~SOURCES: Ftg. Hain Th
~ ( -,..." Ftg. Access. ~
Legal Description \later Heater--. Other:-'oo.J
Range............... Alter-Yep. ~
Fence De Change/Use
va,u'r\.l-IojYlJ Other- ........... /
Bulh;lnQ ptrmit -InfO: Describe Work,(Le., Build Single ~
Famil v nes dence Hi th /l.tta~h~d (1ara(1~ \ ~ ~
Owner C )('~ q \\ \ j, (\)\ \ Q Q XLJ
Addrcss \ ~n~o V. ~ W F , , Phonc
cons;r~~d~ -~ ) 41477
(name)
Phone
(address I
,To fY\ ~~ iJ ~ ad-
./
Address
DESIGN TEAll
(1 its. no.)
{exniresl
(nhom~ no.J\
Primary
Structura 1
Electrical
Meehan; ca 1
CONTRACTo~namel
Genera 1 ( [' )
7"" (
PlumbinQ
v
(l)f !J1tyu rEd"ffi...~
(1 ics. no. \
(exoiresl
(ohane no. \
Electrical
~1echanical
PLUr1BING
ELECTRICAL
MECHANICAL
Each single fixture
I FEE I CHI\RGE NO..o.-1
Residence of
I rr.r I rH~ NO. I
I FF"-'J:JJARli.E.
-IJQ.,. ,
furnace/burner to
SQ. FT. BTU's
SERVICES
I
I
I
t:5 ~~
- -
Floor furnace
and vent
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Recessed wa 11
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
COM/.1. /I NO. FEEDERS
Install/alter/relocate
rl;~trih_ fppder~
amps.
Appliance vent
seoil r~ tp
Sta'tionary evap.
cooler
Vent fan with
sin~le duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hoorl ~nd dud
Wood stove/heater
~Ia ter servi ce
~ Temporary Construction
Change in existing
rpo;..i 4CJlc~
multifamily, corrrn. or
Industri~l
Sewer
Of
amps.
TOTAL CHARGES
WHERE STATE L~\I REOUIRES
shall not be valiJ until the
TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
I ISSUANCF OF PFR!lIT
I ~ PL,-40TAL CHARGES
Electrical Contractor, the electrical portion of this permit
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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel.:lOn pertaining to the work described herein, and that UO OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further certit that m.y registra~~. 1;::;7: e Builder's
Board is in full force and effect as required by ORS 701.055. that if exempt the is for exemr>tionjs noted her on, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will b sed on th~~. , /
IW1E(please print) 0P7na~ 1.u/r.o.eP-7;-, SI"rIATU -/~6>-A;:; ~~\.~ZfJtmL2' 7. .;7
FOr. OFF I CE USE DIllY .-P'
Sq. Ftfl. f1ain x
Sq. FtlJ. Access x
Sq. Ftg. Other x
Zone
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Value
Value
Value
Fire Zone
Flood Plain
TOTAL VALUATION
BUILDING PERNIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ ..ill,/Blda Per Fee
Plan Ck. Res
30t/Bldo Per Fee
Fence
Systems Development
Charoe (I.5~)
PLur~BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERr\IT
Cha rges and
Surcharges
{'-:::j.CO
------n----
, . I,'>
Sidewalk
A/C Pavi ng
Total Comb. rermit
TOTAL
/6.70
HECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
~
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant tu furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 U3 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examQle- heat/electrical ceiling/or forced air qas
2. example- watertleater/electr'lca lIor ~
E. Square footage or valuation, etc.
1. example- 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. examyle - convert single family residence into
res,taurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TE~1 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regard i ng des i gn i f1 fOr'mil t i on 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
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. -
III. Applicant to sign and date
Whenever possible, the initial application will b~ used as
a worksheet only. Where possible, Building ~ivision 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:
Cl erk ~fli3 )
'-../
.
II
PERMIT VALIDATION
/!)- '7-gq
/55/1
Permi t
.
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
,I