HomeMy WebLinkAboutPermit Electrical 1990-4-3
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jltlSPECTIOtl LItlE CITY OF SPRJNGFIE~D INFORJ1ATION UNt
726-3769 COMBINATION APPLICATION, PERMIT 726-3753
. Job Address \~)' 1\ \\~\ 'Y'G..ul C' ~ ~~;~GY SOURCES: ~~: ~i~: ~~~~ss.
legal Oescri~ti~~- - ~ 1 !-later Heater Sq. rtg. Other
\~ New Add Alter Pep.
Ranqe -- --Fence Demo Change/Use
Valu, of [0/,\\\ o.J Other--
Builriina Permi~ Info: Describe Work(i.e., Build Single
Familv n~sidence Wi~~t!~S~~~ f~aqe)
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Own~ ~Irf\ ~ \\~ \'\ \'f'Q \\f\ ru- ,
~~ ''0\~~ \\\.q ') l~()l1J~Phone
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A-
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Address
UESIGN TEAr~
(name)
Phone
(address\
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I
V2 vrn l1:)
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Construction Lender
(l ire:,
no.1
(p~rlir~s \
',:,hone no.l
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addr~~~\
(1 ir:e:, no. \
(PlI'1;"I"IO:'
(....,..",p fln \
Genera 1
Plumbina L-\,
Electr;cal \ '\C1.J("{\ \. \) ~ r Q ~ crt
U:::~\'.l\~\~l.\0M( )
4~'S-.1A-%
~'echanical
PlUrlBlNG
ELECTRICAL
MECHANICAL
NO.
FFF r:HARGf NO
~~~ r~~ Nn
!:'l'~ r~ARG.E. ~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU' 5
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
1~later service
[Sewer
SERVICES
Recessed wa 11
~~~~P kp~tp~ ~nrl ~~nt
\
-3
ITempOrary Construction
IChange in existing
rpc;. i d_pncp
Imultifamily, comm. or
Innustri~l
\ IOf '8(1) amps.1
ICO~~./INo. FEEDERS I
l~~~~~~~~ai~~~~~~locate I
Of <~.rf') amps.1 4.5~
da~\\'\~ ItlS0 l\~':il
I
I
,!,) ~ ~o
11.o,S)
Appliance vent
seoaratp
Stationary evap.
r:nnlpr
Vent. fan wi th
sinole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood ilnd durt
I t'lood stove/heater
Storm Sewer
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'li REQUIRES that the Electrical work be done by an
shall not be va1i~ until the label has been signed by an Electrical
I SSUANCf OF PFRrll T
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED 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 Spri ngfi e 1 d and the laws of the Sta te of Orel.:lOn pertai ni n9 to the work descri bed herei n. and tha t rw OCCUPAIKY wi 11 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 subcontractors and employees who are in como1iance with ORS 7nl.0~ ~~~ be used on this project.
,0 pr;n~~~~~~~ ~) ~~f::'S ~3~\~~ w'-{~ ~ om~-3-9 0
Fo~ OFFICE USE orll Y I
Zone Type/Canst. Units Sq. Ftg. r1ain ,x Value
Fire Zone Bedrooms Occy load Sq. Fta. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUilDING PERr,1IT
Charges ant:
Surcharges
Plan Ck. Comm/Ind
65~/Bldo Ppr Fpe
------------PTan Ck. lies
30%/Bldo Per ree
Fence
Isyste,~s Development
Charoe (J.5~)
Plur~BING PERMIT
Charges and
Surcha rges
d~~
- \~.'1 (')
Demo
ELECTRICAL PERr~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
AIC Paving
I Curb Cut
I
ITota1 Comb.
I
I TOTAL
rermi t
.JLo~ ~D I
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I, example- Tax Lot 100, Lane County Map Reference
II 03 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examele- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
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. example - 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. 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 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
fu 11 schedu 1 es
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 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 penmit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permi t Cl erk nAJli ./
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date