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HomeMy WebLinkAboutPermit Electrical 1990-4-2 r; . .;.1 . CITY Uf SPRINGfiELD COMBIIIATlON APPLICATION/PERMIT EilERGY SOURCES: Heat !"ater Heater Ran~e ValuE of Hork: . I I1ISPECTIO~ ! INE 726-3769 Job Address rg I \ leg~l Description P""-c.vAy US, '- P,o";...,.e"", INFOR/IATlON UN' 726-3753 Sq. Ftg. 1.lain ~q. ftg. Access. Sq. Ftg. Other i1ew Add Alter Rep. --Fence Demo Change/Use -Other- -- -' Owner SJ,..O-o/~j, Address / "303 ~ 'Po rtlo-J 0 In (2 e s+ "",H~.u..>'\ i . I , " () _ .AI" Buj.Jeiina Permit Info: Describe Work(i..e.. fV* \N. '--0 rt'\leo...Phoner". 'II-C:J ~~lv nesidence H;J.h...A,tt~,~~~1 faraqel Build Single '1'7 ;),~ Cl Construction Lender Address U'~I~N I cAr1 Phone (address) (l ics_ no.) (name) i Primary Structural Electrical Mechani cal CONTRACTORS (namt) (address) (lies.. no.) General Plumbina Electrical ~1echanical PLUIIBING , J:'J:'J:' rl:!AR.G.E.. NO_ ELECTRICAL NO, FFE CHARGE NO Each single fixture Residence of SQ. FT. Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (l bath) Duplex (1 bath) each Additional bath SERVICES I I /~ 100 / ITempOrary Construction I'change in existing rfls i QP.J1ce ImultifamilY. comm. or Industrial 10f amps. ICO~1./IND. FEEDERS I Install/alter/relocate rli~trih_ fpprlpr~ IOf amps. I I I ~Iater service Sewer Storm Sewer r exoi res) (OhOM no. I (pxnirp~\ (nhnnp nn_ 1 MECHANICAL ... J:liARliE.. furnace/burner to STU's F1 oar fu rnace and vent Recessed wa 11 SD~hp~tPr ~t Appliance vent 5}:D~ratp Stationary evap. cooler " Vent fan with sinole duct I Vent system apart from heatina or A.C. I Mechanical exhaust. hood and duct I ~Jood stove/heater I TOTAL CHARGES TOTAL CHARGES WHERE STATE L.\I~ REQUIRES that the Electrical work be done by an shall not be vali1 until the label has been signed by an Electrical ISSUANCF OF PFRrIlT TOTAL 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 Derformed 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 Ore~lOn perta; ni ng to the work descri bed herei n t and that IlO OCCUPAUCY 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 subcontractors and employees who are in compliance with OPOS 7Ql.055 will be used on this project. SIGiIATURE1~~ \J 1J ~ HAi,IE(please print) Kenneth W. Hamilton Zone Fi re Zone Flood Plain fD~ OffiCE USE miL Y Sq. Ftg. riain Sq. Ft~. Access Sq. Ftg. Other Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group BUILDING PERfIIT Plan Ck, COIl1l1/lnd Charges an': ------------ 65~/Bldn Pj'r Fpp Surcharges Plan Ck, Res 30%lBl do Per Fee PLUHBING PERMIT Fence Charges and ------------ Surcharges Demo ELECTRICAL PERI~IT IS, 00 Sidewalk Cha rges and -----,-:;?--- Surcharges A/C Pavi ng MECMANICAL PERMIT Curb Cut Charges and ------------ Surcharges Dm4/2/90 x x Value Value Value x TOTAL VALUATION Systems Development Charae (1.5~) ITotal Comb. Permit : TOTAL I)' ?5- \~,~S . . .1lI -.. . -- , . COMBINATION APPLICATION/PERMIT (CAP) I I. Applicant to furnish A. Job Address B. legal Description I. example- Tax lot 100, lane County Map Reference 11 03 43 2. examele- lot I. Block 3, 2nd Addition to ~prlngfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilinqlor forced air qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. I. examole- 1250 sq. foot house. SOD sq. foot garage 2. examole- if new project, check-new - if addition, chee k add, etc. F. Building permit information: 1. examele - construct single family house with an attached garoge 2. examele - remodel existing garage into family room 3. example - convert single family residence into restaurant (change of use) G. Value of work as defioed 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, Mechaoical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules. the applicant oeed fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, aod 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 SCHEOUlES 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 ;s 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: 10.. . e " I r PERMIT VALIDATION 4Jl-o/J \ lo~~~ Permit Clerk ',- ~) InLLJ . . Permit applicant exempt from registration with the Builder's Board because: Additional Pro~ect Information: PLANS REVIEWED BY: name signature date