HomeMy WebLinkAboutPermit Electrical 1990-4-2
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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
-.. .
-- ,
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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..
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PERMIT VALIDATION
4Jl-o/J
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Permit Clerk
',- ~)
InLLJ
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Permit applicant exempt from registration with the Builder's Board because:
Additional Pro~ect Information:
PLANS REVIEWED BY:
name
signature
date