HomeMy WebLinkAboutPermit Electrical 1990-1-10
I
'I INSPECTION LINE
726-3169
\ (-") I 'C\ \),
. r 0 SPRI GFlEL . INFOR/1ATION UN" 'I I
COMBIN~TI6N ~PPLIC~TION/~ERMIT 726-3753
r:TJv,I, .<~<:, ~lelEaRtGY SOURCES: Sq. Ftq. Hain
()f\o 0 Ir r 11._ _].A ( "'" ~q. Ftg. Access.
\~ater Heater Sq. Ftg. Other
1 Range flew Add A Her Rep.
-,-
ValuE of Hart\. 0.... _Other I
Builtiino Pennit I )'fo: Oeser be Work(i.e" Build Single I)
Familv nesidence with Attached Garaoe) r
Job Address
Legal Description
Owner (0,9 \fClQ~ (0 ~ 0 t\ ')
Address \ 'i<L::O 'Tn i !~ N
(\~ <<\0 ('"j\ m f>, f5'<l-/
Construction lender (J ~
Phone
nalll!:!
Phone
address
,\~9kK
I
Address
Ul:.~lliN H:.N'I
ex ires'
r')hnne no.
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
(address \
(1 ics. no.'
(exnire!=-l
(phone no.)
~~n~r~ 1
Plumbino
Electrical v.~h..- ~O !r
PLUJIBING
ELECTRICAL
4to~~ c{4-d.~ Iltf-
\ \ J 2{)t:( ()
. I
MECHANICAL
'?Jn~Q \ ">PO fi ~ ~ 'J l' . C:'
Hechan; ca 1
NO,
FEE . cHARGF
NO
FFF
r.H~Rr.1=' NO.
, CIlNlGL
SQ, FT.
furnace/burner to
BTLI's
I <FF
i
Each single fixture
Residence of
Relocated building
(new fix. additional)
(
New circuits alts.
or extensions
ISc(l
Floor fu rnace
and vent
S.F. Residence
(1 bath]
Duplex (1 bath) each
Additional bath
,SERVICES
Recessed wall
So~~~ ~~~t~r and vpnt
amps.
Appliance vent
Sfmaratfl
Stationary evap.
r.ooler
Vent fan wi th
sinde dllr:t.
Ven~tern apart from
heatinq or A.C.
Mechanical exhaust
hood and duct.
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rps j QPJ1{,_P
multifamily, comm. or
11ndu."h-i.:ll
~Iater service
Storm Sewer
Of
CO~1./INO, FEEOERS
Install/alter/relocate
rli~trir_ fp~dpr~
Of
amps.
TOTAL CHARGES
WHERE STATE L,\\/ REQUIRES
shall not be vali1 until the
~ TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
I ISSUANCF OF PFRIIIT
10 .'lltJ TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and 1 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, and that 110 OCCUPAIICY will be made
of any structure without the permission of the Building Division. I further certify that my registration \f/ith the 13uilder1s
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
on1 subco traCnJr~m~tO~~~55 will be used on this project.
print) ~T~ !(',lTer SIGllmURE'.fZA DATE/~O/~~,
FOP. OFF I CE LISE lL Y
Type/Const, Units Sq. Ftg.
Bedrooms Occy Load Sq. Ftg.
Stories Occy Group Sq. Ftg.
x
Value
Value
Value
Zone
Fi re Zone
Flood Plain
Hain
Access
Other
x
x
TOTAL V ALUA TI orl
PLuP1BING PERMIT
Charges and
Surcharges
Plan Ck, Comm/Ind
__ __________ ~/Bldo P.~r Fp~
Plan Ck. Res
30%/Blda Per Fee
Fence
'Systems oevelopment I
Charae (1.5t .,
BUILDING PERfllT
Charges and
Surcharges
ELECTRICAL PERIHT
Cha rges and
Surcharges
,0_
_L~-.-9.-CJ--- Sidewalk
I -..J A/C Pavi ng
Tota' Comb. rermit
MECHANICAL PERMtT
Charges and
Surcharges
Curb Cut
1 TOTAL
!~,D
,,'
1
.
COMBINATION APPLICATION/PERMIT (CAP)
l. Appl icant to furnish
A. Job Address
B. Legal Description
I, example- Tax Lot 100. Lane County Map Reference
17 03 43
2. exa~le- Lot I, Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources I
I, exam~le- heat/electrical ceilinq/or forced air qas
2. exa~le~ waterheater/electrical/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,
check add. etc.
F. Building pennit 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
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, 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
O. 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 wor~sheet 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.
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:
,.
PERMIT VALIDATION
~/tD-qO
~ ~\~9
Permit Cl erk (j (J)q )
.
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date