HomeMy WebLinkAboutPermit Electrical 1990-7-10
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jINSPECTION LINE . CITY OF SPKINGFIELD '-4."'~ INFORI1ATION liNt.
_726-3769 COMBINATION APPLICATION/PERMIT 726-3753
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Jo ress \ )()) V \ \.. \ ^ ". A..-/ '. Hea t :q. Ftg,. Access.
Legal Descripti~n- -, (\ ^-3'":t,.,:).- ~.. C:::: I'V' ) \~ater Heater Sq. Ftg. O~her
. It)~ ~.~ ~~ New Add Alter Rep.
- . - . Rang. e - - -
o Fence_Demo_Change/Use
~'n '\ 1\1 Rt ValUE of I,t\' f\ /' Othe
OWV\_~ X1RJ'W!l~~} ::-'tiAJ Buil(;inq permi~ Info: Describe~Ork(~.e., Build Single
:~llr\r n~~\~~ 1~h-,1~ (j'+ n,(;;~, crtD5~':+'d2fY)
constru\tion Lender -0 J ,~.O\' >J r2J ) ClY )
Address Phone
DESIGN TEAI~ (name) (address)
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TOTAL CHARGES J TOTAL CHARGES
WHERE STATE L,'\~ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I HAVE CAREFULLY EXNlINED the completed appl ication 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 Oregon oertaining to the work described herein, and that NO OCCUPANCY 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 ORS 701.055 will be used on this project.
SIGNI\TURE AiJaucLf)~
FOR OFFICE USE ONLY
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Primary
Structural
,J
Electrical
r1echani ca 1
CONTRACTORS
(name)
General
PlumbinQ _
Electrical ,'Lf\.l ')\(l ~6)---ttJ
~1echani ca 1
PLUf1BI NG
NO.
FEE CHARGE NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath)
IAdditional bath
I ~la ter servi ce
each
Sewer
Storm Sewer
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rW.1E(please p~ Ul=lv/d JJ F/J:;tt
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/
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Zone
Type/Const.
Bedrooms
Stori es
Fire Zone
Flood Plain
C')
V
,~
o
-
(1 i C:~. no,)
(~xnires)
(ohone no. I
(address)
(lics. no.)
(exl)irF~s )
(t)hone no. )
'\~qD 1\4Znrtbk Si1itft Me ~Ahl~:
- .' '-"'\ \' '0'01 PS .
ELECTRICAL
MECHANICAL
I FFF r.HARGf/ NO.
I FFF I r.HAR(;F
Residence of
furnace/burner to
BTlI's
SQ. FT.
New circuits alts.
or extensions
Fl oor fu rnace
and vent
ISERVICES
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I Recessed wall
Soace heilter ilnd
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I App 1 i ance' vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart
heatinq or A.C.
I Mechanical exhaust
hood and duct
I Hood stove/heater
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vent
ITempOrary Construction
IChange in existing
residence
Imultifamily, comm. or
Industrial
10f amps.1
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders .
10f amp~1
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from
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I ISSUANCE OF PFRt1IT
f TOTAL CHARGES
'Electrical Contractor, the electrical portion of this
'Supervisor and returned to the Building Division
permit
DJl.TEPO~O
Units
Sa. Ftg. f1ain
Sq. Ftg. Access
Sq. Ftg. Other
x
x.
Value
Value
Value
Occy Load
Occy Group
x
TOTAL VALUATION
I Pl an Ck.
65%/Blda
------------, ~6~~B~~~
I Fence
I D~mo
I S i dewal k
I A/C Paving
___ _ __ _ _ _ __ -' Curb Cut
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BUILDING PER~1IT
Charges an~
Surcharges
PLUt~BING PERMIT
Charges and
Surcha rges
ELECTRICft,L PERfHT
Charges and
Surchqrges
,( 00 CJ()
-CO
~.
MECHANICAL PE~MIT
Charges and
Surcharges
Comm/Ind
Per Fee
Res
Per Fee
ISystems Development I
Cha r(le (1. 5%)
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ITotal Comb. Permit I.
I . f ~'3./"'V"'\
ITOTAL \...Q lJ.J
COMBINATION APPLICATION/PERMIT (CAP)
.. -1
11
C /'
PERMIt VALLDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County ~ap Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air gas
2. example- 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 Sched~les
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 schedul 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
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
" date