HomeMy WebLinkAboutPermit Electrical 1988-7-18
'", INSPECTION LINE .
726-3769
. Job Address / &1HJ ~h fI~ ~
legal Description U J-I d 4:?
o
CITY Ur SPRINGfIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE of Work:
.
INFORlIATION LINt
726-3753
Sq. Ftg. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
Other- --
@'
16'
Address
l~o-vJ u.JaftL
/550 ;J, c(~rtd
Phone ?t! to
1~70
BuilainQ Permit Info: Describe Work(i.e., Build Single
Fam;~v ~esidence With Attached Garaqel
d40L-~ IAhiZ7I tf~
'.-.....
Owner
..J
Construction lender
Address
Ut~IGN IcAI1
(name)
Phone
(address)
(lies. no.)
(exniresl
(ohane no. '
Primary
Structural
\.,/'~co
'14\ ,
Electrical
Mechanical
CONTRACTORS
(namel
(address)
11 ;('!l:. no.)
(pxoirpc;,)
(nnnnp nn. \
Electrical
~dd
~~A-LdJ
~
~
/1 ,\
Genera 1
Plumbino
~'echanical
PlUI,fBING
ELECTRICAL
MECHANICAL
NO. '
FEE cHARGE Nn
Each single fixture
Residence of
FFL .lli!IRIiE .l!O....
SQ. FT.
furnace/burner to
BTU's
FFL .LHARliE.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl vpnt
I
I
I
",I
\..1.1/ \1
ITemporary Construction
IChange in existing
re<;. i d_p_nrp
Imultifamily, comm. or
Industrial
10f amps,1
I COMI,!. lIND, FEEDERS I
IInstall/alter/relocate I
dic:trih. fppdprc:
10f amp~1
Appliance vent
SEloaratp
Stationary evap.
cooler
Vent fan with
sinolEl duct
Vent system apart from I
hea t i no or A. C.
Mechanical exhaust
hond <'lnd durt.
Wood stove/heater
Additional bath
~Iater service
Sewer
Storm Sewer
ISSUANCF OF PFRrm
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the B~ilding 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 performed 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 rw OCCUPAr~CY 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 OP.S 7n1.055 will be used on this project.
t}&,-
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
~ S!GIIATUREt:'P "U4.-/
- FOr. OFFICE USE~-
Sq. Ftg, riain
Sq. Ftg. Access
Sq. Ftg. Other
OATE
7-1 J-fl
?~fu;tf- T
HAME(p1ease print)
x
Value
Value
Value
TOTAL V AlUA TI orl
x
x
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Blda P~r Fee
- - -- - -- -- -- -""'P'f'an Ck. Res
3D%/Blda Per Fee
Fence
Systems Development
Chara. tJ.5~) ,
PlU'1BING PERMIT
Charges and..--.
SurCharges .
I D~mo
;;):;:).5V I Sidewalk
-------TI:;I A/C Paving
I Curb Cut
I
I
I
I
ITotal Comb. Permit
I
I TOTAL
2)3, 03.-
! ,
ELECTRICAL PERrHT
Cha rges and , \
Surcharges """"\
MECHANICAL PERMIT
Charges and
Surcharges
.
COMBINATION APPLICATION/PERMIT (CAP)
I
I,
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax lot 100, lane County Map Reference
I! U3 43
2. exam~le- lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examDle- heat/electrical ceilinQ/or forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- 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. OESIGN TEAM ANO 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 t &. 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 penmit fonm 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. 8UIlDING 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
.
.
PERMIT VALIDATION
\Iqz>
<1-/ ~.,'f
.
Permi t Cl erk
vV
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
". .' ~
PLANS REVIEWED BY:
name
signature
date