HomeMy WebLinkAboutPermit Electrical 1980-8-19
Address
Phone
Buildinq Permit Info: Descr{be Work(i,e.,
Family Residence With Attached Garaqe)
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Build Single
100 ·
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1 INSPECTION LINE
: 726~3769
Job Address Z 01-~ J
Legal Descri~tion "7,0 ()
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Construction Lender ' ,
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork:
INFORI1ATION UNI:
726-3753
Sq. Ftc). f.la i n
Sq. Ftg. Access.
Sq. Ftg. Other
Ne\. Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
Owner
Address
DES I GN TEAf'1
(name)
Phone
(address)
(1 ics. no.)
(exoires)
(ohone no. I
Pri ma ry
Structural
Electrical
: f1echanical
: CONTRACTORS
(name)
(address)
(1 ics, no,)
(exoires)
(ohone no, )
, Genera 1
, Pl umbi nq
; Electrical
~1echani ca 1
PLUf1B I NG
ELECTRICAL
MECHANICAL
"
NO,
FEE . CHARGE NO
FFF rHARr,F NO,
FFF rHARr,F
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
amps.1
I
I
$ t(1). hCJ
I I
I
I
I
I
I
I
I Recessed wall
Soace heatf'r ilnd
I
vf'nt.,
;< I SERVICES
I
jTempOrary Construction
IChange in existing
residence
Imultifamily, comm. or
Industrial
10f
ICOMM./IND. FEEDERS
I Install/alter/relocate
distrih. feeders
10f amp~1
I
I
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TOTAL CHARGES J TOTAL CHARGES
I~HERE STATE L.'I,W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical rortion of this permit
shall not be val id until the label has been signed by an Electrical Supervisor and returned to the Building Division
IS.F. Residence
(1 bath)
I Duplex (1 bath)
IAdditional bath
I~later service
I Sewer
IStorm Sewer
I
each ,I
I
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Appliance vent
seoarate
Stationarv evao.
cooler J ,
I Vent fan with
sinale duct '
I Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and duct
I Hood stove/heater
1
I
I
ISSUANCE OF PFRMtT
TOTAL CHARGES
I HAVE CAREFULLY EXAI1INED 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 NO OCCUPAr~CY will be made
jof any structure without ,the permission of the Building Division. I further certify that my registration with the Builder's
IBoard is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
;",y ,"b"o'""", ::d 'mploy'" oh, '" i, "m,'i"" wi'h ORS 7'1.055 Wi:! ~ ":::';' '~Oj,".
:NAt'1E(please printL '\EiJ f.1 ~HR 11 SIr,iUITURE n~ll(e:!~_ D/l.Ta1BJOO
FO~ OFFICE USE ONL
'Zone Type/Cons t. UnHs
Fire Zone Bedrooms Occy Load
Flood Plain Stori es Occy Group
BUILDING PER~1IT Plan Ck. CommlInd
Charges and ------------ 65%/Blda Per Fee
Surcharges Plan Ck. Res
30%/Bldq Per Fee
PLU~1BING PERMIT I Fence
Charges and ------------
Surcharges I Dt;mo
ELECTRLCAL PERf1IT I Sidewalk
Cha rges and ------------
Surcharges I A/C Paving
I1ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
So. Ftg.
Sq. Ft!).
Sq. Ftg.
r1ain
Access
Other
x
x
Value,
Value
Value
x
TOTAL VALUATION
ISystems Development
Charqe (1.5%) "
I
ITotal Comb. rermit
i TOTAl
'~.,., .. ... '"".- ..
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner ~nd construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air gas
2. example- wa~erheater/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 fa,mily room
'3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) qf the
Structural Specialty Code .-'
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Buildin~
Division Staff must be able to contact appropriate
persons 'regarding design information or job ~ite
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical S~hedules
. A. Except whereb,lank spaces occur in the descri,ption
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 permi~ form the~chedules
have been abbreviated
2. If the item(s) to be installed are not ccivered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delive,red to the
electrical contractor for signature by his electrical
supervisor. The general contractor is ,not authorized
to sign the electrical label.
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.
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 ~harges are due and
payable when the permit is issued.
II.
I I I.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'l;~.
PERMIT VALI.oA~TION
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Permit Cl erk
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Permit appl i cant- exempt' from reg i str~ti on with the Builder. I s Board becau'se:
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Additional Project Information:
PLANS REVIEWED BY:
name
signature
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date