HomeMy WebLinkAboutPermit Electrical 1990-7-19
Owner .c,'j'a'Z- ,.", c.. ~ ~ ~ \ J ~ '- ~.:. J l O\~ ~
, Address 51-if: ~ ". (\ .s ct- Phon'726'!Z}:> .
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Construction Lender r:. ~.I:...
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Phone
(address)
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Value of Hork:
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Buildinq Permit Info: Describe l~ork(Le., Build Single
Family nesidence With Attached Gara0e)
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(lics. no.) (exoires)
INFORI1ATION UN!: .1
726-3753
Sq. Ftg. "-lain qb ~
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
~
CITY OF SPRINGFIELD
,_ Cm1BIilATION APPLICATION/PERMIT
lj;1 cr-o:....of-K j \:1 I ~- ErIERGY_ SOURCE,S.: ,
"'l-L.~t '4~{f~.u6"{..' Heatc:J~ ~\Z.1.1t'''
Ha ter Heater v..J In.
. Legal Description /?..~?..':2:2-~ 51. c!J>;> ~C/
! ' , -, Range 1'-' / I)--
~ INSPEfTION LINE
~l726-37 69 _ '
_ J~b Address( ~wJ.eO\>"""~ (
~
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~
,
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Address
DESIGN TEAM (name)
: Primary '\?:,\-I).-'. I:""ft.
6~ Je::. b
~-y-c.p{
(Dhone no. J
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~n 1 ':1 " ") os.
Electrical
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9(:::) cKcox 71..J-
S\. \ u ~^4":>ev c..?n c:c! ~8l -0'3"3:)
Structural
If
r1echani ca 1
CONTRACTORS
I.
(name)
(address) (lics. no.) (exoirps)
. I . ..,...., 0' 'C; J~-If't ..
C50~ ~ """-\.Y-" It L......-z- J ...u~ cl ~ c..~" S' - ~ I
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(r:>hf)n~ nf)- )
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.5""-17-,.)-, I
Plumbinq
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t (
(91)Y't(O
Genera 1
~lechani ca 1
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S57P.5
Electrical
PLur,IB I NG
NO.
Each single fixture
Relocated building -
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
~Ja ter servi ce
Sewer
Storm Sewer
TOTAL CHARGES TOTAL CHARGES /S.. -.C> TOTAL CHARGES
, WHERE STATE L'l.H REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical 'Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~1INED 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 OCCUPAf1CY 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
ooly "",oote,,toe, 'od 'mploy", who 'c' '0 ,0m,li,0" with ORS '01.055 will" ",d '0 th~"t.
lJAr.1E(please print) Lc> c;. 0 ~ ~.J~..::::.a....v <;,J . SIGN^TU~ ~
FOR OFFICE USE ONLY
So. Ftg. 11ain~~rvalue~.....<~
Sq. Ftg. Access x Value.
Sq. Ftg. Other.r~~~74''''9 Value /6...3';;::>
~ TOTAL VALUATION
rk" 8-:;>- 9 ~ ~ /'?9:<O
Systems Devilopment .'~" Co ~
CharCle (1.5,) _~./J"_ ~
DIl.TE 7- t q - f!( 0
Zone R c.. .
Type/Const. ~~~
Flood Plain
Stori es
/
Units
Occy Load
Occy Group
~~
~-"2
Fire Zone
Bedrooms
BUILDING PER~1IT
Charges and
Surcharges
L2":;>O
-- ---------
.8'f!f!:
Plan Ck. Comm/Ind
65%/Blda Per Fee
Plan Ck. Res
30%/Bldq Per Fee
/I- 38
PLUt~BING PERMIT
Charges and
Surcharges
Fence
. .y~~ :ic7i'-l"
~ <x~S-
/"5a
--
D6mo.
ELECTRIU.L PERfHT
Charges and
Surcharges
. .
_ _ -4S~, ""'-\Sid'W'" p'$Z~g' S?
\.: - ". 79' ~/C Paving
-'
Tota~,Comb. Permit
/~~.3'g
MECHANICAL PERMIT
Charges and
Surcharges
"
Curb Cut
"
TOTAL
~;::;:J.i/":::::j,;~"-, ~
,~, '.. /,t#,.&:- .
" -
~
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 and construction lender
D. Energy Sources
'1. example~ heat/electrical ceilinq/or forced' air gas
2. example- waterheat~r/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
Structura I Spec i a I ty Code .
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division ~taff must be able to _c;ontact, appropriate
personsr.eg?rd,ing ,design information' or-job sHe
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-ln 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 be~n 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
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. _.
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 payabl~ 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.
';. .
III.
IV.
V. FOR OFFICE USE ONLY
4'
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P.ERMIT VALIDATION
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Permit
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registra~ion with the Builder's Board because:
, r
Additi ona 1 Project InfoP)llatfon:
'\.
, ,
PLANS REVIEWED BY:
L.,p~.#E ~<.-<:...~s;gnature..~
., /'
name
date
?- ?/-~tt::S
/