HomeMy WebLinkAboutPermit Electrical 1990-4-17
Job Address
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Legal Description j 1 r D? ..:;34 - , I
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W~tll'l-r
... c:ey I):' SPRINGFIELD
. CC~Bli'iAT;ON APPLICATlON/P~Ri1IT
EiiERGY SOURCES:
Heat
\~ater Heater
Ran~e
Valu€ of Hork:
.
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l'rtISPECTlOII LItlE
1 726-3769
INFORlIATION LINt
726-3753
Sq, Ftg. '.Iain
:q. Ftg. Access.
Sq. Ftg, Other __
tlew Add Alter Rep,
--Fence Demo Change/Use
Other- -
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Owner /l<.J...t.,L1"
Address Of( /} t;
I. ,(00 I
Phone
Builciina Permit Info: Deser be Work{i.e., Build Single
I F~mily ~esidence With Attached Garaae\
Construction Lender
Address
DESIGN TEAl1
{namel
Phone
laddre~sl
(1 ics. no.l
(exoires)
(ohane no. .
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTORS
(name)
(addr~ssl
flies. no. \
(exoirf!s\
(ohnnf! no. \
General
Electrical
Nfli) WfiJ./I .fJUkiL
J
1'pvI.tf~. r->"
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6ioH
fx(. Ir21- jb
Plumbina
~'echanical
PLUl,lB I NG
ELECTRICAL
MECHANICAL
NO.
FEE . CHARGE Nn
':E.L.c.lJAB.li.E. NO,
""-' .ldlARliL
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building .
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath 1
Ouplex (1 bath) each
Additional bath
SERVICES J ()/J fMnp
'l;t,1lJ
Recessed wall
Sn~rp hPAtpr Anrl vpnt
Storm Sewer
Of
amps.
Appliance vent
~~DiI ra te
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilnd rllJr:t
Sewer
Temporary Construction
Change in existing
rP5 j qr."ce
multifamily, camm. or
Tndustrial
Water service
COffi~,/IND, FEEOERS
Install/alter/relocate
dic;tr;b. fpeder<=:
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
ISSUANCf OF PFR!IIT
, TOTAL CHARGES , TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 tID OCCUPAIICY will be made
of any structure without the permission of the Building Division. I further certify that my registration "ith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon. and that
only subcontractors and emplOyee~ who are in comoliance with ORS 70I.a2.e~~~ecio-l-tj2.-
HAt.IE(please print)~1' j,L~M(~1 SIGtlATUR _' . '.4. ( /~.-/, ___ OATE L/-/ .7-:711
I FO~ OFFICE USE miL Y"" p.-- ~
Un'its Sq. Ftg. riain e( Value
Occy load Sq. Ft9. Access x Value
Occy Group Sq. Ftg. Other x Value
Fire Zone
Flood Plain
Tyoe/Const,
Bedrooms
Stories
Zone
TOTAL VALUATION
BUILDING PER/lIT
Charges and
Surcharges
. Plan Ck. Coom/! nd
65%/Rlda Per Fpp
------------ Plan Ck. R-es
30~/Bldq Per Fee
Fence
Isyste, ms Development l
Charpe (1.5~)
PLU'~BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERIHT
Cha rges and
Surcharges
2-2. C;-O Sidewalk
------------
) , ) :.3 A/C Paving
Total Comb. rermit
MECHANICAL PERMIT.
Charges and
Surcharges
Curb Cut
--'j/F--n---
t//, f..g-:3
TOTAL
)3, Ltg
........-:
.
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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 4j
2, example- Lot I. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examPle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
I, 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. examEle - 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 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
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
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Permit Clerk
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Permit applicant exempt from registration with the Builder's \Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date