HomeMy WebLinkAboutPermit Electrical 1989-5-2
Value of Hark:
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I Guildna Permit Info: Describe Work(i.e., Build Single
Far.lilv P.esidence ,.,i th fI.ttached r.araoe) <.
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Illes. no. I
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IilSPECTIOU Llijf.
726.3709 '
LIlY uf SI'RIIIGfIElU
COIIB iliA T! ON APPLI CAT! ONfPERMlT
.
Job Address 3S-,Jv, G/Jr6'VA'1
l.e~.l Oe<eription \IO~?-,L7_0Cf)~
E!IERr,y SOURCES:
Heat
!-later Ileater
RanrJe
Owner JJ.4('1'/'\ ('
:.....<..
V,.~ .. '.' !-"l
NfORJIAT: .:/ L.",
726-3753
So. Ftq. "lain
~q. ftl). Access.
So. ftq. Other
llel1 . Add Alter ~eD.
-Fence Demo Change/Use
Other -- --
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O!
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:
,\ddrcss
Phone
I..1IL' J:JlIlJlGE .1!ll.....'
Residence of I
SQ. fT.
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p2.~ ."'()~-
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conr.t. or I I
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I C0I1/1. {I NO. fEEDERS I I I
\ II~stallfa1ter/relocate h", ('\ '2Q'\
I rll'".trlh fpprlprc; r//. L,:--r-
10f amps.1 - I
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TOTAL CHARGfS , TOTAL CHARGES IJ TOTAL CHARGES
HI/EnE STATE L.\\J REQUIHES that tile Electrical \'iork be done by an Electrical Contractor, the electrical nortion of this pen:lit
shall not be valH until the label has been signed by an Electrical Sunervisor and returned to the Building Division
Construction Lender
,\Jdress
OESIGll flAil
tnameJ
!'hone
{address}
Primary
Structural
Electrical
C' \~"'~ ~\.)
2~-18(,
\.('\p '\.
!lechanical
CONTRACTORS
{name 1
(address)
(lirs
Genera 1
Plumbino
Electrical
S~ M PIII-I-.
2Z-9.?'c...
/ :s ffh 17;11.6,,; 51."
t1echi'lnici'll
PLUrmlllG
ELECTRICAL
no,
FIF
f.IIARr.r
J1L
Each single fixture
I Relocated bui lding
(new fix. additional)
'5. F. r.es idence
(I h<1th I
Ouplex (1 hath) each
INew circu~ts alts.
or extenSions
ISERVICES
\1 \...ffi ~y.,V
I Temporary Construct inn
Additional bath
!Hater service
IChange in existing
rfl<. ; denrp
Imultifamily,
Indu"tri;11
Sewer
I
Storm Se\./er
10f
amps.1
(exni res I
{ohone 'no. J
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'iiZg -31..2.<j
nn I
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P.; ? -3/.2..9 .I
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vpnt I I
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(PXOll"PC;;\
(Ilhnnp "" ,
MEClIANICAL
furnace/burner to
BW's
I Floor furnace
and vent
Recessed wall
c;otl.rp hPi'!tPl" i'nd
I Apol iance vent
c;;eo.at'tl.t:.p
I Stationary evap.
cooler
I Vent fan \'lith
sinnlp duct
I Vent systeM apart from I
heatino or A.C,
I ~lechanlcal exhaust
hood and durt
I Hood stove/heater
ISSUANCf OF PfR!lIT
I IIAVE C^I~ErULLY [XNlItlCO the completed aprlication for ~ermit, dnd do hereb,v certify that all information hereon is true
and correct. and f further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the Stilte of OreC)on f.lertaininl) to the work described herein, and that riD OCClJPAUCY ,~i11 be made
of any structure without the permission of the (111ildin~ Division. I further certify that I'lY refllstration \-/ith the Builder's
Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemption is noted hereon. and that
orily subcontractors and cr.lployees ",,'ho are in com:Jliance with Or.S ]111.055 \'Ii11 be used on this nroject.
IIArlE(please fJrint)
slr.l/i\TURrf'~_-,- d.&
FO~ Off I CE USE Dill Y
Zone
Fire Zone
Flood Plain
Tyne/Const.
Bedrooms
Stories
l/nits
Occy load
Occy Group
SQ. rt!l. t1ain
SQ. HtJ. Access
SQ. Itg. Other
DATE j": 2.. "Jl1_
x
Value
Value
Value
x
x
TOT AL VAL UA TI ON
BUILDIIIG PERl-IlT Plan Ck. Corrm/lnd IShste~s Oevelopn~nt
Charges an~ ------------ 65!/Bldn Ppr Fee 'C arQe (1.5')
Surcharges Plan Ck. n'es I
' 30!/Bl dn Per fee
PLUI1BING PERMIT >:'f I Fence I I
C!1arges and ------------, I I I
SurCharges OP,RIO
'1~.(X) n -- rJ-- _u "--
,(L(CTRIUL PERI:IT I Sidewalk. I __'_ oc..\.l~'). I .l(0
Cha rgcs and - ---~-.~-i5:--- I Ale PavinQ. I ITotal I
Surcharges (ol'lb. rermit j
flECliAtrlCAL PEP.1l1T I,Curb I I'~;TW'
Charges and Cut , ~8.~
Surcharf1es '- -----------71- I lit.: \
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COMBINATION APPLICATION/PERMIT (CAP)
l.
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Applicant to furnish
A. Job Address
8. legal Description
1. example- Tax lot 100, Lane County Map Reference
J/ UJ 4J '/
2. examnle- lot 1. Clod J. bid "Adl.J.iUon to
J.. ,.Spnngf-iel.d [~tates r' ,I
'..'C. Name,/'etc':- of owner-and construction lender
'0. . Energy Sources /. I
1. examf?le. heat/electric~.!_c_~iJin.9lor forced air Qas
2. examole- wdterhealer/cl~ctrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- J250 sq. foot house, 500 sq. foot garage
2,' example- if new project, checknew _ if addition, t
check add, etc. / ,!
..
F. Building pe-nn1t information: / .'
1. examDle - construct 5inyle family house with an ~
at lached garage
2. examole - remodel existing garage into family room
J. exarnule - COrlvert single family residence into
res taurant (change of use)
G. Value of \'Iork as _defined in Section 303 (a) of the
Structural Specialty Code
II. DESIGN TEAl,. AND CONTRACTORS
To avoid design~or construction delays, BuilcJing
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
Abbreviated Plumbing, Nechanical, & Electrical Schedules
A. Except I'Ihere .blank spaces Occur in the description
portion of the Mechanical and Electrical Schedules,
the appllcant need fill-in only the No. Boxes adjacent
to the appropriate item(s} to be installed
B. Full Plumbing. Nechanical, and Electrical Schedules
are available 'at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
Z. If the item(s) to be installed are not Covered on
the abbreviated schedules you should consult the
full schedules ... .
C. BUILDING OIVISION STAFF WILL FILL OUT ALL .FEES AllO
CHARGES UN THE SCHEDULES
o. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
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
wilt 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 \..dll be Processed until these
fees are paid. All other fees anti char9cs are due and
payable when the permit is issuetl.
II.
be delivered to the
by his electrical
is ~ authorized
I I I.
IV.
V.
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FOR OFF! CE USE ONLY
Permit'Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArICY:
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PERMIT VALIDATION
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
. ~ . .r. . I I '
PLANS REV~
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date S-2:-~