HomeMy WebLinkAboutPermit Electrical 1989-11-28
lrl)PECTIOfl lliH:.
726.3769
.. LIlY UI SI'RIIlGflELU .
_..-- COIIBIIIATlOM APPLlCATIOMfPERMIT
- E!IERr,y SOURCES: ____ (
Job Address Ss 20 6~.gv -ff2JNbPf<v.J Ileat ____
I.egal Oe,cription \(1 0768bl Q() rD~ Ilater II r
Owner
~onc. j/-s-,m!o~
o &"'. 2poi'
,
~' {)It:
,\ddrcss
C,-,,> @vtf '
'7 7-10 '-
Constr-uction lender
,\Jdress
ot.SIGfl Il^1\
tnameJ
Primary
Structural
Electrical
!1echanical
CONTRACTORS (name I
General (";,otflhvD' ~f.-huf
,
Plumbina
Electrical
"p.chClnicCll
PLUI1RIrlG
~
Hf
(HARr.r I Nn
Each single fixture
Relocdted buiiding
(new fix. additional)
IS. F. Res idence
{j bath I
IDuPlex (I bath) each
jAdditional bath
~!ater service
Sewer
Storm Sewer
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-I
)
TOTAL CIlARGfS
[,IIlERE STATE L,i11 REQUIIIES
shall not be valH until the
Zone
Tyoe/Const.
Fire Zone
Bedrooms
Flood Plain
Stories
BUILOIIIG PERI,IIT
Charges an~
Surcharges
------------
PLUI1BING PERMIT
Cha rges and
SurCharges
,ELECTRIUL rERI~1T
Charges and
Surcharges
I\WIMIICAL PEP.l1IT
Charges and
Surcharl)es
r;~
ValUE" of Hor
(I ies. no. I
(address)
NJ" fJ -ef/;~ ;PY/~;;"tf
(1 ire;. no. \
ELECTRICAL
I r.rr
Irl-lI1R.GL'~1
Residence of
SQ. fT.
--r
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New circuits alts.
or extensions
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ISERVICES
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ITemporary ConstructiQIl
IChanqe in existing
rf'sidf'nrp
Imultifamily, CQnlr.l. or
Inrluc;.triill
IOf
I C0I111,/I NO, fEEDERS
Ilnstall/alter/relocate I
rlic;.trih_ fpf'cff're;
Of amps.1
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amps.1
NfORlIAL .:1 ll..:,
7Z6.3753
So. Ftq. folain
~q. HI). Access.
SQ. Ftq. Other
--'lel'l_l{d~_Jl.1 ter _~eD.
Fence~mo Change/Use
Other -
(exo;res I
(exoi rpc;. \
MECIlAMICAL
furnace/burner to
BTli's
Floor furnace
and vent
I Recessed wa 11 . .
~n~rp hp~tpr ~nrl
I
I Apol iance vent
c;.poal'atp
I Sta"t i onary evap.
cooler
I Vent fan \'lith
sinole duct
I Vent system apart from I
.heatinq or A_C
I ~lechanical exhaust
hond ilnd rlort
I Hood stove/heater
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ISSIlANCf OF PfmllT
(ohone no. I
(nhnnp nn )
72(; -/'1,n
",pnt
lrn-
,-
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rlJARliE'
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t\ (A I TOTAL CIlARGES
that tltel Electrical \.mrk be done by an
label has been signed by an Electrical
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'00 i
0!
h}J!
I [)uil(;inQ Descnbe I-Jork(l.e., Build Single I :
Phon~-<lV~1 f~P;~\I:~+-.~~~ ~1~l1 V\ )'\(' ~ ~ I
Phnne: ~A.~~~ \~~f\(\~ c\ .' I
{address}
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1\ I A I TOTAL CIIARGES
Electrical Cc+,tractor. the electrical portion of
Supervisor and returned to the Building Division
Systems Development
Charoe (1. 5'.)
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Units
Oeey load
~ccy Group
Plan Ck.
65%/Bldo
Plan n.
30%lB1 do
Corrm/lnd
Ppr Fpp
Res
Per Fee
f HAVE CAP.ErUllY EXNlINCO the completed aprlication for I)ermit, and do hereb.v certify that all information hereon is true
and correct. and [ further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Sor i n9 fl e 1 d and the Laws of the S ta te 0 f Orenan oe rta i n i 09 to the work descr i hed here in, and that UD OCCL!PAIlCY \~i 11 be made
of any structure without the permission of the ~lJildin~ Division. t further certify that Illy reqistration "lith the Builder's
Goard is in full force and effect as re(]uired by Or,S 701.055, that if exempt the basis for exemntion is noted hereon. and that
onlc.:A~d emr~ees ~re in comOli~ 70UJ55 will be used.on this nroject.
!1A:\E(p1ease nrint)~h>&e<. ~~;z,1v6 SIr.Il^~~~
fO~ OffiCE USE Q;ILY
So. rtg. l1aio
SQ. FtlJ. Access
Sq. ft9, Other
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,- k -+ S'1"e> 1
I Ale PavinQ I
I Curb r.ut I
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Fence
\Pi .00
- ,q()
OF-mo
x
Value
Value
x
x
Value
TOTAL VALUATION
ITotal (omb. rp.rmit
l-oT"
Ill.! 1\l
1\ IA
thH perr.lit
DATE
#'~~
{8,90
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COMBINATION APPLICATION/PERMIT (CAP)
L Appl icant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
II oj 43 .
2. examole- lot I.' Block J, 2nd Addition to
.Sprlngfield Estales
C. Name,'etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilino/or forced air Qas
2. exampJe- waterhealer/eleClt"icil i/or solar
."E. Square footage or valuation. etc. -
1. examole- J250 sq. (oat house. 500 sq. foot garage
2. exampJe- if new project. check-new _ if addition.
cheel add. etc.
f. Building permit information:
l. examole - construct sinyle family house with an
attached giJrc!lge
2. eXdffioJe. remodel existing garage into family room
3. examole. COuvert 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 TEAl,! AND COIHRACTORS
To avoid design or construction delays, BUilding
Division Staff must be able to contact appropriate
persons regarding design infonmation 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
'8. Full Plumbing, folechanical, arid 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 AlID
CHARGES ON THE SCHEDULES
O. 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 \'Iil1 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
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PERMIT VALIDATiON
'~~OlD~S
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Permi t'
""HURl
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
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name
signature
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date