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HomeMy WebLinkAboutPermit Electrical 1987-9-11 /4FOR/1AT: _:4 ll,,~ 726-3753 So. Ftq. I-ia in_' -'"<XJ ~q. F't!}. Access. So, FtQ, Other -'le\"~-y.lter_~eD. Fence Demo Change/Use Other - - 1 fJcV{ .+I;'v U I 2.7<, ~:kf.. ...4, I r::zar of-. :ek~dZ'\Q ~"'tcJc.....L..C- () I, (lies. no.) (exnires) (nhone , IrSPECTlorllllE C1lYUFSPRlrIGF/ELU r" 'r 7i6-'3769 '.; CO/IBIrlA1ION APPLICATION/PERMIT I' 'fl Job Address ':>52.3 ~.1~ ~}\nf , ~~;~rJ7~ht,QQS · I D 't' . \ .. AJ"o. Ilater Heater ~<'~JllJl, Le9a e'cnp 10n I -; -()~ - "2-2..- 2-- "'1'2- ==-IV!. J Ranlle Owner "'S&fC\V' b, C(l('~-h,fl\.) , Address 340.5" t:o.ld"T- 01 vr, ---;'hone7%-, 0(;, ~:etd ((}<-1,1' Q74.'77 Construction Lend{y) ~.A/A . Val u, n>f 1:'')1'_1<: If 5'OCO, CO uih;ina Permit Info: Describe Hork(i.e.. Far.li 1 V nes idence l'lith /I.ttached r.araoe) Address DES I GrI It^" fname Primary ""':J\ \NJI 1\ 'b, C~)c.p , (~(!)r )~(f {.S , ' W-O.fVI S ~SIC; 1.:5 (D:::r./Ol I f-br/v'/J ) qJ f\(J q., d'\ ' Structural Electrical !1echanical CONTRACTORS fname\ 3ressl (lie<, nn,l CMpOVCl--hf\ ( L\'J+e..c( a0ouc::..) (exn~ rps', (' uW/f/I.(ACfa! General ~,.,"' ~ V\ () \~ [) OtJL\OU-\ ~'lll to $ V\ ()\o!..t'_ lirl7Orc... 10/07 Plumbino C(tl(' , Electrical 1_-"p.,1 ".VI ~d, .:;y-,. II,,~ Hechanical PLurlBIrlG ELECTRICAL MECHANICAL ;:0. 'E HARGE II, Each single fixture Residence of furnace/burner .to BTll's SQ, FT. :,. -----/Relocated building (new fix. additional) I IS,F, P.esidence I I (I bath) I Duplex (1 bath) each I I IAdditional bath I. I Temporary Construction -----I~!ater service I I ,- .r-ICha~ge in existing I rp~.1 rl..f'nre ISewer I I I Imultifamily. COITrn. or Inrl[J<;triil.l I Storm Se"er I I I I Of -----I I --I r ICOm1./IND, FEEDERS I '++llnstall/alter/reloeate ~lh_ fpprlpr<; I " Of amp..1 , I I I II I , I Apol iance vent 5poaratp I Stationary evap. cooler I Vent fan \'Ii th sinole duct I Vent syster.l apart heatino or A.C I ~lechanica 1 exhaust hood il.nd rllJrt I Hood stove/heater I I I ~"New circu~ts alts. or extenslons '2 CP >v;..,RE I ISERVICES S< I Floor furnace and vent I Recessed wa 11 ~Oil.CP hPil.tpr il.nrl VP"t amps,l TOTAL CHARGES WHEP.E STATE L~W REOUIRES shall not be valij until the ISSUANcr OF PFR!lIT TOTAL CHARGES "Z'2, 50 TOTAL CHARGES Sui Id Single d 10 IE) J I~ ,- no. J '( r?--/;V ({{L ihPr -'/92,R (ohnnp nn.) 7t/rc-!1WC/ 3'is: 087'-1 from T I I I I r I I I I I I I I I I I I that the Electrical work be done by an Electrical Contractor. the electrical nortion of this permit label has been signed by an Electrical Sunervisor and returned to the Building Division I HAVE CAREFULLY EXM1INED the completed aprlication for ~ermit. and do hereby certify that all information hereon is true and correct. and I 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 State of DrelJon pertaining to the work described herein. and that IlO OCCUPAIlCY \"i11 be made of any structure without the permission of the Ouilding Division. I further certify that my re9istration with the Builder's Ooard is in full force and effect as required by ons 701.055. that if exemot the basis for exemntion is noted hereon. and that only subcontractors and employees \'Iho are in comoliance with OP.S 7111.055 l'/il1" be used on this nroject. 11A:IE(please print) !lJdv A, f2rber-& SICIlATURF. FO:: G~nCE USE DillY /4- g 6:<-I.L;; DArE '/-/1-0"'7 Zene Cr. Fire Zone Flood Plain Tyee/Const, ~-~ Bedrooms Stories -L Units Dccy Load Oee'y Group A- '3 Sq. Ftg. l1ain )C SQ. FtIJ. Access x Sq, Ftg, Other..(IDD /-gJ-::z'if Value Value Val ue ,v.5".a::>,...." BUILDIrlG PERI.11T Charges an~ ""\ Surcharges d- T01AL VALUATIOIl Systems Development ~~:;:) Charoe (Un ...:..::.--'h"7,10 Fltf,/~ (omb. rermi t PLUI1B IIlG PERMIT Charges and SurCharges .c' L". Plan Ck. Conm/lnd ~~. ~~ 65t'Bldo Ppr fpp -------~:,;--Pian Ck, Res ' -::z.. -' ~ 1 30%/81 do Per Fee r---------,--I ::::e ,ELECTRIC~.L PERI~IT Cha rQes and Surcharges Y I1ECHANICAL PERHIT Charges and Surcharges I S1dewalk J A/C Paving I Curb Cut I -__22'2"='__ /,/3 ------------ ITotal I TOTAL I 7'2,66 tt .. \ . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I, Applicant to furnish A. Job Address B. legal Description 1. examole- Tax lot 100. lane County Map Reference II OJ 43 2. example- lot 1. Block 3, 2nd Addition to ~prlngfieJd Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examl?le- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- J250 sq. foot house, 500 sQ. foot garage 2. examole- if new project. check-new _ if addition. check add, etc. F. Building permit information': 1. example - construct single family house with an attached garllge 2. examole - remodel existing garage into family room 3. examole - 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 TEM1 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 8. Full Plumbing, Nechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit fonm the schedules have been abbreviated . 2. If the item{s) to be installed are not covered on .the abbreviated schedules you should consult the fu 11 schedu 1 es , C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO 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. {D275' q/tt/o1 " V, FOR OFFICE USE ONLY I I Permi t Clerk Cf/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 1 i " , , I Permit applicant ex~mpt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: , signature ~.--? ,,'" (~ date 9-2:<-8? . name ~R/V6' NC?i ~