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 ~