HomeMy WebLinkAboutPermit Electrical 1987-5-22
Tl1ISPECTiOlI LlllE
726-3769 .
Job Address
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Ll TV UF SPR l1IGF I ElD
CDrlBIlIATlON APPLICATION/PERMIT
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ElIERGY SOURCES:
Heat
Hater Heater
legal De~cription
RanQe
ValuE of Hark.:
Owner
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Address
Construction lender
Address
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Primary
Structural
Electrical
t1echanical
CDIJTRACTORS
(name)
Genera 1
PlumbinQ
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Electrical
~.'echanical
PlUllBlIlG
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Each slngle flxture
-----IRelocated building
(new fix. additional)
Is.F. Residence
11 bathl
Ii CHARGE
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Duplex (1 bath) each
Additional bath
~!a ter serv; ce
Sewer
Storm Sew*:r
'1
Zone
Fire Zone
Flood Plain
Tyoe/Canst.
Bedrooms
Stories
BUIlDIIJG PERMIT
Charges an~
Surcharges
PI an Ck.
65%1Bldo
------------ ""Pian Ck.
JO%/Bldn
I Fence
Demo
PlU'lBING PERMIT
Charges and
Surcha rges
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. ElECTRICP.l PER1~IT
Cha rges and '-\
Surcharges
,;;2;:;1..:;; 0 Sidewalk'
--------.-<70-1 A/C Paving
11ECHANICAL PERlIlT
Charges and
Surcharges
------------
1
S51~
t NFORllA r: ..:i lI.., 'i
726-3753
Sa. Ftq. "iain
~Cl. ~t9. Access.
So. Ftg. Other
Uel;' Add /1.1 ter ~eD.
-Fence Demo Change/Use
Other - -
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Buih;ina Permit Info; Describe l.Jork(i'.e., Build Single
Familv nesidence lHth Il.ttached r.araae)
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Phone
Phone
address 1 ics. no. exOl res (ohone no. J
, ' Ci l/CO
~\,?y C/I./ r-, I
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(address) (1 i cs, no. ) (exoires) (ohone no.)
ELECTRICAL
Residence of
sq. FT.
New circuits alts.
or extensions
SERVICES
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<70 I
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CDl1f.1.1I NO. FEEDERS
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TOTAL CHARGES J TOTAL CHARGES
WHERE STATE L\U REQUIRES that tile Electrical work be done by an
shall not be vali~ until the label has been signed.by an Electrical
Temporary Construction
Chance in existina
rpsirlyprp -
multifamily, conrn. or
Indu<;triil:l
amps.!
Install/alter/relocate
rli~trjh_ fpprlpr~
Of -LtrD
amp~1
u~
(/7""
MECHANICAL
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.cJJARG.E..1
, 11
furnace/burner to
BTlI's
I Floor furnace
and vent
Recessed wa 11
~Oil:rp hp~tpr ~nrl
vpnt
I Apol iance vent
seoaratp
S'tationary evap.
cooler
Vent fan loJith
sinole duct
Vent system apart
heatino or A.c.
rlechanical exhaust
hood il:nd durt
from
J
J
\-load stove/heater
I SSUANCF nF PFR'IIT
TOTAL CHARGES
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Electrical Contractor, the electrical rortion of this permit
Supervisor and returned to the Building Division
ComnlI nd
p.pr Fee
Res
Per Fpe
Curb Cut
TOTAL VAlUATIDrI
Syste~s Development
Charoe (1.5<)
Total Comb. rermit
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I HAVE CAREFUllY EXAf1INED the completed ap!11ication for [:lermit, 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 Orel)on pertaining to the work described herein, and that IlO OCCUPAlKY h'ill be made
of any structure without the oermission of the Building Division. r further certify that my registration with the Builder's
Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 7~1.05~~~ed on this nroject. ~
11A/1E(please print)_F 'O~ f )'/IIf.vrfr ';..,/ SIr.IIATURE ~ cm~~ DAT~Ii'/.z-.Z.
' , FO~ nFF i CE USE mil Y / I
Units .Sq. Ftg. Hain x Value
Occy load SQ. Ftn. Access x Value
Occy Group Sq, Ftg. Other x Value
TOTAL
;:2 3, t.j.f)
4t
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100, Lane County Map Reference
'1I 03 43
2. examole- Lot I. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheaterielectrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. check-new ~ if addition,
check add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
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. DES I GN TEAl.! ArID 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, 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 011 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 oossible, 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:
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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:
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PLANS REVIEWED BY:
name
signa ture
date
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