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HomeMy WebLinkAboutPermit Electrical 1987-5-22 Tl1ISPECTiOlI LlllE 726-3769 . Job Address .C:; / d -- ~vJ ';C'cV '> Ll TV UF SPR l1IGF I ElD CDrlBIlIATlON APPLICATION/PERMIT .- ElIERGY SOURCES: Heat Hater Heater legal De~cription RanQe ValuE of Hark.: Owner ~~Wo SI:;) ~ Address Construction lender Address IJ Primary Structural Electrical t1echanical CDIJTRACTORS (name) Genera 1 PlumbinQ ~/'- ~hA'~ Electrical ~.'echanical PlUllBlIlG 1 Each slngle flxture -----IRelocated building (new fix. additional) Is.F. Residence 11 bathl Ii CHARGE I I I I I I I I I I I 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 ------------ . 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 - - t2Akj \)? cr I Iv\) .lJ I~ Buih;ina Permit Info; Describe l.Jork(i'.e., Build Single Familv nesidence lHth Il.ttached r.araae) ~crU /IJCJ A~/).i/t/ .L Phone Phone address 1 ics. no. exOl res (ohone no. J , ' Ci l/CO ~\,?y C/I./ r-, I ~ (address) (1 i cs, no. ) (exoires) (ohone no.) ELECTRICAL Residence of sq. FT. New circuits alts. or extensions SERVICES I I ! I I I I I ~ I I <70 I I ~:s'.LI/) I I I I I I I I I-+- Of CDl1f.1.1I NO. FEEDERS I I I I I I 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 I I I .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 ! 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 --, 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: . PERMIT VALIDATION 8ad. 9/ b-22~t1 .I CC- Permit Clerk l ~ j Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: 1 PLANS REVIEWED BY: name signa ture date 1