HomeMy WebLinkAboutPermit Electrical 1987-9-15
Guildnq Permit Info; Describe Hork(i-.e., Build Single
:~~5^tt~,
V
HISPECT 1011 LI liE
726-3769 '
Job Address
C I TV UF SPR HIGF I ELD
COIIBlilATlON APPLlCATlON/PERMIT
E1IERr,y SOURCES,
Heat
t'la ter Hea ter
Legal
'3 ;L @:5 K katuP../J
De,cription /702 _3) 2- / m(o(}/ ~
RaMe
Valur of Hark:
Owner
r/:JfJAJ-ed
~-t;l/r.
J
Addrcss
Construction Lender
2;?U
Address
Ut.~llifj ftAr-'
Phonc
(address)
(name)
( 1 ics. no.)
,(~
v/ ~'~U()D
L'},
Primary
Structural
Electrical
!1echanical
CONTRACTORS
t NFORJ1A T: ;:1 L: ..:. I:
726-3753
Sa. Ftq. r':ain
~q. !='tg. Access.
So, Ftg, Other
!lei" Add Alter ~eD.
--Fence Demo ChangelUse
Other -- --
~\
~I
I~
jl~,
( exni res)
(onone no. ,
:. ,J 1'1
\t
(lies. no.)
(ohnnp nn 1
(name \
(address )
Genera 1
Plumbino
Electrical
{)uJ1lft/
'.\echanical
(eXD~ res',
PLUIIBHlG
ELECTRICAL
~ , MECHANICAL
FFF I CHARr.F -'!Q.....
I
I
I
j
Electrical Contractor, the electrical rortion of this perQit "
Supervisor and returned to the Building Division
I
I HAVE CAREFULLY EXNlINEO the completed ap!11ication for germit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work aerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Oreqon pertaining to the work described herein. and that flO OCCUPAIKY \'Iill be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board 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 employee, who are in comoliance with Or.S 7nl,05~Wi~1 be use~on ~~Oje
/lAilE(please pnnt) HCLrr.J.j [. cl~ve.Itl.l-tl_ SIG11^TURE~
FOr. OfFICE USE OIIL Y
'Sq. Ftg. rlain
So. Ft9. Access
Sq, Ftg, Other
SysteQs Development
Charoe (1.5',)
I
I", 0, # / ./i}.,Ali
(3(~ j<,' I
;:0.
'-.ElL CHARGE ~'
Residence of
Each single fixture
IRelocated building
(new fix. additional)
l's.F. Residence
11 bath I
IDuPlex (I bath) each
IAdditiona1 bath
I~!ater service
I Sewer.
SQ, FT.
1- New circuits alts.
or extensions
I SERVICES
I
I Temporary Construction
I Change in existing
rpc;iderH"p
I I mul-t{r'amily, corrrn. or
Tnrtu<;tritll
I Of amps.
I' C0I11-1,/IND, FEEDERS
I I Install/alter/relocate
rti<;trih_ fpprtpr<;
1..-, I Of amps.l
~li) } I
\.V I
I I
Storm Sewer
I
I
-I
I
I
TOTAL CHARGES J TOTAL CHARGES
WHEnE STATE L'H REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Fire Zone
Flood Plain
Ocey Load
Oec'y Group
BU I LD IIIG PERI,II T
Charges an~
Surcharges
I Plan Ck, Conm/lnd
____________ 65%/BldC1 Pyr Fpe
Plan Ck. Res
30%/Blda Per Fee
I Fence
------------
PLU'1BlNG PERMIT
Charges and
Surcharges
Demo
" ~,.l-)
CV
,ELECTRIC~,L PERI:IT
Charqes and ~).
Surcharges Y \
_ ____LS-:_o:!?._ Sidewal k
. (of) AIC Pavi ng
I
I
I
TOTAL
furnace/burner to
BTU's
F J:JJARliL
r
I
I
I
I
I
I
.1
I
I
1
I
I
I TOTAL CHARGES
Floor furnace
and vent
Recessed wall
,n~~p hp~tpr ~nrl u~nt
Apoliance vent
'il?oari'lU>
Stationarv evan.
cooler. ,
Vent fan \'lith
sinole duct
Vent system apart from I
heatino or A.C.
MeChanical exhaust
hood i'lnd du~t
Wood stove/heater
ISSUANCF OF PFR/IIT
x
Value
Value
Value
x
x
TOTAL VALUATION
.20
IIECHANICAL PEP.11IT
Cha rges and
Surcharges
Curb Cut
Total Comb. rermit
------------
15. gD
~
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B. legal Description
1. example. Tax lot 100. Lane County Map Reference
17 oj 43
2, examole' 'Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced air oas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house, 500 sq, foot garage
2. example- T71new project. check-new - if addition,
check add. etc. .
F. Building permit information";
1. example - 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, OESIGN TEAI'I 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.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank soaces 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
B. 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 ON THE SCHEDULES
o. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electr,ica,l Jabel,. _ ~
AppTican't 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. '
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.
II.
"
be delivered to the
by his electrical
is not au~~o:ized
JJI.
IV,
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
f
PERMIT VALIDATION
g0~(l?-
~~(t)-r 1
J
Permit Clerk
a--
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
i
PLANS REVIEWED BY:
.,
I
name
signature
J
date