HomeMy WebLinkAboutPermit Electrical 1985-11-27{^l,r'o/ 6
LII{E
c0r1BI APPL I
Job Address
Legal Description
Ranqe
EIIERGY SOURCES:
I'later Heater
,a7
Owner
Va I ue of liork :
Sq. Ftg. Access._
0therSq. Ftg
llew Add Al
. l'la i
Address Phone ng Pernit Info: Describe Work( i.e., Build Singie
-Eesidence I,li th Attached Garaoe)
Builcii
Fami ly
Construction Lender
Address Phone I
)oL\
\
DES I GN TEAI,I name addres s l/exDt res ohone no-
Primary
Structura l
E l ectri ca l
Hechanica l
CONTRACTORS name addres s 'I ics- no-'pYnl rp<ohone no.
Genera l
Pl umbi nq
EI ectri ca l
ilechanicai
PLUIIBI NG ELECTR I CAL I'lECHAN ICAL
FFF CHARGE N0.FFF l^TA PNF NO FFF CHARGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTU' s
Relocated buiiding
(new fix. additional)New ci rcui ts al ts
or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
seDarate
l.later servi ce Cha
req
nge in existing
'i dencp
Stati onar-v evap
coo I er
Sewer mul ti fami Iy, conm. or
Indrrstrial
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
COr,lIt./IND. FEEDERS Mechanical exhaust
hood and duct
I n sta I i /a i ter/ re1 ocate
di ctri h. fppdprs l'Jood stove/heater
0f
/n UOn
ISSUANCF OF PERI{IT
TOTAL CHARGES TOTAL CHARGES tD 40 TOTAL CHARGES
WHERE STATE Lll,l REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valiC unti'l the label has been signed by an Electrical Supervisor and returned to the Buildinb Division
{()DATE rSIGNAl,lAl.lE ( p1 ease pri nt )DotAnt ,,+LExA4ro4t
for oermit
pe rfo rmedt any and al
te of 0regon
n of the Buiof any
Board
n9
701 exempt
055 wi l
,Y aheredoFULLI NEDEXAH the etedI a c ta I n 'It 0n nhereo s'I trueatncertcompb.ypr)
nd co t and woI rkrrecIrtherfucertitha II I nfyshabedone a ccordance wl th he na0rdi esnc theof TCt ty
Ie ad ndof the ofLaws sthe ta nT n'I to th k Iworng fiSpri and NCthat Y0ccuPAr'rc IWI beI madeedescrherebedntoe rta
Itrucswltu re tthou the 1ss o dI I D 'I 1 0n1 I 1permiScfurtherert atth s'|titra t r'lon +th Dhe der SutIfyregmy
'|n Ifu I 'Iforceefandtfecas1uredORSthaI+f055 ba 'Is fors t on 1 s hereonnoted a thatndthereqexempby
on ntrasubco andctors 1 s arewho nI I 1 WI 701yempoyeeanceth0r?s 1 be sedu no 1th tecIcomcproj
Fire Zone Bedrooms 0ccy Load Sq. FtS. Access x Va'l
Flood Plain Stories 0cc.y Group Sq. Ftg
TOTAL VALUATION---
Fto. l,lain
. 0ther
Iits
x lue
Zone Tyoe/Const. Un
rVa
Pl an Ck. Cornm/ I nd
65%/B1do Ppr Fec
teris Deverqe t1.5%
Svs
Cha
opmmtBUILDING PERI'IIT
Charges and
Surcharges Plan Ck. Res
30%/Bldq Per Fee
FencePLUt4BING PERMIT
Charges and
Surc ha rges Dgmo
Sidewa l kELECTRICT,L PERI1IT
Charges and
Surcha rges
lo,oo
Tota'l Comb. PermitA/C Paving
Curb CutHECHANICAL PERMIT
Charges and
Surc ha rge s 2.Ar,-UL,llW | .zo rcfulOTAL
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ue_
coMBINATI0N AppLICATI0N/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. SIgI!.lg-: Tax Lot 100, Lane County Map Reference17 03 43
PERMIT VALIDATION
2.examol e-
sEmnlri
Lot L Block 3 , 2nd Addition toeld EstatesC. Name , etc.of owner and construction ienderD. Energy S 0urces
I examp l e-
examp I e-re foota
heat/eIectrica I i I in or forced air gas
2 wa ea e sol arE. Squa ge or valuat on, etc.example- 1250 sq
example- if new
check add, etc.
foot house,500 sq. foot garage
2 proj ect, check new - .if add.ition,
II.
F. Bui lding permit information:l. examp,le - construct single family house with an
- attached garage
?. !*?rp]. - remodel existing garage into family roomJ. exampte - convert single family residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of the. Structural Speciaity CodeH. DESIGN TEAI.I AND CON1RACTORS
]g lygid 9:tis^n or construction detays, Buiid.insurvrsion Staff must be able to contact appropriitepersons.regarding design information or jbO iitecorrections, etc.
Abbreviated Plumbing, Mechanical, E Electrical SchedulesA. txcept where blank spaces occur in the descriptionportion of the Mechan.ical and Electrical Schedules,the applicant need fiil-in only the No. Boxes jajii"nt
_ to-the appropriate item(s) to -be instailed8. Full Plumbing, Mechanical, and EteCirical Schedu.lesare avaiiable at the Buiiding Division1. To conserve space on the-permit form the schedu.leshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to theelectrical contractor for signature by his electriiai'-supervisor. The general con[ractor ii not authorized
Applicant to sign and date
Hhenever possible, the initia'l application wil.l be used asa.worksheet only. Where possible, Building Division Stafiwill.prepare a type written copy and returi it to theapplicant at the tjme the actuai permit is issued toi tris
s i gna ture.
Fees and Charges
Plan check fees are due and payabie at the time of theapplication, and no plans wiil-be proceiied until thesetees are paid, All other fees and charqes are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
Permit applicant exempt from registratjon with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s't g nature date