HomeMy WebLinkAboutPermit Electrical 1984-12-03INSPECTION LINE
726-37 69
m
COI{BI NATI ON APPL I CATION/T
TNFORI{ATTON LINE
726-3753
k
b,\
t\.
Job Address IQO A ^Yx-s4wurylu ,,
EIIERGY SOURCES:
Hea t
l'Jater Heater
Ranqe
Sq. Fto. l,la'in_
Sq. Ftg. Access._-
Sq. Ftg. 0ther_jew_Adda1 ter_P.ep.
_Fe nc e_Demo_C ha n gel U se
-other-
Legal Description
Value of Hork:
Owner
Address
I /.4 Phone Builciin
Fami l y
g Permit Info: Descrit
Residence tlith Attache(Ga 'e., Build Single
AoU0 1q-zq)l
Construction f-[n/er x
Address Phone ru-- , ?{. a/'c<+:
IJt5I GN I tAI.l name address 'lcs. no exDt res ohone no.
Primary
Structura I
El ectri cal
Mechan i cal
name addres s I i cs. no.exD l res nhonp no
Genera I
Pl umbi no
ttlechan i ca I
PLUI1BI NG ELECTRICAL MECHAN I CAL
FFF CHARGF NO FFF NHARGF NO FFF
Each single fixture Residence of furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New circuits alts
or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES
Recessed wal I
SDace heater and vent
Duplex (1 bath) each
Additional bath Temporary Construction i0 0D
Apol iance vent
seDa rate
l.later servi ce Change
res i der
'in exi sti ng
nce
Stationary evap
coo l er
Sewer multifamily, cofirn. or
I ndustri a I
Vent fan with
sinqle duct
Storm Sewer 0f amps.
Vent systern apart from
heatino or A.C.
coHr.r./rND. FEEDERS
Mechanical exhaust
hood and duct
I nsta I I /a I ter/ rel ocate
dist-rih- feeders Hood stove/heater
0f S
. qtlo .4o
?)1^l^)*l ,zo
ag@ 6 ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES 3t 10.bo TOTAL CHARGES
WHERE STATE LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
comp e ap!')'I ica
alI
qon
Bu iI
t l o n for Derm I t an d do he reb.y ce rt 'I ha f a 1 'I n forma t 'I n hereo n is true
the City'l be made
ilder's
and that
and correct, and I further certify t hat any and
tate of Ore
wo rk pe rformed S ha I I be don e 'I n accordanc e wl t h the 0rd 'I n an ces o f
of Spring
of any st
Board i s
fi e I d an d the L aws f the S oe rta 'I n1 ng to the work des cr'l bed here i n a nd th a N 0 OCCUPAI,I CY wl I
ru cture w1 +ho ut the permi SS 1 of the d ing D
701.
I 'l s t 0n I furt he r cert 'I fy tha t my reg I s tr,a t t 0 n vJl th the B U
1 n fu 'l I force a nd effect as req u I r'ed by 0 DC 05 5 tha t I f exemp t the bas 1 s fo r ex emp t '|0n .I s noted hereon
only subcontractors and employees who are in comoliance with Ot?S 701.055 wi'll be used on this nroiect
ItAllE(please print SIGN DATE 7
:FICE USE OI,ILY
Zone______Jype/ Con s t .
Fire Zone Bedrooms
ni ts Sq. Ftg. l'lai n x Va lue--
,0ccy Load Sq. FtS. Access x Val
Flood Plain Stories Occ.y Group Ftg. 0ther-x Va lue
ToTAL VALUATI0N_
BUILDING PERI.IIT
Charges and
Surcharges
Plan Ck. Conm/Ind
65%/Bldo Per Fee
Svsterns Deve
charqe (1.51 opment
Plan Ck. Res
30%/Bldq Per Fee
PLUI,IB IN6 PERMI T
Charges and
Surcha rges
Fence I ot^o IS ,ZO
D6mo
ELECTRICAL PERI'IIT
Charges and
Surcharges
t Q:Q-o- -.-.-,4O
Si dewa I k
A/C Paving Tota'l Cornb. Permi t
I,IECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL *ta 0o
SQ. FT
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, Znd Addition to
SpE'ng--field EstatesC. Name, etc. of owner and construction IenderD. Energy Sources
PERMIT VALIDATION
1. exampl e-2. example-
Square foota
hea t/e I cal c 'I I forced a.ir gas
lrra e or soTar
E ge or valuation, e
II
i. examp'le- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the app)icant need fil'l-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theeiectrical contractor for signature by his electricalsupervisor, The general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
l,lhenever possible, the initial application wilI be used asa v.,orksheet only. Where possible, Building D.i v.i sion Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
ots (,313 {
III
IV.
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s i gnature date