HomeMy WebLinkAboutPermit Electrical 1988-07-10PECT I
-3769
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cor,tBI nATr 0N nppl r cnuoH/pERMI T
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726-
Job Address 4
Legal Description Zae-t'n-o Vb, ,.2?j 1
Ranqe
l.later Heater
EIIERGY SOURCES
Hea t
Owner
Value of llork:
Sq. Ftg. Access.--
Sq. Ftg. 0ther
Jlew_rqdd_A I Ier,a€-p .
_Fence Demo Change/Use_other---
nSq. Fto
Add ress Phone B
F
t Info
ce tli .e., Build Single
4zrrr-e Ar;
Construction Lender Z-z,"tuizZ 1-2,ioe &ao.{-t-ry
Addres s Phone v
DO
D()s
s.*
t^l
OES I GtI TEAI4 name addre s s cs. no.expr res phone no. l
Pri ma
Struc tura I
L/Electrical
Mechani cal
,CTORS name addrps s 'l i cs. no.exDt res (ohone no-
Genera I
El ectri ca l
ELECTR I CAL MECHAN I CALPLUHBI NG
THAPNFFFFFFFCHARGFNONOFEECHARGENO
furnace/burner to
BTU' S
Residence of
FTSQEach single fixture
Floor furnace
and vent
New circuits alts.
or extensions
Relocated building
(new fix. additional)
3n Recessed wal 1
Snace heater und venL'r,a')SERV I CESS. F. Residence
( I bath)/3Duplex (l bath) each
Apol iance vent
seDa ra te,.*tr*, const"uc(onAdditional bath
Stationary evaP.
coo l erge in existing
dence
Chan
res il.later servi ce
Vent fan with
sinole ductmul t if ami ly, corm. or
TndrrstrialSewer
Vent systern aPart from
heatinq or A.C.0f s.
Storm Sewer stlCaex
COHI"I,/IND. FEEDERS
l,lood stove/heaterI nsta l I /a l ter/rel ocate
distrib. feedersr\
0f amp s.\.1
\vI
ISSUANCT 0F pFRt{IT
TOTAL CHARGESb3TOTAL CHARGESTOTAL CHARGES
oxt 7 -/4SIGNA
c t3IllAtlE(please print).ui te ,a
, REQU
unti l
tsofth0npermectrcaportthetractorEectrcaCondonanworkbetricaEIecREthastltetV1onEsATELlI.I di Di sERHHtongtheBuandreturnedrvorsac
bytriEEC Supenedansbybeenhatheabesbeva,ltnoha
0regon
the Bui
exemp
055 wi
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any
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TOTAL VALUATION
Pl an
an
Y
I
Res
FrI
S q. Ftg. AcceLoad
cy Group Sq. Ftg' Other
x
x
ts
Val
'I ue
opmeflternsDeve
1.5%
Fire Zone Bed
BUILDING PERI.IIT
Clrarges and
Surcha rges
Val ue
Ftg . t'la iZone Tyoe/Const
Flood Plain Stories- 0c
Fence
Dgmo
PLUI4BING PERMIT
Charges and
Surcha rges
St dewal k
Tota'l Cornb. Permi tA/C Pavi ng
p e.so
r ,13
ELECTRICAL PERI!IT
Curb Cut
TOTAL
I,IECHANICAL PERNIT
Charges and
Surcharges
2 3.b=
Pl umbi nq
.Q
s
Charges and
Surcha rges
CCI4BINATION APPLICATION/PER},IIT (CAP)
I. Applicant to furnishA. Job Address8. Legal Descriptionl. ii+5ff Tax Lot 100, Lane County Map Reference
Z. examDle_ tot.l. Block 3, Znd Addition toS[.Fffiielo LstatesL. name, etc. of rD. E;;;dy'i;;.;l.o'nt" and construction lender
I ec tri
?c tr*]*E. Squa valuati or
I examo I e-
examo I e-
check add
1250 sqif new
on,
2
foot house,500 sq. foot gara ge
etc,
project, chec k new - if additi oDt
F Buildi ng permit informa ti onIexamp I e
a ttac hed
-_construct single family house with angarage
2 exampl e
examp I e
res taura
remodel existing
3 - convert si
garage into fami ly room
nt(ngl e fami ly residence i nto
G. Value of work as
change o
def i ned
f use)
Structura I Special ty Code
in Section 303 (a) of the
H.OESIGN TEAI,I AND CONTRACTORSTo avoid cles l9l
ff
n or construction del aJs, Bui ldiDivision Sta must be able to contact a
n9
pers on s rega rd i ng design info ppropri a te
correc t i ons, et rmation or job siteII.Abbrev.ia ted PIumbi ng, lilechanica l, & ElectricalA.Excep
port i
t where b lank spaces Schedu l es
on of the Mechan i ca I
occur in the desc ri ption
the appl icant need fi l l-in and Electricai Schedul es ,Eoxes adjacentto the a ppr0pr iate item(s
Hechanical
only theto be in
No.
B.Ful I Pl umb i ng,stalled
are avaiiable , and Electrical Schedul es
1. To cons
at the Buil ding
the
Division
ha ve
erve space on permit form the schedules
2. If been abbrevi a ted
the
the item(s) to be installed are not covered on
ful I
abbreviated sc hedules you shoul d consult theschedul esC. EUILDING DIVISION STAFF I.,ILL FILL OUT ALL FEES ANDCHARGESON THE SCHEDULESD. As noted on the CAp,I contractor the label mustfor signature
be delivered to tel ectrica he
supervi s or. The 9enera I contractor
by his electrical
to sign the el ectri ca l 'labe I
rs.not authorizedIII. Appt icant-to si 9nle,
and dateI'lhenever possib the initial applicat
tlhere possible, Buil,
ion will be useda worksheet only.ding Division Sta
as
wi l1 prepa re a type written copy and re ff
appl i
signa
Fees
cant at the time the
turn it to the
tu re.actual permit is issued for his
Iy.and Cha rges
PIan check fees are due and payable at the time of theapp I
fees
ication , and no plans wi 'll be processed unii I theseare paid Al I other fe es and c ha rges are due andPayable when the permi t is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
-[ tr
?-t,V
Permit Clerk
)lq vo
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
t applicant exempt from registration with the Builder's Board because:Permi
Additional Projeit Information :
PLANS REVIEWED BY:
name si gnature date
C{-.