HomeMy WebLinkAboutPermit Building 1984-09-10IIISPECTION LIIIE
726-37 69
CiTY OF SPRINGFIELD
COHBI IIATI ON APPLICATION/PERI.ITI
m '..726-3753
Legal Descri otion /V22-
Job Address
ownerfpnsra* 6ns-a€ *
Sq. Ftg. Access.--
Sq. Fto. 0ther_
llew_Adda1 ter_Pep.
Fence Demo Chanqe/Use
Zol*""Z.WZ_<-. _Val of l.lork:
llater Heater
Ranqe
Ftq. I'lain_
a
EIIERGY SOURCES:
Hea t
Bui'
Farn'
Address l?.ts /y- 46& 6t. )**Z>Zl iinq Pernit Info: Describe tlork(y Residence llith Attached Garaqe
.e., Build Single
Constructi on Lender
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Addre s s Phone
DES i GI TEAI.I name address lcs. no.exoi res ohone no.
Structura I
Pri
Electrical
Hechanical
CONTRACTORS n ame a ddres s 'I ics- no-)PXnl rps fnhonp nn-
,l/ -'<-- Dre-s.-Zstdt+? /.q< -68e-6AGenera I
Pl umbi nq
El ectri ca I
I,lechani cal
ELECTR I CAL HECHAN I CALPLUIlBI NG
FEF CHARGF NN FFF C HARG F N0-FFF CHARGF
Each single fixture Residence of
FTSQ s
furnace/burner to
BTLI
Relocated buiiding
(new fix. additional)
New circuits aits
or extensions
Floor furnace
and vent
S.F. Residence(t hath)SERV I CES
Recessed wal I
Snacp hpatpr end vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seoarate
l,later servi ce Change i n exi sti ng
res i dence
Stationary evap
cooi er
Sewer I ndustri a I
multifamiiy, comm. or Vent fan with
sinole duct
/bt Storm Sewer 2s-'0f Vent systern apart from
heatinq or A.C.
COMI.I./IND. FEEDERS
l4echanical exhaust
hood and duct
I ns ta I I /a l ter/ rel ocate
di cfri h fpedprs lJood stove/heater
0f amPa
ISSUANCF OF PFRIlIT
TOTAL CHARGESTOTAL CHARGES 2so TOTAL CHARGES
WHERE STATE L1l'l REQU
shall not be valil until
IRES that the Electrical work be done by an Electrical
the label has been signed by an Electrical Supervisor
Contractor, the electrical portion of this pernit
and returned to the Bui lding 0ivision
I HAVE CAREFULLY EXAI1INED the completed apnlication for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certif_v that any and all work oerformed shali be done in accordance with the Ordinances of the Cityof Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPANCY will be madeof 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and empioyees who are in comoliance with 0l?S 701.055 will be used on this Droject.
r{Ar.tE(prease o";"tlt/i /. |qy 1l e ttrrla tf q srGit^TURE DATE
E
Zone-----__Type/Const. Uni ts _ Sq. Ftg. l,lain x Val
Access x Val ue
o rn u fr i ty4 - r- u u, u "-iffi T
7€
ood Plain Stori p<
Ftg.
Group Sq. Ftg.
Flre Zone Bedrooms_ _Occy Load
VtryA 6iy
/r'-L,/u,oo rqe (1.5iSvs
Cha
tems oeve opmeatPl an Ck. Corm/ Ind
55%/Bldq Per Fee
EUILDING PERI.IIT
Clrarges and
Surcharges Plan Ck. Res
30%/B1dq Per Fee
FencePLUqBING PERI,IIT
Charges and
Surcha rges ae Demo
SldewalkELECTRICAL PERI:IT
Charges and
Surcha rges 96.e Total Corqb. Permit 462.A/C Pavi ng
Curb Cut 77'oTOTAL
I,IECHANICAL PERHTT
Charges and
Surcha rqes
4rz*t)
TOTAL VALUATIOII
C0MBINATI0N APPLICATION/PERflIT (CAp) l
I. Applicant to furnishA. Job AddressB. Legal Description
l. examole- Tax Lot 100, Lane County Map ReferenceIT6TT:2. exaqrplq: Lot l. Block 3, Znd Addition to5prlngfield Estates9. Name, etc. of owner and construction lenderD. Energy Sources
example- hea
example- watre footage o
t/e I ectri ca eili forced air g Receivedea te r,soiarr valuation, e tcfoot house,500 sq. foot garag 1
(- .Y OF SPRINGFIELD
Clty Hall
Sprtngtietd,.pregon
Dopsrtment ol pub[c Woftr
OFFTCIAL RECE!PT
No. B G355e
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Date
Rec'd From
Address
19
2E. Squa
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2 proj ect, check new - if addition
F. Buil nformat i on :I struct single family house with an
2
9eexamole -
example -
remodel exist'ing ga rag e into family ro
reS ta u rant
convert si
change of use)
ngle fami ly residence into (G. Value of work a s defined in Section 303 (a) of theStructural Spec ialty Code
H.DES IGN TEAI{ AND CONTRACTORS
ays, Building (' To avoid designDivision Staff r
example- 1250 sq
example- if new
EFEEI a-dd, etc.ding permit i
exampie - con
attached gara
2. If the i tem(s) to be installed are not covered othe a bbreviated schedules you should consult thefull schedules
<)e
airooa titL?3tt/Lttxocia?HEta, ruc:Nt. oiraox
Permi t Cl erk
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Ao
z9o
<DO
or construction del
must be abie to con tact appropriitepersons regarding desi gn informati on or job sitecorrections, etc.II.Abbreviated plumbin g, Mechanical, & Electrica I Schedules (A. Except where bl ank spaces occur in the d escri pti onportion of the Mechanical and Electrical Schedul es,the appi icant need fill-in onl y the No.
be instal
Boxes adjaceto the a ppropriate item(s) to 'ledB. Full Pl umbing, Mechanical, and Electricai Schedu'lesare available at the Buildi ng Divisionl. To conserve space on the permit form the schedu lhave been abbrev i a ted
Amount
(
BY r
III
IV
C. BUILDING DIVISION-.STAFF WILL FILL OUT ALL FEES AND iCHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to th!electrical contractor for signatur. [i r,ir .i"ii"ii.i"-supervisor- The general conlractor ii ,ot authorized- , to sign the electr.ical labe.l .Applicant to sign and date
I'lhenever poss.ible, the initial appl.ication will be used asa.-worksheet only. l,there possibtb, guilding Division Staiiwrtt-prepare a type wr.itten copy and return it to theapplicant at the time the actuii lJrmii-i, irrr"a io" r,issignature.
Fees and Charges
Plan-check fees are due and payable at the time of theapplication, and no plans wi)t-Oe proieiiia until thesefees are paid. AII other fees and .ni"g"r-u"" due andpayable when the permit is issued.
FOR OFFICE USE ONLYV
PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAIICY:
rmPe t'l a cI tan ex fromtpp i tSemp tra onireg thw1 Buthe Ii d e r s aBo rd bec ua se
Additional Project Information :
na^e bgryE 4ry& s
PLANS REVIEWED BY:
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SFRrcFlEE C/7? - aoPT...-eguired ln spec r .Jh s ..
IT IS THE RESPONSIBILITY OF TIIE PER},IIT HOLDER TO SEE THAT ALL INSPECTIONS ARE MADE AT T}:E PROPER TI}IE,THAT EACII ADDRESS IS READABLE FRO}{ T}:E STREET, AND THAT TIIE PERJ.{IT CARD IS LOCATED AT TIIE FRONT OF THEPROPERTY. BUILDING DIVISION APPROVED PI,ANS MUST BE ON JOB SITE AT ALL TIIIES.
PROCEDURE FOR. REQUESTING IIISPECTIONS: Call 726-3769 (recorder) srare you CITY DESIGNATED JOB NUIEER,job address, tTPe-of inspection requested and vrhen you will be ready for the inspection. Contractorsor otrners name and phone number. Requests received before 7;00 am will be nade the sarne day, requestsreceived after 7:00 am will be nade the fo11or,:ing work day.
Your City Designated Job Nr:mber Is: Aa46y7
Job Address
Orrner
Contractor:
SITE INSPECTION: To be rnade
;EGr efiffiG-n, but prior
to setup cf fcrms.
IJNDERSLAB PLIJ},IBING, ELECTRICAL
6 IIECHANICAL: Tc be nade before
any tr'ork is covered.
CONCRETE SLAB INSPECTION: Tc be
nade after all inslab building
service equipment, conduit, piping,
accessories and other ancillary
equipnent itens are in place but
before any concrete is poured.
FOOTINGS & FOIJNDATIONS: To be made
after trenches are excavated and
forms are erected, all steel inplace, but prior to pouring concrete.
INDERGROIJND: P I umbing, Electrical,
Gas, Sanitary Sewer, !fq1&S€Eg-.Weter and Drainage lines. To be
made prior to covering or filling
trenches.
UNDERFLoCR:, Plunbing, Electrical,
Mechanical. To be nade prior to
installaticn of floor insulation,
decking or floor sheathing.
POST & BEAM: To be nade prior to
installation of flocr insulation,
decking or floor sheating.
FLOOR INSULATION 6 VAPOR BARRIERS
To be made prior to installetion
of decking or flcor sheating.
MASONRY: SteeI location, bond beamsgrdTfig or verticals in accordance
with U.B.C, Secticn 2415.
ROOF SIIEATHIITIG ,UID NLILING: Prior
to installing any roofing. [v;]
ROUGH PLLT}fBING, ELECTRICAL 6 LN I
I'!ECIiANCI.\L: No work is to be covered
until these inspections have been
made and approved.
FIN.qL PLTJMBING
FINAL ELECTRICAL
Phone:
Phone 687-66e
Z e*uaoq, 7/2'?72/
AT'IIC DRAFT STOPS & CURTAIN WALLS
FIREPLACE: Prior to placing facing
naterials and before franing
inspection,
INSULP,TION 6 VAPOR BARRIER: To beffind
required vapor barriers are in place
but before any lath or gypsun board
interior wal1 covering is applied.
FRAMING: To be made after the roof,
all framing, fire blocking and
bracing are in place and all pipes,
chimneys and vents are complete and
the rough electrical, plumbing and
heating wires, pipes and ducts are
approved.
FIRE & SEPARATION IttALL: Located 6
CcnstructeC aCcording to plans.
LATTI AND/OR CYPSTIM BOARD INSPECTION:
To be made after all lathLng and
g)?sum board, interior and exterj.or,
is in place but before any plasteri
is applied or before gypsum boardjoints and fasteners are taped and
finished.
W00DST0\tES: After installation is
EomFIetea.
SIDEWALK & DRI\IEWAY: Required for
all concrete paving within street
right-of-way, to be made after all
excavating conplete G form work 6
sub-base material i.n p1ace.
CURB AND APPROACH APRON: After forms
are erected but prior to pouring
concrete.
PARKING LOT: After gravel is in
place but prior to placing asphalt
or concrete,
ce t'jith
on lding Code a special
inspector shall be employed by the Orrner/
during construction of thefcllowing work. A ccpy of the special
ng reports shalL be furnished to thelding Division
STRUCTURAL CO}ICRETE:
tr.5:l.-1306 a.tl--In excess of 300
tr
STRUCTUR{L IVELDS: Preformed on thejob. {2722 f)
HIGH STRENGTH BCLTING During all ,bolt installation and tighting
operaticns (306 a.5)
SPRAYED ON FIREPROOFING (u. B. c.
StanCards 43-8)
SPECIAL GRADING, EXCAVATION .\\D
FILLINC: During earthwork, (305 a.11
& Chapter 29)
GLU-LAM BEA].IS: Inspection Certificate,
by an approved agency, furnisheC to
the City's Building Division before
beams are placed. (2501-U.B.C. STDS.
2s-10,11) .
*In addition to the inspections
specified hereon, the Building
Official ,ray rnake or require other
inspections of any construction
work to ascertain compliance with
the Building, City or Zoning Codes
CITYTS SITE PLAN REYIEII BOARD INSPECTION: Must be requested 2 days in advance of the date ycu
wish inspection. All project conCitions such as landscaping, parking lot striping etc. nust
be completed befcre requesting this inspection.
FINAL BTJILDING: Must be T equesteC after the final Plumbing, Elect::ica1, llechanical and Fire
Dcpartmcnt inspections are made and approved. No Occupancy of the premises can be nsde until
a Certificate of Occupancy has been issued by the Building Divisicn and posted on the premises
DATE
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FINAL iiECIlA,\I CAL
FI}IAL FIRE DEPART'I\IE}IT
SICNA'
IAL INSPECT
XILL I.U**HOLES AND CLEANOUTS II.IUST BE ACCESSIBLE, ADJUSTI'IENT TO BE I.I,ADE AT NO COST TO TI.IE CIfi
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II{PROVENENT AGREEMENT
IN CONSIDERATION of the covenants here'in recited, the City of Springfield, herein-
after referred to as City,and Thurston Granqe , hereinafter referred to
as App'licant, do covenant and agree as follows:
WHEREAS Appl i cant des i res a bui l di no perm'i t from C'i tf' ; unq
I,IHEREAS, the development of said building (s) will cause both an'immediate and'long-term demand on the various public facilities of the City;
NOl,t THEREF0RE, the App'l'icant and City agree to the follow'ing schedule of public
facility improvements and respective cost assumption pof icy:
Street improvements i ncl udi n a sidewalk and s n a n t e rth
treet e
By
Di recto r of Public Works
Other
Legal Description:
Beginning at a point 103.86 feet North 0 degrees 20'10" Eastof the Beginning point of County Road No. 432 (known as Russell
Road) said point also being 1144.92 feet South 0 degrees 20'
10" West of the Northwest corner of the W.Y. Miller Donation
Land Claim No.48 in Township 17 South, Range 2 t^lest of the
Willamette Meridian; run thence South 89 degrees 44' 20" l,lest
230 feet; thence South 0 degrees 20' 10" l^Jest 267.28 feet to
the centerl'ine of County Road No. 440 (known as Thurston Road);
thence South 58 degrees 17' West along said centerline 242.95
feet to its intersection wfth the Southeriy extensions of the
East line of the FIRST ADDITION T0 BEE-SUN as platted and
recorded in Book 63,,Page 8, Lane County Oregon Plat Records,
thence North a'long said Southerly extension and said East line
27A38 feet; thence North 58 degrees l7' East 516..l8 feet
to the centerline of said County Road No.432; thence South
0 degrees 20\ 10" West along said centerline 145.70 feet to
the point of beginning, in Lane County, 0regon.
EXCEPTING THEREFROM that portion platted and recorded as
BURNELL PARK in File 73, Slide 77, Lane County Oregon Plat
Records, in Lane County, 0regon..
It js further understood that Applicant agregs to siqn any and all waivers, petitions,consents, and all other documents necessary to obtain the above iisteA uppii.uUie-iinprove- -'
ments yndel 9ny imorovement act or proceeding of the State of 0regon, tahb County, oi^ Cityof Springfield as may be propose! or adopted"and to waive all right to remonstraie againsisuch improvements, but not the right_to protest the amount or mainer of spread.ing thiassessment thereof if the sanie shall appear to Applicant to bear inequitaUfV or"unfairlyuoon said property of Applicant;
N0l4 THEREF0RE, the city agrees that Applicant,s execution and performance of theterms of this Agreement will be deemed to be"in compliance with the City's pofi& pertar'ningto Irnprovement Requirements, and-if Applicant compiies in e./ery r.rp..i widfr all otherapplicahrle laurs of the State of 0regon, Lane County, and the City, lhe saia nppi.icantshall be entitled to the'issuance oi a buirding permlt; and - - "rr'
IN ADDITI0N, it'is the intention of the parties hereto that the covenants hereincontained shall run with the land herein described, and shall be binding upon th. heirs,executors, assiqns, administrators, and successors of the parties heret5, drld shall'beconstrued to be a benefit and a burden upon the property hbreiri descpibed. This Agreementshall be recorded in the Lane County Deed Records.
B*!,EREF0RE, the parties have set their hand and seal this 10. day of -OF*_,
CITY OF SPRINGFIELD APPLICANT
STATE OF OREGCN
COUNTY OF LANE
0n this /O
me and signed th
day or -Se o t
I moos
4 o
SS.
e above
r g
NOTARY PUBLIC
My Comm'iss ion Expi res:
do cunreffi.
t t9 k*ere personally appeared before
{
lltVtKUX,iJt'\e"LEJLHrc)b"
lNc.
1001 Division Avenue o Eugene, Oregon g74U o Phone (503) 689-6600
CONTRACT PROPOSAL.,-
Llcense Number 19613
Date
Building Permit #
mator.Dave tlencaa
letlon date
Engineer or A
?e.
Provi.dr
naterhts to rha r$
1) tnstall r itk,T{;t*lfsrfucentor ol thr Lot.7eb (,
plpa frou h
catch baoin to thc catch
Plans & SpecifiGltFons+
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44'tt,'4)!1,,f
&All q uanti es pri are based. in thc city curbliae.
,) Excavato f6E, and pour r coacr,
approacb lntb thc lot.
., ! ! ' .4)' eaa i veed H\rer to''dii rot.
j "'" "-l- ^, \5) Paye'the tgt6o'x96il) vttu
el: :f aoptupt;; ._,, ,i _ . ::gl lasteIl a concrlto.'Ltruaca.
curb oa .thq oast side of tba.neuly paved 1ot, .{. :: ,,
on approved plans & specifications dated
which are i n concurrence with the City of
general conditions
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TOTAL PROJECT (based on unit prices) $
TOTAL LUMP. SUM PRICE
dollars
$6(.'l .oo
ollars
1
Quantiti Unit/Price
:t A:
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suu
lf Owner or Prime Contra insists upon completion of work against advlce of MORSE BROS.CONTRACTORS,lNC. because of weather itions or sub.surface condiilons, the Owner or Prime Cont shall assume allrisk of defeits'due to weather or sub-surface condit
I (we) hereby accept this p
MORSE BROS. .CONTRACTORS, iNC.z'
MORSE BROS. CONTRACTORS, INC
specif ied.
Owner/ Prlme Contractor Date
Approved
Date
and authorize
to proceed as
by
Go-Owner/ Mortgagee Date
(Sse additionat terms & conditions on reverse stOej
ress abovel
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A-*-,:.--#
The. acceptance of this project is subjectto the approval of the Credit Department.
k
Job'#
CUSTOMER COPY
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INSPECTION LINE
726-37 69 COHB I .. 7?6-3753
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Job Address 65qg fgctrra* ,?>-EIIERGY SOURCES
Hea t
l{ater Heater
Ranqe
So. Ftq. I'tain_
Sq. Ftg. Access._
Sq. Fto. 0ther_
_l,lew-q66 AI ter_Rep.
Fence Demo Chanqe/Usefi*erTlvtU<-.
Legal Descri ption //-y'/-
Value of l,lork:566.*ownerTn ,sra/y 6zsga€ 1
Addres s !7.t5 4/- 66t7 57, 2e)*z>zt Builciinq Pernit Info: Describe llork(
Familv Residence I'lith Attached Garaoe
.e., Build Singie
Construction Lender
Addres s Phone
name address 'I CS . nO.exni res ohone no-
Pri ma
Structura I
El ectri cal
Hechani cal
ACTORS n ame addres s taq no exDt res ohone no.
Genera I ,|y', '.<a D+c-s. -Z y?+?. /a -6.99-6A
Pl umb'i no
E I ectri ca l
Ittechanical
PLUI{BI NG ELECTR I CAL },IECHAN I CAL
N0.FEE CHARGE NN FFF rHA PGF NO FFF r}IAAAF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New circuits alts
or extensions
Floor furnace
and vent
S,F. P,esidence(l bath)SERV I CES
Recessed wal l
Soacp hpatpr and vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDarate
[,later servi ce Change in existing
res i dencp
Stati onar-v evap.
cool er
Sewer mul ti f ami 1y, cornm. or
Jndrrctria l
Vent fan with
sinole duct
/aDt Storm Sewer #"0f amps.Vent systern apart from
heatino or A.C.
COMI'I./IND. FEEDERS
Mechanical exhaust
hood and duct
Instal I /al terlrel ocatedistrib. feeders IJood stove/heater
0f i
ISSUANCF OF PFRI1IT
TOTAL CHARGES 2Fo TOTAL CHARGES TOTAL CHARGES
WHERE STATE LII,I REQU
shal I not be va l i,l unti I
IRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certif-v that any and a'll work oerformed shall be done in accordance with the 0rdinances of the City
of Springfield and the Laws of the State of 0reqon oertaining to the work described herein, and that NC OCCUPAI,ICY will be made
of any structure without the permission of the Building Division. I further certify that my reqistration r.rith the Builder's
Board is in full force and effect as required by ORS 70i.055, that if exempt the basis for exemption is noted hereon' and that
only subcontractors and ernployees who are in comoliance with ORS 7n1.055 will be used on this rrroject.
r,rAr'rE(prease pri^ilt4/; /. |a(y f l e /Uli t/v5 s IGi,lATURI
FFI E E
Zone Uni ts.Ftg. l'lain x Value.
Fire Zone Bedrooms Occy Load Ftg.Access x Val ue
orn"" fru/ 4- r-r. r r" 5667Flood Plain Stories.0c c.y Group Sq. FtS.
flare R<.Ffr vtryeZ 6ry //Aua47 fuE:ToTAL VALUATIoil_
BUILDING PERI.IIT
Charges and
Surcharges
P'l an Ck. Conm/ I nd
65%/81rlo Ppr Fep
aa steris opmmt
Plan Ck. Res
30%/B1dq Per Fee
PLUI,IBING PERMIT
Charges and
Surcha rges
@
a?
Fence
DEMO
ELECTRICP,L PERI|IT
Charges and
Surcha rges
Sidewal k
A/C Pavi ng 96.*Total Comb. Permit 62.n
IlECHAIIICAL PERMIT
Charges and
Surc harge s
Curb Cut &t,7tts .
TOTAL 77.'o
,
E'-Y OF SPRINGFIELD
Clty Ha[
Sprtnglield, pregon
Dopartment ol publlc Workr
OFFICIAL RECEIPT
COMBINATION APPLI CATION/PERMIT (CAP)
I. Applicant to furnish (
A. Job AddressB. Legal Descriptionl. glalplg: Tax Lot 100, Lane County Map Reference (17 03 432. example- Lot l. Block 3, 2nd Addition toSfiTffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
No. B 6355e
19
Hec'd From
Address
Received
E
1. example- heat/electric?l ceili!g/or fg.fced air g2. EfimpE waterhEIGFIefilTFTtITor soli-r
Square footage or valuationlEtl--
1. example- l?5-Q. sq. foot house, 500 sq. foot garagz. €xample- if nev{ project, check new _ if add.itionEIEEI-i-dd, etc.
#a€{
-
4io
a6
5a
<Do
O-
(
F. Building permit informat.ion:1. example - construct single family house with anattached garage
?. examp-le - remodel existing garage into fam.i 1y roJ. example - convert single family residence intorestaurant (change of use)G. Value of work ai defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avo'id design or construction delays, BuildingDivision Staff must be able to contalt appropriitepersons-regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electr.ical SchedulesA. txcept where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes iajii.
_ to-the appropriate item(s) to be .installed
B. FulI P'lumbing, Mechanical, and Electrical Schedu.lesare available at the Buitding Division1. To conserve space on the-permit form the schedulhave been abbreviated2. If the item(s) to be installed are not covered othe abbreviated schedules you should consuit thefulI schedulesC. BUILDING DIVISION STAFF l,lILL FILL OUT ALL FEES AND iCHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de'livered to tn!electrical contractor for signature by h.is eiectriiai -
supervisor. The general contractor ii not authorizedto sign the electrical 1abelAppiicant to sign and date
Whenever poss'ible, the.initial application w.i
.l .l be used asa.worksheet only. l,lhere possib)e, Bui ld.ing Division Staiiwil'l.prepare a type written copy ind returi it to theapplicant at the time the actual permit is issued iJ, nissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will-be processed unti.l thesetees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
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II.frz
4>aAmount
i-BY
lRtooa pitxTtit/LttHocia?HER3. fucENf. OitooN
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 da te'brr'3ry4'i gnature
(