HomeMy WebLinkAboutPermit Electrical 1989-07-21--_\--
COMBI
Ft9
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Val ue of
TI -3
I'la n
Sq
owne
CTION LINE
769
A'I ter_P.ep.
APPL I CAT I
l-ega1 Description
Job Address
EIIERGY SOURCES
liater
Hea . Access._
0ther
hange/ Use
.e., Build Single
Ga ra
nq
Re s deAddres s Phone
AtI /pIder)pn
$
\,
N
(PhoneAddre s s resex D'addressname
Pri ma
Struc tura I
Mec han i ca l
Pl umbi n
lc
MECHAN I CALELECTR I CALPLUI{B I NG
furnace/burner to
BTLI' s
Residence of
FTSQEach single fixture
Floor furnace
and ventNew circuits alts.
or extensionsRelocated building
(new fix. additional)
Recessed wal I
Snace heater and ventSERV I CESnceS. F. Res
Duplex (l bath) each
Apol iance vent
seoarateTemporary ConstructionAdditional bath
Stationary evaP.
coo l erin existingChange
rpqi de ncel,later service
Vent fan with
s i nole ductmultifamily, comm. or
IndustrialSewer apart from
.c.
Vent system ,
heatinq or A0frm SewerS Tecfranft;Tnxhaust
hood and ductc0Mr.1./IND. FEEDERS
tlood stove/heaterInsta1 I /aI ter/re1 ocate
distrib. feeders-
amps.0f
ISSUANCE OF PFRI'IIT
byri
an Electrical Contractor' the e
cal Supervisor and returned to t
'lectrical portion of this permit
.he Building Divisionthe Electrical work be done
has been signed bY an ElectWHERE STATE LAN REQUIRES t
shall not be valiC until the I
hat
abel
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
S IGNAI'lAttE (p lease Pri nt)
Uni ts
0ccy Load
Zone
!q. Fts
0cc.y Group Sq. Ftg
Ind
D
x
s
S
DAT F
T'yoe/ Cons t.
TOT AL VALUATION.
Val
lue
Per F
of any
Board exemp
055 wi
n s trueIfoIrmat0nhereontthaIacerttrmlandhereb.y0nofrrticapeetedhetc0mpappLLEI o f c 'Ithe0rdna'I nces tywlththenIcc0ardanceshadIdonebeIrkrformendIawoIr)acer1rttthadanftIefyu rthndarrc0tec I1 madebeYPAr'lc w1thadtNO0ccuheIrenandesc riwork bedn'I I theto0retoSthetetape rta ng
any
offIanddhetLawsofS'I e 1
'I sn9v,l theth BuprlsItraIton1tthahefurtcerrtregm.y1s'I on'|I fyd'I n'I Dth
qon
Bui Iss'I 01 ofn ew1tthouethsrutrectuperm a ndnhereo0n'I 5I tednofor5t'|exemptbashettthaf1ORS7I0505saredIanrceedtffecrequbyS'I n'I Ifu fo'I
s1 +I be sedu n0 th70'l Dr0J ec
1 thwl OP.Sa1nIancerend1whocompranttocarsnn'I bco emp oyeesSUv
opmentan Ck
Ftg. l'lain
Fire Zone Bedrooms
Flood Plain Stories.
Val ue
an Ck.
30%
BUILDING PERNIT
Charges and
Su rcharges
Access
0ther
Fence
Demo
PLUI4BING PERMIT
Charges and
Surcha rges
Stdewal k
Total Comb. PermitA/C Pav i ng
ELECTRICAL PERI,IIT
Charges and
Surcha rges
Curb Cut
TOTALMECHANICAL PERHIT
Charges and
Surc harqes
INFORT4ATION LINL
'rI
K*
Iohone no.
(ohone no,a ddrps s (lics. no.name
der'
that
d
COMBI NATION APPL I CATION/PER}IIT ( CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County
17 03 43?. example- Lot l. Block 3, 2nd Addit
Springfield EstatesC. Name, etc. of owner and construction l,D. Energy Sourcesl. example- heat,/eiectrical ceilinq/o,
_ ?. .--=rpT.- waterEEaI6i@rTifbrE. Square footage or valuationl-EtEl-
PERMIT VALIDATION
Map Reference
ion to
ender
r forced air gas
sofa r
II
III.
l. example- 1250 sq. foot house, 500 sq. foot garage2. exampte-r Tf-new project, ctreik-?Ew - if aoditioi,
check add, etc.F. Building permit information:1. example - construct single fami)y house with anattached garage
?. examp_le - remodel existing garage into family room3. exampie - convert single family residence into
- restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated P)umbing, Mechanical, & Electrica'l SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Piumbing, Mechanical, and Electrical Schedulesare available at the Building Divisionl. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated scheduies you should consult theful l schedulesC. BUILDING DIVISION STAFF I,JILL 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 electrical -
supervisor. The general coniractor ii.not authorizedto sign the electrical label
Appl icant to sign and date
Hhenever possible, the initial application will be used asa.worksheet only. l.lhere possiblL, euilding Division StaiiIn r r.prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gnature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiil-be processed unti.l thesetees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV
V Permit Cler
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
cant exempt from registration with the Builder,s Board because:Permi t app'l i
Additional Project Information:
PLANS REVIEWED BY:
name datesignature
,rLO v