HomeMy WebLinkAboutPermit Electrical 1989-11-27ON LINE
Cc)HBI AP ICATI ERMIT 726-3753
EIIERGY SOURCES Sq. Ftg. l'1a
Job Address Hea Sq
Sq
Ftg . Access,_-
. 0therLegal Description l,later He a dA I ter_Rep.
Change/U seRanqe.
Val ue l.lo -0ther
Owner bAddresPhonescrl^lork
F 'I Ni rh At ra
.e., Build Single
f\t
Cons truct r
Addres s Phone
name
Prima
Struc tura l
El ectri cal
Mechani cal
Genera I
'I
EI
l.lecha
PLUHB I NG ELECTR I CAL MECHAN I CAL
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additionai )
Fl oor furnace
and vent
S. F. Residence
( l bath)SERV I CE S
Recessed wal I
Soace heater axd venl-
Dup]ex (l bath) each
Additional bath Temporary Construct i on
Apol iance vent
sepa ra te
l,later servi ce
Cha T:r#9'sti ng
rAs
Stati onar.v evaP
cool er
Sewer uI
ndr.
fJmily, connn. or Vent fan with
sinole duct
Tent syste,n ipart from
heatinq or A.C.Storm Sewer
t r 0f s.
c0Mr.1./IND. FEEDERS
Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
di stri b. feeders
l'lood stove/heater
0f
ISSUANCF OF PFRI1IT
TOTA,L CHARGE S TOT AL c HARGE S TOT A L c HA RG ES
LAN REQU I R ES t ha t the E I ec tr 'I ca I work be do ne by an EI ec t rl ca 1 Con t rac tor th I ec t rt ca I port 'I on of th I s perm 'I t
l^lH ER E STA TE
ed EI t rl I Superv I a n<i re tu rned to t he ul 1 d I ng Di I S 1 on
S ha 1 1 no be VA I I :l un t '|I t he 'I a be 'I ha s be en s 1 9n by an ec ca sor
CAREFUL t he comp e appl i ca
and al I
Oregon
the Buil
t on DC rml t do her eb.y cer t '|f.y tha t a 1 I n rmation hereon is true
Ordinances of the CitY
0CCUPANCY wi I I be made
on vrith the Bui]der's
noted hereon, and that
nd correc t and I fu rth r cert 1 fy t hat any
tate of
ion of
work perfo rmed sh a I 'l be do ne I n a cc orda nce wl th t he
a
'I the k de I bed h re 'I n an d tha t NOfSpringfie
any strucrd is in
I d and the Laws o f th e S DE rta I n n g to wor sc r
t tu re w1 thou t the permi ss d 'I ng D 1 'I s I on i fur th er C e rt I ty t h a t m.y reg I 5 t ra t '|
Boa fu I 'I force and effect as req u 'I red by ORS 7 0l 055 tha if exempt the ba S I S for e xempt 'I n '|s
ro.jIsubcontractorsandempIoyeeswhoareInc0mpIIancewlth0Rs7ol055tJlIIbeusedonth'I s p ct
0 n v
DATEI'lAl'lE(please prin I GNATURE
Lone.
Fire
Cons t,Uni ts Fttt
Fto
Ftg
x Val ue
Occy Load Access
0ther
.x
x
al ue
Flood Plain Stories,0cc.y Group Sq Val ue
TOTAL VALUATION
BUILDING PER}IIT
Charges and
Surcha rges
Plan Ck. Conm/Ind
65%/Bl dq PelFee
teris
rge
VEt1 o
1
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERI,IIT
Charges and
Surcharges
Sidewalk
A/C Pavi ng
Curb Cut
Total Cornb. Permit
TOTAL \B 1SI,IECHANICAL PERMIT
Charges and
Surc harges
"\
I
pYnl reqICS- nO.
nhnnp nn-pYnl rpqtas- no-namp:ONTRACTORS
tcf a!ldor:FFFFl^II A DCF NN
New ci rcui ts al ts.
or extensions
h'{
'/5:
COMBINATION APPLICATION/PERMII (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. g{gg!_tg- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition to
SFiTn-gfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. exampl e- heat/slectrqa_l_ cgi l .!Ig/o
2. examp l e- waterheater/_e,1 sqlr:4gl/or
Square footage or vaiuatiol), etc. -
r forced air gas
E
sol ar
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Bui lding permi t inforrnation:1. example - construct single fanrily house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single fanli.ly residence into
restaurant (change of use)G. Value of work as definr:d in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction de'lays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.IL Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedules
are available at the Building Divisionl. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF l^llLL 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 electricalsupervisor. The general contractor is not authorizedto sign the electrical labet.III. Applicant to sign and date
Whenever possib)e, the initial application will be used asa worksheet oniy. Where possib.le, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.IV, Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no p)ans will be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
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V. FOR OFFICE UST ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Addit'ional Project Information :
PLANS REVIEWED BY:
name s i gnature date
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