HomeMy WebLinkAboutPermit Electrical 1987-11-24COMBI ERMIT 726-3
Job Address
l-egal Description 3 O 0
Owner
EIIERGY SOURCES
Hea
llater Heater
tn
5q. Ftg. Access._
Sq. Ftg . Other
_l,lew_Add_AFence Demo
i ter_Rep.
Chan ge/ Use D$
-f,O
O<]
C\.s
Val ue of l,lork
Address BuiIclin
Fami l y
q Pernrit Info: Describe [^,lork('
Residence I,lith Attached Garaqe
:e., Build Single
Constructi on Lender 0
Addres s Phone
DESIGN TEAI4 name address rcs. no.exD I res ohone no-
Pri mary
Structura I 4'lS, \har
EI ectri caI
l''lechani cal
n ame addres s 'l i cs. no.exD r res (ohone no.
Genera I
P I umbi no
l.techani cal
PLUI{BI NG ELECTR I CAL MECHAN I CAL
FEE CHARGE N0.FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
sQ FT
furnace/burner to
BTLI' s
Relocated building
(new fi x. addi t i ona l )
New ci rcui ts al ts
or extensions
Floor furnace
and vent
S.F. Residence
( l bath)SERV I CES
Recessed wal I
Snace heatpr and vpnt
Duplex (l bath) each
Additiona'l bath Temporary Construction Apol iance vent
seDarate
[,later servi ce Change in existing
res i dence
Stati onar-v evap
cool er
Sewer multifamily, comm. or
Industrial
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
c0Mt1./IND. FEEDERS
Mechanicai exhaust
hood and duct
I n sta I I /a I ter/ rel ocate
distrib. fepders l'Jood stove/heater
0f amp s.
\1,\
ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali,l until the label has been signed by an Electrical Supervisor and returned to the Building Division
HAVE CARE FULL EXAM INE D the comp I ted apnl ica
any and al1
of 0regon
of the Buil
ti 0n t and hereb.y ce rt tha t a I n 'I on hereon 'I s true
and correct, and I further certifv that work rmed s ha I I be don e 1 n ac cordan ce WI th t he 0rdi na nc es of t he C I tyof Spri
of any
Board i
ng fi e I d and the Laws of t he S ta te DE rta 'I I s to the work desI further
t i f exempt
701 .055 r.ri'l I
crt bed he rel n an d t ha t NC OCCUPANC wl I I be made
s truc ture wl thou t th e perm i ss I 0 n d ing Divis
701.055,
on cert I fy t ha t m.y req i tra t 1 on l/r l th t he Bu 'I I de r Ss in full force and effect as requi red by ORS tha the Ud s 'I S for exempt 'I o n I s noted he reon and t ha +
only subcontractors and employees who are in comcliance with
Ee.n'l .^rooD >
0t]s be us ed 0n +h 'I s proj
I{AtlE(please print)S I GitATURE r/-.2
)E r.tsE 0it
Zone Typel con st Units S o. Fto. l4ain x Val ue
Fire Zo np Bedrooms Load !q Ftg. Access.x Val ue
Fiood Plain Stories.Gro S . 0ther Val ue
TOTAL VALUATION-
q.Ftg
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/81do Per Fee
terns Deve
R0l
opment
Plan Ck. Res
3l%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
D6mo
ELECTRICAL PERI|IT
Charges and , ISurcharges "1 .75
Sidewal k
A/C Paving Tota'l Comb. Permit
I,IECHANICAL PERMIT
Charges and
Surc ha rges I
Curb Cut
0/ E ZO TOTAL ls.?r
\l
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. elample- Tax Lot 100, Lane County Map Reference
17 03 4s2. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources
,/electrical ceilin or forced qir gas
ea e ectr CA or solaF
valuat 0[,E
1.
2.
Sq
1.
2.
II
III
IV.
exampl e- heat
example- wate
uare footage or
examp_le- 1?50 sq. foot house, 500 sq. foot garage
example-.if new project, check new - .if addition,
check add, etc.F. Building permit information:1. example - construct singie family house with anattached garage
?. example - remodel exist'ing garage into family room3. example - convert single family residence intorestaurant (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, Bu.ild.ing
Division Staff must be able to contact appropriite
persons regarding design informat.ion or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanicai and Electrical Schedules,the applicant need fill-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 I.JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label
Applicant to sign and date
Whenever possibie, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the t'ime the actual permit is issued for his
s i gna ture.
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
PERMIT VALIDATION
[05
Permit Clerk
7
q
,{IF
/
-\1
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Perm'it appl icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
datenameS1gnature