HomeMy WebLinkAboutPermit Electrical 1987-03-13COMBI
SP
PL ERMIT
Job Address E'JERGY SOURCES
Heat
Ran
Sq . Ftg . l'la i
Sq. Ftg. Access.--
sa
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C>
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Lesa'r Description/Itt ) 3 | CC O d') i Ce
A llr Value of l,lork:
^dbess gbc lv, /and n be Work(
rd Garaqe
.e., Build Single
4/,lkz %vo
Construction Lender
Addre s s Phone J25
Ut5IGN ILAPI name address phone no.
Primary
St ructura I .V
El ectri cal 4v \
Mechani ca I
CONTRACTORS name add res s 'l ics- no- )exDl res ohone no- )
Genera l
20")0 -l-F
nl
PLUMBI NG ELECTR I CAL MECHAN I CAL
N0.FEF CHARGF NO FFF THAAAF I'10 FFF CHARGF
Each single fixture Residence of
sQ FT
furnace/burner to
BTU' s
Relocated buiIdinq
(new fix. additioial)New circuits alts.or extensions
Floor furnace
and vent
S.F. Residence
( l bath)SERV I CES Recessed wal I
Soace heatpr and vpnt
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
separate
l,later servi ce Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily, comm or
I ndustri a I
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
c0Mr'1./IND. FEEDERS Mechanical exhaust
hood and duct
Instal l /a1 ter/rel ocatedistrib. feeders l,Jood stove/heater
0f
r t./tr
ISSUANCF OF PFRI{IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAI'I
shal I not be vai i,l
I REQUIRES that the Electrical work be done by an Electrical Conuntil the label has been signed by an Electrical Supervisor and
tractor, the electrical portion of this perm.it
returned to the Building Division
L EXAIl I N ED comp e app I I cartion for oe
work perfo
oertaining
t and do hereb.y certify ta information hereon s trueandcorrectandIfurthercert'I fy' that any and al I
State of 0regon
ssion of the Buil
rmed s hall be done in accordance with the Ordjnances of the Citywork described herein, and that NC OCCUpAl{Cy will be madefurther certify that my registration r,rith the Bu.ilder,sf exempt the basis for exemption is noted hereon, and that
.055 wiII be used on this project.
of Springof any st
Board is
fi e I d and the Laws of the to theructurewlthoutthepermiding
701
Di vl s 1 on I
I fu I 1 force a nd effect a s requ 'I red by ORS 05 5 tha t 'I
on 1y S ubcontr ac tors and emp 1 0yees who a re 'I n comD I I anc wl t h 0Rs 7n1
r{Ar,rE(prease print) E/rorf T C/S<ol S IGNATURE DA'3t3-8
Zone_______Tyoe/Const. Units Sq Ftg
Ftg
Ftg
. l,lai x ValFire Zone Be drooms Load . Access
. 0ther
x Val ue
Flood Plain S Gro xrVa lue
TOTAL VALUATION-
to ri es
BUILDING PERT.IIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65llB1dq Per Fee
/sterns
rarqe
opment
Plan Ck. Res
30%/81dq Per Fee
PLUMBING PERMIT
Charges and
Surcha rges
Fence
D6no
ELECTRICAL PERIlIT
Charges and , \Surcharges v \
6DJ Stdewal k
A/C Paving
Curb Cut
Total Comb. Permit
14ECHANICAL PERMIT
Charges and
Surcharges "?q a TOTAL 2 {o
:,U* lU,> 2,L.2a
l,later Heater_0ther
Phone
FOP NFFIC
COMBINATION APPLICATION/PERMIT (CAP)
I. Appiicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, ?nd Addition toSpringfield EstatesC. Name, etc. of owner and construct'ion lenderD. Energy Sources
l. example- heat,/eiectrical ceiling/o2. exampl e- waterheater/elEETiJcETorE. Square footage or valuation, etc.
r forced air gas
sol ar
II
1. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- ii new project, check-new - .if addition,
EIEEI-fdd, etc.F. Bui lding permit information:1, example - construct singie family house with an
attached garage2, example - remodel existing 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 Speciaity CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bui)d.ing
Division Staff must be able to contact appropriate
persons regarding design information or job s.itecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Eiectrical Schedu'les,
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 theful l schedulesC. BUILDING DIVISiON STAFF WILL 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 electnical labelIIIAppiicant to sign and date
I'lhenever possible, the initial application will be used asa worksheet only. tlhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual perm'it is issued for his
signature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV.
V
PERMIT VALIDATION
EA%77
?-(s'Y1
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s i gnature date
u