HomeMy WebLinkAboutPermit Electrical 1982-08-21NSPECT i ON
26-37 69 COMBI ITI CAT 726-3753AP
Job Address t_tn
Lesal Description llOC
EIIERGY SOURCES:
Hea f,
Ranoe
llater Heater
Owner
7a,o
Vai ue of l,lork
:q. Ftg. Access._
Sq. Ftq. other
_l{erv_Ad d_At te r]en -
_Fence_Demo_C ha nge/ U s e
0ther
Sq . Ftq . l'la i
PhoneAddres s B\o$ -{\ \$Vn Builc,inq Pernrit Info: Describe l^Iork('
Farnily Residence tlith Attached Garacle'
:e., Build Single
I rl
Construction Lender \
Addres s Phone
O
boD
-o
DESIGN TEAM name addre s s lics. no exDt res n0
Primary
Structura I
Erectricat C.UD t[0-P-\t-\oB Yna'r n :l qJo laSl '74b-5c{53
l''lec ha n i ca I
name a ddrps s (lics. no-)ohonp no- )
Genera I
Pl umbi nq
El ectri ca I
Ittechanical
PLUIIB I NG E LECTR I CAL MECHAN I CAL
NO FEE CHARGE NN FFF CHARG F NO FFF CHARGF
Each singie fixture Residence of
SQ. FT
furnace/burner to
BTL| ' s
Rel ocated bui 1 d ing
(new fix. addit'iona1 )
New ci rcui ts al ts
or extensions
F.l oor furnace
and vent
S . F. Res i dence(l bath)I SERVICES I r';,JO Recessed wal I
Space heater and vent
Duplex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seDa rate
l,Jater serv ice ge in existing
dence
Chan
res i
Stationary evap
cool er
Sewer multifamily, comm. or
IndustriaI
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
c0r,1r.1. /IND. FEEDERS Mechanical exhaust
hood and duct-
instal I /al ter/re1 ocate
di stri h fppdprs l'Jood stove/heater
0f
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAN REQUIRES that tlre Electrical work be doneshali not be vali,l until the label has been signed by an Elec
by an Electrical Contractor, the electrical portion of this permittrical Supervisor and returned to the Building Division
DATE 7 €/-va
the pe
nd effe
YFULL NEXAMI theED e trmr and d 0 tirfo0ntcac0mpapr)0e cer tha athereb.y
c0 trrec anda nd uf hert cer rt t tha a and work rmed ah befyanyperfo done n oracc ncda W1 ht
dI0e a thend Laws thf se taSprngfi te fo n rta to WOthe r dOregoDC e c bert hered n a thnd tasfstut ruc wtre Lthou rml s o ofn Buthe d Di sVI on fu rngrt he cer ti ttha re trSfym,y soa
any
rd s n fu force a tha cactsreuld70rORS055t t heL bas s rfo ex t 0nreqexempbyemp
o bcsu nt to rsrac danv who rea nernpoyees ance thwl us0 7 n1 055 1,,/ l be u onedcomD th s r0 ectp
7
ENAI"I ed rse ntpp S TUREGiJA
nformation hereon is true
the 0rdinances of the City
. I'lC 0CCUPAI{CY will be made'ation r.rith the Builder'sis noted hereon, and that
Zone Tyoe/Const. Un.i ts So
T0TAL VALUATi0N_
x.0ther0c
I
Ftg Acces s
c.y Group Sq. Ftg
Val ue
Value-
Ftq. l'lain.
cy LoadFire Zone Bedrooms
Flood Plain Stories
Plan Ck. Comm/Ind
65%/8ldo Per Fee
Svster:rs Devel ocment
Charqe (1.5c)BU]LDING PERI.IIT
Charges and
Surcha rges Plan Ck. Res
30%/Bl dq Per Fee
FencePLUMBING PERMIT
Charges and
Surc ha rges Dgrno
Si dewal k
Total Cornb. Permit
ELECTRICP,L PERIIIT
Charges and
Surcharges
I
A/C Paving
Curb Cut .iOTALI{ECHANICAL PERMIT
Charges and
Surc harges
l I
PERMIT VALIDATION
Permi t Cl erk
++
*
5r{3"q
6t6b
iZ".*pL
\ajot<
Applicant to furnish
A. Job Address
B. Legal Description
1. exampie- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, Znd Addition to
Spri ngfi e1 d Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exampie- if new project, check new - if addition,
EIecF add, etc.F. Bui lding permit information:1. example- - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - convert single family residence jnto
restaurant (change of use)G. Vaiue of work as defined in Section 303 (a) of the
Structural Speciaity CodeH. DESIGN TEAM AND CONTRACTORS
ign or construction delays, Building
ff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, l4echanical, & Electrical SchedulesA. Except where blank spaces occur in the description
portion of the l,lechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installedB. Full Plumbing, l"lechanical, and Electrical Schedules
are available at the Bui lding Division1. To conserve space on the perm'it form the schedules
have been abbreviated
?. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful I schedulesC. BUILDiNG DIVISION STAFF l^IILL FII.L OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial appl ication wi'll be used as
a worksheet on1y. l,Jhere possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gnature.
Fees and Charges.
PIan check fees are due and payable at the time of the
application, and no plans will be processed unt'il these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
Ii
III
IV
example- heat,/electrical ceiling/
exampl e- waterheater/el ectri cal /o
are footage or valuation, etc.
or folcegla]1 gq9
r so.l ar
COI4BINATI ON APPLICATiON/PERMIT ( CAP )
V. FOR OFFICE USE ONLY
1.
2.E. Squ
To avoid des
Division Sta
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Informat'ion :
PLANS REVIEWED BY:
name
da teSigna tu re
--'--