HomeMy WebLinkAboutPermit Electrical 1986-8-14
Job Address,
3r50
n1~
CITY Of SPHiil'a I ELO'
COf1BIIIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
t~a ter Hea ter
. ,OJWJ rm
INfORlIATlON Llilt
726.3753
Sq. f tq. 1,Ia i n
~q. Ftg. Access.
Sq. ftq. Other
Uew Add Alter ~ep.
--Fence Demo Change/Use
-Other - -
{cD
1 IIISPECTION LHlE
726-3769 '
.
Owner ~ Q.{ (.~ '! cy0,,!, j
Address U ()
Ranqe
Va 1 u, of I~ork:
0()
16
\J)
~
~
legal Description
Phone ?;;( h
Builriino Permit Info: Describe Work(i.e.~ Build Single
Far:1iJv nes;dence l'Iith J'l.tt3ched l1araae)
U~ 6J} c2 h/
'J.-Yt-tO/LL fL / A:..t' ~
.~5 X' ~
Construct;nn lender
Address
Ui:.~ I liil fEAll
{namel
Phone
(address)
(1 ics. no.)
(exnires)
(ohane no.l
Primary
Ii
~
~
;; ,
Structural
Electrical
f1echanical
CONTRACTORS
(name)
(address)
(l1tS. no.)
(exnirpc:,)
(ohone nn \
Genera 1
Electrical
(~4-A- ~~hCIAL ~.
[S/lqq
~~ 'f/Jf..{' t<)/1 rI c? ,/
t;.J- - - ~-- . - - - .
7-;). {- 'i '7 if51-~M
Pl umbi no
Mechanical
PLurlB IrIG
rHARr.f LlO
ELECTRICAL
MECHANICAL
--1ill.:..!
FEF
Each single fixture
Residence of
FFF I fHARr;F. fm
furnace/burner to
BTlI's
'il
I
I
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
(] bath I
Duplex (1 bath) each
New circu~ts alts. I
or extenSlons ')
~/Jr mOLf.
J;;l S '0
Floor furnace
and vent
SERVICES
I Recessed wall
~n,'lrp h"";.tp.. rlnti """....t
Additional bath
Storm Sewer
Of
C0I11'1. II NO. FEEDERS
amps.
Appliance vent
~""I)arat.p
I Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
IMechanical exhaust
hood .:lnd dur:t.
~!a ter servi ce
Temporary Construction
Change in existing
rp};rtp.nr~
Imultifamily, COrml. or
InrllJc;,trial
Sewer
I Install/alter/relocate
rlic;,trih fpprlprc;,
I IOf
I-
I
I
Wood stove/heater
amps.
tll"
I ~02lsro
I 11D
d3 liD
ISSUANCf OF PfR!lIT
TOTAL CHARGES J TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work. be done bv an
shall not be vali~ until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1WED the completed apfllication for ~ermit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Orel]on pertaining to the work. described herein, and that IlO OCCUPArKY will be made
of any structure without the permission of the Buildin9 Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemotion is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project.
1IA1,IE(please print)
~'DAUlt) ~~f)lrJSoNsIGlIATi!RF.
om g-Ic('~0
FO~ OffICo USE OilLY
Zone Type/Cons t. Units Sq. Ftg. f1ain
Fire Zone Bedrooms Occy Load Sq. Ftl]. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
.
x
ValuE'
Value
ValuE'
x
x
TOTAL VALUATION
BOILOWG PERl'lIT
Charges an':
Surcharges
Plan Ck. Comm/lnd
65%/Blda Ppr Fpp
...----------- P'T'an Ck. R.es
30%/Bldo Per Fee
I Fence
I Demo
-_____~~..021 Sidewalk
~l:) A/C Paving
Syste~s Development
Char~e (1.5n
PLO'1BWG PERMIT
Charges and
Surcharges
ELECTRIU,L PERI~IT
Charges and
Surcharges
Total Comb. rermit
.1ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
I TOTAL
~3 .Lio
.
-'
,
-
,.
COMBINATION APPlICATION/PE~~IT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot <100. lane County Map Reference
il OJ 43
2. examole. lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
~ Energy Sources
1. examole- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrlcalior solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house. 500 SQ. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - convert single famlly residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WIll FIll OUT All FEES AND
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must be delivered to the
electrical contractor for sionature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label.
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
l6 c'(Q q (2-
8 --(~-~b
V. fOR OFF! CE USE O:ll Y
Permit Cl erk
(lr/
1
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date