HomeMy WebLinkAboutPermit Electrical 1989-5-17
lil~I'ECTIOrl lJia.
716-3769
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Job Address 2787 Olypmic, Unit 4
I.e~al Oemipt ion \ f} () 3 d ~ \ (jO"5:CfJ
L11 y I)f SI'RlIlGf I EI.U
COIlBlIIATlON APPLICATION/PERMIT
E!IERr,y SOURCES:
Ileal
Hater Heater
Owner
Tom KE:l0Tiia
2787 Olympic,
Unit 4
,\ddress
Construction lender
Address
Ul~llirl ll^"
\namcJ
I'hnnc
(address)
Primary
Structura I
Electrical
!lechanica 1
CONTRACTORS
(name)
(address)
Genera 1
Plumbino
Electrical
OREGON ELECTRIC SERVICE 2370 W 7th Pl.,
t'~chan i ca 1
PLUlIBIrIG
ElECTRICAL
....1ill..:.
....liL CIIARGE . JIG- .
IResidence of
SQ. FT.
Each single fixture
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COI~1./INO. F[[OERS
- I~~MK!'/reloc.te
_J1..is.trih rplWrorc:
Of amps.1
IRelocated building
(new fix. additional)
I'S.F, r.esidence
'I bolthl
-louPlex (I batb) each
IAdditional bath
I ~!ater service
I Sewer
j Storm Se\'I~r.
-,
New circu!ts all{' \__
or extens Ions C)...,"'I
'SERVICES
-,
I Temporary Construct ion
IChallqe in existing
rf''l; drnr~
ImultifJmily, comm. or
IndlJc:.trial
IOf
Zone
Tyoe/Const.
Bedrooms
Units
Fire lone
Occy load
Flood Plain
Stories
Occ.y Group
BUILOIrIG PERI.lIT
Char'}es an~
Surcharges
Plan Ck, COllJll!lnd
65!/Oldn Ppr Fpp
Plan Ck, nOes
JOt/Oldn Per Fee
Fence
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PLU"BING PERMIT
Cholrges and
Surcharges
------------
Dnmo
. ClECTRIUL PERI:IT
Cha rQes and
Surcharges
&~~SJ
1.\3
Sidewalk
..1 A/C Pavin9
I Curb Cut
IIEClIAlIICAl PERIHT
Charges and
Surcharqcs
Ranlle
Valu( of HorK;
(I ics. no.)
(I irs. no, I
\0
mORllAI:.:1 ll....
716-175}
So. Ftq. '.:ain
~Q. ftl). Access.
So. Ftg. Other
Ilel;' Add ",1 ter ~eD,
--rence Demo Chan9c/Use
Other - -
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(\1 }) r) 11 T'S I J I
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Cexnires I
(l'xoirpc:. \
Eugene 2046C 10/89
MECHANICAL
-ELL J:JIARGlI..illL..
iUtlDS.1
.XJ,SC
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686-4blL.ilh;inn Permit Info: (Jescnbe I-Jork{i.e., Build Single
Phone r,lr.Ii 1 V nes idence Hi th (It tached r..\rane)
llNloi\l 01+
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TOTAL Ct1ARGrS TOTAL CIIARGES TOTAL CIIARGES
I HIlEP.E STATE l \11 REQUII~[S thell the Electrical ''lark be done by an Electrical Contractor, the electrical rorUon of this permit
shall not be ."alH until the label has been signed by o'In Electric;ll Surervisor and returned to the Building Division
I HAVE CAI!UUllY EXMlIr/[[) the completed aprlication for ryerlllH, and do hereb,v certify that all information hereon is true
and correct, and I further certify that any and all ''1ork nerfonllcd shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the Stille of Orellon oertaining to the work descrihed herein, and thilt 110 OCCL!rMlCY ''1ill be made
of any structure without the permission of the llllildin~ Division. I further certify tho1tlTl'y rC!1istration "lith the Ouilder's
OO<lrd is in full force and effect ilS required by ons 701.0!J!i, th,ll if cxel1lot the basis for exemntion is noted hercon, and that
only subcontri'Jctors and employees who are in com::l1iance with Of~S 7111.055 \,,'111 be used on this nroject.
IIMIEe"le.,e print) 1/ fl V-WoM t!JLlt;.v- . SIr.llATURF. --:> J. 12-, (!).I k
FO~ OFFICE IISE ~
So. H!J. fl<'lin
SQ, rt~. Access
Sg. Ft9. Otber
furnace/burner to
OW's
I Floor furnace
and vent
I Recessed wall
_~KLhp"t,.r "nr!
I
I Apoliance vent
c;,eoal'atp
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent ~ystcm apart from I
heHinq or A.C.
I Nechanical exh<1ust
t"!ClClc1 .lnd rlurt
-I \lood stove/heater
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ISSIJAflCr OF PFP,/11T
x
Value
x
Value
x
Value
TOTAL VAlUATIOrI
Systems Development
CharQ. (I. 5'.)
/Total (~b. rermit
: TOTAL
fohnnf' no. I
(l)hOI1P nn \
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343-1681
rLIJJlAIlliL
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DATE ~ -n-~
d3,la3
III"""'"
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COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
.A. Job Address
B. legal Description
1. example. Tax lot 100. lane Counly Map Reference
" OJ 43
2. ex.mnle- lot I. Block 3. 2nd Addition to
: ~prln9fjeld (stales
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le. heal/electric~!~eilin~/or forced air Qas
2. examole. wdterhcdler/clectl"lCill/or solar
L Square footage or valuclUon. etc. -
1. examoJe- 1250 sq. foot house. 500 sq. foot garage
2. example- TTnew project. checknew _ if addition,
check add. etc.
F. Building permit information:
1. examnle - construct sinyle family house with an
attached garllge
Z. eXdmole - remodel existing garage into family room
J. eXdmole. convert single family residence into
restaurant (change of use)
G. Vdlue of \'Iark as defined in Section 303 (a) of the
Structur'a I Spec ia Ity Code
II. DESIGN TENI AND CONTRACTORS
To avoid desif)n or construction delays, Ouihliug
Division Staff must be able to contact ilpproprillte
persons rega rd i ng lies i gn in fonna t i on or job site
corrections, etc.
II. Abbreviated Plumbing, Nechanical, & Electrical Schedules
A. Except Hllere b lank spaces OCcur in the descript ion
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
8. Full Plumbing, Nechanical, 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 arc not Covered on
the abbreviated schedules you should consult the
full schedules
C. BUllOIIIG DIVISION STAFF Will FIll OUT ALL FEES AlID
CIlARGES 011 THE SCllEUUlES
O. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electric,))
supervisor. The general contractor is not authorized
to sign the electrical label. -
III. Applicant to sign and date
I-lhenever possible. the initial application will be used as
a worksheet only. I-lhere possible. Building Division Staff
will prepare a type written copy and return-i.t-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 ,.,.ill be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE OrllY
.
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PermitCle k
PERMIT VALIDATION
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Infonnation:
PLANS REVIEWED BY:
name
signa ture
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da te
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