HomeMy WebLinkAboutPermit Electrical 1989-2-17
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legal Oe~cription ~
(:J ~ Ranne
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Owner ~ uCW& / l~ )Q ~ ,~ Jt1..JJ>> n \. ~~ Va u, of 1I0r .
0- ( t;uihi;na Permit Info:
Address Phone Far.1ilv rlesidence Uilh
(/q
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(name)
IrI,PECTIOlI LHlE
726-3769 '
Job Address
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Construction lender
Address
Ul:.~J(jfj r1:.J\l"i
\name)
Primary
Structural
Electrical
!lechanical
CONTRACTORS
General
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Plumbino
Electrical
~'echani ca 1
CITY UF SPRIrIGFIELU
COIIBIIIATI ON APPLI CATION/PERMIT
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1-0 !
10) !
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(ohone no. )
NFORtIAT: .:1 LI....
726-37;3
So. FtQ. ,.jain
~Q. rtlJ. Access.
SQ. Ft~. Other
/leI'!' Add /1.1 ter ~eo.
--Fence Demo Change/Use
I -Othe~- .-
Describe Work\l.e.. ~uild Single
Il.ttachp.d r.araoel
'~/ec,
E!IERGY SOURCES:
Heat
\.ta ter Hea ter
-I
/-e~.
Phone
(address)
(lies. no.)
(exniresl
/
-,- ZJ'f,~
C..-z. rl,r)
_" c..
(address )
9/hu R {-~ (7 ()-<.)")-r
( 1 ics. no.)
(exoires)
(ohone no.)
()?:!
PWflBlIlG ELECTRICAL
1:0, '-ITL CIIARGE '--00....
Each single fixture
-----/Relocated building
(new fix. additional)
IS. F. Res i dence
(1 b^,hl
10uple, (I bath) each
jAdditional bath
Sewer
I
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I
I
I
I
I
------ 1'--1
~lUA 1+
-, I I I I
I I
I
Ha ter servi ce
Storm S~wPr'
-I -- -..
I
-----I
I
I
I
MECIIANICAL
-.EEL J:liARliE '-1l!L
Residence of
furnace/burner to
BTlI's
SQ. FT.
,-----
I
I
I b
I
I
New circuits alts.
or extensions
I Floor furnace
and vent
I Recessed wa 11
Sr'I;l('P hp;:ltpr ilnrl
I
...."'nt
, SERVICES
I
I
ConstructiQl1 r
I
corron. or I
amps.
,
I
I Temporary
IChange in existing
rp~.i r!.~r'I(,P
Imultifamily,
Inr!llc;tri;11
IOf
IC0f1fl./IND, FEEDERS
Install/alter/relocate
i . fper!prs
I Apol iance vent
~pl)aratp
"Sta'tionary evap.
rooler
I Vent fan I"i th
sinale duct
I Vent system apart from I
hpatinn or A.C.
I Mechanical exhaust
hoar! and dun
/l'JOOd stove/heater
I
I
I
Of
amps,l
I
I
I
~7~,~
ISSUANCE nF PFRlIIT
TOTAL CIIARGES J TOTAL CIIARGES
',(ilEnE STATE lolll REQUIRES that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
r HAVE CAREFUllY EXNtlNED the completed aprlication for rJermit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed 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 He OCCUPAUCY \'1il1 be made
of any structure without the permission of the Guilding Division. 1 further certify that my re9istration with the Guilder's
Goard is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and emnloyees \...ho are in comoliance with Or.S 7r)1.D55 \'/il1 be used on is nro,iect.
IWIE(please print)~<:!..
Units
Occy load
.Occ'y Group
SICIIATUR,
FOP. OrrlL~ U~E
'S~.
SQ.
Sq.
O^,TE
2 -/0 -'8'1
~#1/17~/~
.
Zone
Fire lone
Flood Plain
Tyoe/Const.
Bed rooms
Stories
Q;ILY/ /-
Ft!J.~in
Ftg. Access
Ftg. Other
,
Villue
Value
Value
,
,
TOTAL VALUATION
BUILDlflG PERf'lIT
Charges an~
Surcharges
-----------
J
PLU'1BING PERMIT
Charges and
Surcha rges
,ELECTRICAL PERr:lT
Cha rqes and
Surcharges
flECIIANl CAL PERI1lT
Cha rges and
Surcharges
Plan Ck.
65%!Bldo
Plan n.
30%lB1 dn
Corrrn/fnd
Ppr Fpp
Res
Per Fee
Systems Development I
CharQe (1. 5')
I
I
I
I
ITotal Comb. rermi t I
I TOTAL ~ 1:S, qs
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
II cij 43
2. examole- lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilin9!or forced air Qas
2. examolp.- waterheater/eJeCtrlcal/or solar
E. Square ro6-tage or valuation, etc. -
I. examole- 1250 sq, foot house. 500 sq. foot garage
2. example- if new project. check-nfw _ if addition,
check add, etc.
F. Building permit information.:
1. examole - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examOle - convert Single family residence into
restaurant (change of use)
G. Value of \~ork 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 Nhere 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, ~lechanical, 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
D. 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. -
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 cneck fees are due and payable at the time of the
application, and no plans l.,.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 ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIJCY:
.
.
PERMIT VALIDATION
:
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12e/,'-r'- ~ /3/7;/ ,
Permit Clerk d, ~ ~""-I "
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Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
name
signature
j
J
date