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HomeMy WebLinkAboutPermit Electrical 1989-2-17 \/)L' legal Oe~cription ~ (:J ~ Ranne I I /! I 'k' Owner ~ uCW& / l~ )Q ~ ,~ Jt1..JJ>> n \. ~~ Va u, of 1I0r . 0- ( t;uihi;na Permit Info: Address Phone Far.1ilv rlesidence Uilh (/q tI/D / J/\ \ (name) IrI,PECTIOlI LHlE 726-3769 ' Job Address ~ ("'" 5(..., Construction lender Address Ul:.~J(jfj r1:.J\l"i \name) Primary Structural Electrical !lechanical CONTRACTORS General ~ ;2.( C!-- Plumbino Electrical ~'echani ca 1 CITY UF SPRIrIGFIELU COIIBIIIATI ON APPLI CATION/PERMIT PD/) - QAJ . I I , o<li 0('1 DI I 1-0 ! 10) ! j(;J ,I (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 I 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 : ~ '. 12e/,'-r'- ~ /3/7;/ , Permit Clerk d, ~ ~""-I " ~ -1/6. -8'9 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