HomeMy WebLinkAboutPermit Mechanical 1989-5-4
1f1~I'Ecr 1011 L IfIL
726-3709
t Jo~7Il!dressrJlo.sle
legal Oe~cription
lnameJ
LIlY uF SI'RIIMIELU ~ NfORlIAT:.:i L,,,, I,N'\ ",
-e COIIBIII^T10N APPLICATION/PERMIT 726-3753 V'"
(00 . r E!lERr,y SOURCES: So, ftQ. "ain rYI I:
1,r0" fJ' _"'l Ileat ~q. !'t!). Access. \..}J
o r Uater Ileater SQ, Ftq. Other C2
R lie" Add ~,lter ",eo. :::0 'I
aone -rence Demo Change/Use
Valu, ~ l"Kk' Other- - IllJ I
[luih;ino .ermi~ Info: Ilescrlbe Horkli.e.. Build Single r.' I:
Familv Residence IHth /lttached r.araClc) LJV
1\'\\9-. \' \'\C\ ~(\ f\.~, ~ ~ J.. t) I I
I OJJOOO \(')\\) (J {I
I flies, no.\ fexnires~ ,t'n~n~ :0,',
Address
O"ner h-MlQ.., c\ (-}((XI,
~1cchanical
CONTRACTORS
General ?"Qi.0 J 50. r\\t'tWJ
PlumbinQ ~
\\m--.\,Nt ,~f\'l \\~.
PLurm'u)G . ] (J
FFF I rll^Rr,F UHl__1
I Res idence of
SQ. FT.
INew circu!ls ails.
or extenSIons
ISERVICES
I
Construction Lender
Address
Ul)llifl rU\l1
Primary
Structural
Electrical
Electrical
~'echan i ca 1
nu.
Phone
Phone
(address)
(namp)
,
,i
(nhonp nn l-----J
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3\~_~P,\D\ ,
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(address \
( lies. no.)
(expires)
8S'S ~., \ ~ &'JO.o.tAN
~ I
ELECTRIC^L
MECHANIC^L
,rr
r~ARG.E.- un
Each single fixture
/Relocated building
(new ~ix. additional)
IS.F. P.esidence
(1 bath)
IOuPlex (1 bath) each
IAdditional bath
IOf
I Cor1/1.1I NO. FEEDERS
Ilnstall/alter/relocate
di~trih. fppdpr~
IOf amps,l
I
I
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TOT^L CHARGES I TOT^L CHMGES
"111EP.E ST^TE L \II REQUIRES that tile Electrical "ork be done by an Electrical
shall not be vali'J until the label has been signed by an Electrical Surervisor
~!ater service
Sewer
I Storm
-,
I
I
-,
I
I
Se\'Jer
I
I
,
I
,-
I
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fu~ace/burner to
<....fqCX'Y) BW's
I Floor furnace
and vent
I Recessed wa 11
~o~rp hp~tp~ ~nrl upnt
ITemporary Construction
~Cii'a~;e in existing
Irpc;.idpnrp
I Imu'lt(family, CQnl!l. or
TncflJ<;trial
I Apol iance vent
<;POi!r;Hp
I Stationary evap.
cooler
I Vent fan with
sinol,. duct
I Vent system apart from,
heatino or A.C.
I Nechanical exhaust
hood ilnd rlurt
I tlood stove/heater
amps.1
tSSIJ^NCr OF PfR'IlT
la,CD
TOTAL CIIMGES
Cantractor, the electrical portion of this perr.lit
and returned to. the Building Division
I IlAVE CAREFUllY EXNlINCO t~le completed aprlication for t)ermit, and do hereb,v 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 Sor i og fi e 1 d and the laws of the S tate of Oreryon oe rta i n i og to the work descr i bed here in, and tha t UC OCClJrAUCV \"i 11 be made
of any structure without the permission of the Oullding Division. I further certify that my reflistration \ol1th the Builder's
Ooard is in full force and effect as rCCluired by ons 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees ",ho are in comDliance with Or.S 71")1.055 \'Iill be used on this nroject.
SIr.II^T1!R~~ &i~_OATE ~-'i _ ~~
FO~ nrFICE lISE'6ffLY .
IIN1E(please
print0ah',///p','s 'h.. v>s~
- -"-
Zone
Fire lone
rlood Plain
OUILOIrIG PERHlT
Char']es an:::
SurCharges
PLUlmlNG PERMlT
C~arges and
SurCharges
,ELECTRICf..L PERr:lT
Cha rQCS dnd
Surctld rges
f1ECIlANICAl PErHHT
Charges and
Surcharl']es
.\
)
. Tyoe/Cons t.
Oedroams
Stories
lJni ts
Occy load
flccy Group
Sf!. Hg. ltain
SQ. Ftc]. Access
S~. Ftg. Other
x
Value
Value
Value
x
x
TOT^L V^LU^TION
Plan Ck.
_ _ __ _ __ __ __ _ 65%/Oldo
Plan Ck.
30t/Oldn
. I Fence
------------
I Of-RIO
I
Corl1ll/1 nd
p.p,- Fpp
Res
Pc r Fee
Syster.ls Oevelopn~nt
Char"e (1.5')
__J~~~LW__I Curb Cut
'\~ I
ITotal (amb. rermit
i TOmL
\ ~ ,'\es
f
,.
,
..
COMBINATION APPLICATION/PERMIT (CAP)
I.
II.
Appl icant to furnish
A, Job Address
8. legal Description
1. example- Tax lOl JOO, lane County Map Reference
II oj 43
Z. example- lot 1. Block 3. 2nd Addition to
Springfield Estates
C.. Name. etc. of owner and construction lender
O. Energy Sources
1. exa~~le- heat/electrical ccilin~/or forced air Qas
2. examole- waterheater/eleClt"ical/or solar
E. Square footage or valuation, etc. -
1. examole- J250 sq. foot house. 500 SQ. foot garage
2. examp I e- T1'1lew proj ec t. chee knew - if add i t ion.
check add, etc.
F. Building pennit illformalion:
1. examole - construct sinyle family Ilouse with an
at lached garage
2. examoJe - remodel existing garage into family room
3. examoJe - convert slngle family residence into
restaurant (change of use)
G. Va lue of \'iOrk as defined in Sect ion 303 (a) of the
Structural Specialty Code
It. DES IGN TEAH ANO COIITRACTORS
To avoid deSign or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Nechanical. & Electrlcal Schedules
A. Except ,.,here 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 jt~n(s) to be installed
B. 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 are not covered on
the abbreviated schedules you should consult the
fu 1 J schedu J es
C. BUILDING DIVISION STAFF WILL FilL OUT ALL FEES AlID
CHARGES 011 THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The genera) contractor is not authorized
to sign the electrical label. -
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.
Fees and Charges
Plan check rees 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 permi t is issued.
I I I.
IV.
V.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPA~CY:
.
,.-
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PERMIT VALIDATION
4/ \C{SGj
Permit,
Cler~(/Yl)
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Permit applicant exempt from registration with the Builder's float'd because:
Additional Project Information:
PLANS REVIEWED flY:
name
signa ture
.
9
~
date
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'to
low
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--f}O!lJ;'s tal'V-$
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f?e't1;. r-n
q.SGJrf'Y
for ~u.f'5t-o;,.
o FP"'"
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ELECTRICAL INSTALLATION RECORD
Job Address: ;:;6.5 r::; OC/"'t?1/ZI c Property Owner:
Tenant: Owner's Address:
Electrical Contractor:..:i;;.., ,/-?ppt;4e,<! q'<"'c.7:Label # ~7 7tJ C
Address: ---f?CJ. I..'<..I/)(/::? 6,#-STOtU_.re;:: _ 77//<1
sU~~lnAie~~1,~f uate #-'-I~A?
Description of Work: / - 4t?/? ",q/Yl,o ,~P.e!/..r,-,,=
'/- /c:o A/h. t:J t9te l.e,."..s ;:::eC""--/ __ <;
/. ,
~ ,t')R /Yl""I2t<'~ .RR.4It.C~ LJ',o","--..I,'N
(YJ/A.I/o ----<T/?PA-~ G F""A-r.....r L-Z:'/rY
,.:;)#) d ~L?A~ L'//Jf"Oi'J+- O/'J*'S/"~
,I3M:?/-':'-'JQ.. Ln-zf-:- L/:~A k~ 0_
, 0 (T 0
Inspection Results
.:.~ee ~/)i-.::f/:: eAc)?~~
- -
Electrical Fee
$ /AO.{)()
9.06
$~a2!QQ
'''~~r
Surcharge
Total
#451