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HomeMy WebLinkAboutPermit Electrical 1989-6-19 ~ Ii/SPEer 1011 L1i/E 726-37ti9 . '" LilY IJF SI'R!i/(;FIElO cO/mlnATION APPLICATION/PERMIT "---I E!IERGY SOURCES: Ileat l'la ter Ilea ter IllfOR/1AT: .:1 L:..o 725-3753 So. FtQ. (.lain ~q. ftc). Access. SQ. Ftq. Other r1el~ Add /1,1 ter [leD. '--Fence Demo Change/Use --Other -- -- Ii ~: ~! ~i ~j I i I ! Job Address /'3( S ~~-fr (_ Le'lal De~cription \(\f)~0l )2A ~n CE#TEJfYN'/A-L E.ct!""h";E/YT~Y ~~~C. Owner ~~~~/L,r#/9 ,\ddrcss c.::;;-Z,5' X/7/~( ~r' ...,_ P21onc_...,,.- ,/:'/' ,~--;;....... 0/ ~?'rZ-j;). c$;q . Construction Lendel General /?W/Yt!::/'5 ;;, Address DCS I GII TEN1 Primary Structural Electrical !1echan i ca 1 CONTRACTORS ., RanlJe ----._-- ...,--- ValuE of [,/ork: la~-~ [Jui l(:ino Permi t Info: Fa~ily Residence With Oescribe Hork(i.e., Build Single /lttached Garaoe) ~r-%-c. ? ~~ U~~'~5 /d r:=~.fr~ /At'/_,Mf~;Z? ~~/ (name (nilme) (address) (I i cs. no.) (exoires) (lJhone no.) Plumbinq Electrical ~,y~ ~'f'chanical Plurm I fIG ELECTRICAL ~lECI1AN I CAL i;O.1 Residf'ncf' of furnace/burner to BTlI's - -ElL CIlARGE -I'LL LELE- ..J:HLlRGL 110, I LITLIJ:lJARGL' Each single fixture sq. FT. Relocated building (nf'w fix, additional) IS.F. Residence (1 bat h ) I Duplex (1 bath) IAdditional bath I~!ater service I Sewer Is torm Sel'/er I I I I I I I , I I I I + I I ,- I I 1-,-1 New circuits alts. ~ or extensions '7 /?~ ~/.:?E I SERVICES ' I vpnt I I I I I I :42-62:' Floor furnace and vent I Recessed wall Soacl' hl'il tpr ilnd I each I Temporary Construction IChanqe in existing residence /multifamily, com~. or Industrial IOf -jCOT111.IIND. FEEDERS I jlnstall/al ter'/relocate di~trib, fppdpr~ -1" 'm"i I I I ~ L A.z -so amps.1 I APD 1 i ance ven t , seoarate I Stationary evap. cooler ' I Vent fan \~ith sinole duct I Vent systel!l apart from I heatino or A.C. I ,'lechan i ca I exbaus t bood and duet jlJOOd stove/heater I o/'l&~pY~'....-'7~<lf ks:~ I ' I . I I I I I SSUANCF OF PFP.lllT TOTAL CHARGES TOTAL CHARGES HIIEf1E STATE 1.\1-1 REQUIHES that the Electrical \~ork be done by an shall not be villi'1until the label has been s,igned by an Electrical TOTAL CHARGES ;;c;:.~ this pemit )7$'7" . Electrical Contractor, the electrical portion of Supervisor and returned to the Building Division I HAVE CAnEFULLY EXAlWICI) t~le completed apnl ication for 'lermit. and do herebv certify that all information hereon is true and correct. and I further certify that any and all I~ork oerfonned shall be done in accordance ~Jitb the Ordinances of the City .of Soringfield and tbe Laws of the State of Drenan oertaining to the work described herein, and that flO OCCl'PAllCY I~ill be made of any structure without the permission of the lluildinC] Division. I further certify that PlY reqistration ~Jith the Builder's ,Board is in ful I force and effect as required by OI~S 701.0~~, that if ex'emDt the basis for exernotion is noted hereon, and that only subcontra'ctors and employeesl~ho are in cO~IDliance with OI~S 7nl.055 l'lill be used on this flroject. ImME(please print) Q.JI/:/4/r'J V a~~~ _I -- PI''''' _~~_ _'" , J A.~ 0.';' S 1r.;IATlJRF. FO[l OFFICE lJSE OilLY D^TEL/.,_~ x Value Zone 'P~. Fire Zone Flood Plain BUILDIrIG PERf.11T Charges an~ SurCbarges PLUI1BING PERMIT C~a rges and SurCharges , ELECTR I UL rEfl1~ IT Cha rQes and Surcharges 11EClIANI CAL PEP.11lT Charges and Surcbarqes Tyoe/Cons t. 5'-/ff~. Units So. F tel. Bedrooms Ocey Load Sq. Ft~. Stories / Occy Group E-/ SCJ. Ftg. rIa in Access x Value Othe~ 7/F~~ Value/~~ . TOTAL VALUMIOtl -- Plan Ck. Convn!lnd 55%/BldQ Per F~~ Plan Ck. I!es 30%/Bldo Per Fee I I I I ITotal Comb. fermit I /"23. c:;?/ .8~. i:o ------------ 4- &> 3 Syster.ls Development CharQe (I. 5'Y.) ~:z. "3'3> (' I I I ',0 ,,~-'", ,I Fence - - - - - ~: ~ ~ - ; ~ -/ DF-mo -___z~:~~_ I ~ 1'3 , /s-:~ , - __ _LL_._ ____ .~ a;- F .<?D I TOTAL /?b. 7' ~ t I . .. COMBINATION APPLICATION/PERMIT (CAP) I. II. Applicant to furnish ,A. Job Ad~ress , B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 OJ 43 2. example- Lot 1. Illock 3, 2nd Add it ion to Springfield Estates t. Name,'etc. of owner and constru'clion lender O. Energy Sources 1. -example- heat/electrical ceil inq/or forced air qas 2. 'examole- waterheater/electr'ical/or solar E. Square rootage or valuation, etc. 1. examo le- 1250 sq. foot house, 500 sq. foot ga rage 2. example- if new project, checknew - if addition, check add, etc. F. Building permit information: 1. ~xample - construct single family house with an attached gill'age 2. examole - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change of use) G. Va.!ue of \~ork as defined in Section 303 (a) of the Structural SpeCialty Code H. DESIGN TEM! 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. Abbreviated Plumbing, ~Iechan'ical, & Electrical Schedules A~ Except where blank spaces Occur in the description portion of the Mechanical' and Electrical Schedules, the appljcant need fill-in only the No. Boxes adjacent to the appropriate item(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 11 schedu I es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must electrical contractor for signature supervisor. The genera.! contractor 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 [0 the app 1 i cant a t the time the ac tua I permi tis issued for his signature. 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 p~yable'l:'hen the permit is issued. PERMIT VALIDATION , 1o-8 - 8Cf j\L\\~~ ~ ~ f , ~ r I ~ ('J-- , CleG Jiro) - . . be delivered to the by his electrical is not authorized III. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE 'SA~TISfI~O BEFORE OCCUPAtJCY:. Pe rm i t Permit applicant exempt from registration with the l3uilder's Board because: Acjditional Project I'nformation: PLANS REVIEWED BY: .nqme " , '. l ~" ~/9?1'~D ~~t!!!!:'rf signatur4.Pf'~_~~ ' '/ '/' ,-. . . ,. .. ~"'."'~." , I _ .'. . date ~-19-&'9 .