HomeMy WebLinkAboutPermit Electrical 1989-6-19
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Ii/SPEer 1011 L1i/E
726-37ti9 .
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LilY IJF SI'R!i/(;FIElO
cO/mlnATION APPLICATION/PERMIT
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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 -- --
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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
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Construction Lendel
General /?W/Yt!::/'5
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Address
DCS I GII TEN1
Primary
Structural
Electrical
!1echan i ca 1
CONTRACTORS
.,
RanlJe
----._--
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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
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+
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,-
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1-,-1
New circuits alts.
~ or extensions
'7 /?~ ~/.:?E
I SERVICES '
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vpnt
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: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
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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)
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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
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ITotal Comb. fermit I /"23. c:;?/
.8~. i:o
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4- &> 3
Syster.ls Development
CharQe (I. 5'Y.)
~:z. "3'3>
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',0 ,,~-'", ,I Fence
- - - - - ~: ~ ~ - ; ~ -/ DF-mo
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I ~ 1'3
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- __ _LL_._ ____
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F
.<?D
I TOTAL /?b. 7' ~
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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
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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
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. . ,. .. ~"'."'~." , I _ .'. .
date ~-19-&'9
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