HomeMy WebLinkAboutPermit Electrical 2004-11-16
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)7J~J289
ELECTRICAL PERMIT APPLICATION, ~;~;,,/~o~-?
City Job Number Co "f\. 7co4:- ~c t4-l L Date l\. - l b -0 &- () "'<r//)O' ,/:.oro
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Installation, Aiteration ol\,<R.elocation
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200 Amps or less s ~ \:)~" ~
. 201 Amps to 40&~~m" e\.\O'c--V
, ~e <....~"!>- '? S)'V....\
401 Amp\~~(j000mpt'e ~~7; ~ '0"
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Signature of Supervising Electrician 0 : "i~tt.
~1 A /1 -<...<v~-<"''\~~~We~~~1.@~~t.~~~l\1\.panel
'/' /./ c..--' / ~* <'': &>nCJ @C~ib\.'lY" ~O~ \:)~~ ~"t>1'X
. \. '~~\\(j~~CS~Ri~'C~t~~ith
. ,Owners Name L~+ltZ- ~'" ~ ,,'( ~O\.'o~<?- ~b~~~ ~~~~r $ 3.00
Address v d. ~ ^ '~ ,"()()t. . ~;;(S,\'~ftlf~'fiiff~1:idt:i,ii~~mijffd)?LEil~~Tl~iim,r:iraff\!~
l'7- 5 'l:-- C.J ~ ~ t:- Ct ~~';; ,t4'.2~t.t~ '-i::'i.";;.~H-:'?l;t~i'::'.i;t~tt::i:.c.;H:...~I~IA~IJ.~.;:-;.J.:.ii~\i:~Btt.i"~WI:'kv:t~~i
City e -.) C1- g,fBL. E- Phone' 5t\- \ .. <\ ll., ~ (., ~ LO ~~mp or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergyIResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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1.
LEGAL DESCRIPTION
II 0 ~ 3.1.:-- ~ ~ 0 'L6c:C
JOB DESCRIPTION
12-e-?L~c.:E- ~ \2-'~\c..~ 'N\~ ~-c
Permits are non-transferable and expire If work Is
not started within 180 days of Issuance or if work Is
Suspended for 180 days.
2.
Electrical Contractor 0'~ b f:.l.O. e::9 r'\ c
Address 2- \ as -, 'l:hn $\ 0 ~~<J~~\
~ Of J\ '!\~\, S ~
City \ r('UYi 1.Qlu Phone J'-l~t~~~ \J~
~\'0 <.:<<.;.:~ ~\) '<
\ \,. ((; ~S , ~~
Supervisor License N.J)r;nber c.-~~,sg~~\)
~\~~~~\ '0~v {;) "'- .
Expiration Dat{t~ r <;(<(;t~\..~<"'<<>>~f\\J\)
\'0\..J ~\J'0"~'-.Jx..~~ <.:<'"
Constr. Contr. Nurti~{..\\~~'\6)t2..l1
'-.J\J" \ 1j'"
Expiration Date ~~'\f. 2.. '4- 0 (..
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
~ s. ,(9C)
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C ~~T~'iij~Oli~i;;;:~:iS;2~'itriJ:~'\;'!~~"~m;:w.Ai!II'~Nt.1~~~'~~I!I:,t~_Jf..~j~~,''I! 'l!.iO;)
. o:;.,.,~",P2!,.m;.;"~R:'.~~~~;e...,i.i",~,,~.,,!.l~<,,l!i6'l"j\\J.iffJ\\t~~'~1l11!ti~~~
$ 50.00
$ 69.00
$100.00
''',[f(\f.;ii,);lljmi~~El~4
,J~~\kr~m~
$ 43.00
4.
03.GC>
4--,4-l
Co :::, 0
l~.{ \
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FormslElectrical Pennit Application I-03.doc
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2004-01412
ISSUED: 11/16/2004
APPLIED: 11/16/2004
EXPIRES: 05/16/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1545 S BROOKLYN ST
ASSESSOR'S PARCEL NO.: 1703344402800
Eugene
TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Alteration
Commercial
PROJECT DESCRIPTION: Replace service mast.
Owner: LANE COUNTY OWNED LANDS DEPT
Address: 125 E 8TH AVE EUGENE OR 97401
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
J K GUCKENBERGER ELECTRIC INC
License
45129
Expiration Date
04/24/2006
Phone
541-746-4656
BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: Height of Structure
,I
Secondary Occupancy Group: Ty'ps~eat:
Primary Construction Type \\\~~t\~\fype:
Secondary Construction Type: \~\:.. \'t ~~~~i Type:
# of Bedrooms: \:..i-\> \>\:..~ ~~f~Y Path:
('... c."~\..\1. \,,\S,,\\>\)~'<S'prinkled Building:
..,,('.'\.., .\~ ~ ,<"Y'I:' ,,~\'lo
. ~~~S \>\:..~~\:.\> \);~ \S ~. DEVELOPMENT INFORMATION I 0 _
'\ ,\'\"\)~ >-\'.J\:..\> \>y"~\i .' '10~ :'~'1 REQUIRED PARKING
. ~\) "I\~\:..\~ ~ ,,\\e'?; 0\\\' XL
Front yard Setback:~\J\"l\' <0,\1 \), Overlay Dist: ~eo,," e9Pf:'. e\ \O~'l~otal: .
Side 1 Setback: ~~'\ '\ # Street Trees Rqd: of:'. \0--t'l x-.e 0\ 0-\e S S7:()()1tfndicapped:
Side 2 Setback: I Paved Drive ~qde\eg 0 '0'1 ~ e \~W'?;O~~ g 0\eseompact: ,
Rearyard Setback: % of Lot$f-e'r\i~~'9\e -{,.'00'S ~9>'0 ~ \'0e ~ ~of:'.e
Solar Setbacks: h...(\~ ~W'?; 0\e\' () \'0\0 \e'?; 0 \eW'9. ',0.\\0(\
r _,,,I \ _ (",e ("\(\\ ,,0'9 .",e _~\\\C
I PUBLIC I~~OV~~\~~~' ~0\;\\\\\'1 ~~""').
0"-' . ~\e ~~.t:l.n?!!-
\'(\ R) ~o~ x-.e Ce O\~~iilHn'ype:
()()g '. 09>"\ ~e. ,\,~
c~\, e\ \0\ ~e\ ,S Downspouts/Drains:
'(\\)~'O Gef'
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pal?:e 1 of2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01412
ISSUED: 11/16/2004
APPLIED: 11/16/2004
EXPIRES: 05/16/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$4.41
$63.00
11/16/04
11/16/04
11/16/04
1200400000000001619
1200400000000001619
1200400000000001619
Total Amount Paid
$73.71
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Reouired Insoections ,
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Pa2e 2 of2
· 225 Fifth Street
Springfield, Oregon 97477
· 541-726-3759 Phone
r-:ty of Springfield Official Receipt
,velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001619
Date: 11/1612004
3:06:47PM
Job/Journal Number
COM2004-01412
COM2004-01412
COM2004-01412
Description
Perm ServIFdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard JKG ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Jmp 092167 In Person
Payment Total:
Amount Due
63.00
4.41
6.30
$73.71
Amount Paid
$73.71
$73.71
11l16/2004
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