HomeMy WebLinkAboutPermit Electrical 2007-2-20
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION "
City Job Number (CIAA ZOO? - C/ C> Z '5 C Date
1.
T.
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LEGAL DESCRIPTION:
(702 ,?ft.{l{
JOB DESCRIPTION:
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Permits are non-transferable a\ld expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
3.
A.
Service Included
1000 sq. ft. orless
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19.00
$50.00
2. B.
Electrical Contractor rn y 2. -QC-l- V' \ C \ tA '1\J 11'\j(. 200 Amps or less
I () , 20 I Amps to 400 Amps
Address 3 d. 3 ) G ~ \ \ '0-.1 ( 0 foJ .Q 401 Amps to 600 Amps
I
G ~ 60 I Amps to 1000 Amps
City r\W~~~ ~ Phone 7;>q-)(.1 S-~ Over 1000 AmpsNolts
U Reconnect Only
Supervisor License Number 3 <../?""3 <:,
Expiration Date 10/ () 7
"
Constr, Contr. Number c;, 750 6:::;
Expiration Date 1/1 fjO' ) 0"7
Signature of Supervising Electrician
~L~D~ ~
Owners Name b~,. ~ Co ",e-,-/
Address l.{ 0 Z '7 - C~e{~~
City <; S? r"0 Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
b'3
c.
Installation, Alteration or Relocation
$ 43.00
$ 3.00
8% State Surc~betc~,,~ef\5 -
10% Administrative Fee.,) ,
5% Technology Fee
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 8-06,doc
Status
Issued
CITY OF SPRINGFIELD I
Building/Combination Permit
PERMIT NO: COM2007-00250
ISSUED: 02/20/2007
APPLIED: 02/20/2007
EXPIRES: 08/20/2007
VALUE: '
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4029 CAMELLIA ST
ASSESSOR'S PARCEL NO.: 1702314401635
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: 200amp service change
Owner: GEORGE COUEY
Address: 4029 CAMELLIA ST
SPRINGFIELD OR 97478
Phone Number: 541-
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
MY ELECTRICIAN INC
License
87506
Expiration Date
11/20/2007
Phone
541-729-1454
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
B.~,.Q~~ries: Lot Size:
"lUikUlift;Structure: Sq Ft 1st Floor:
T1llY~ert!'~lf SHALL EXPIRE IF THE ~H,f.t.2nd Floor:
AlIif~' ~~l#t{~asement:
jBI8.,e'fY.J?lP UNDER THIS PERMIT I~NGt'aragefCarport
C JWe~g~Ii>lafu9 OR IS ABANDONED FOOJ Ft Other:
A~~ri~IDAYi~:OD. nfa Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
R-3
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
PavAiTDEiJ\t14~N:uregon IClW reqUIres you<fempact:
% M>iI!o't\(joMe5lgiC/opted by the Oregon Uf'l :y
Notification Center. Those rules are set forti
;~ Q!,~ J::;:-~f. j-f,~ I~ Llllvuijll v~n :1::>;C:-UUl
PUBLI . . f
. . 10 copIes 0 the rules b
calling the center. (NCStd:~It6J~one
number fOfth~ OMg<>nd!WIRl ~l~riiA9n
Center /s 1-8OC-332-2344).
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
Paee 1 of2
CITY OF SPRINGFIELD.
Building/Combination Permit
Status
Issued
PERMIT NO: COM2007-00250
ISSUED: 02/20/2007
APPLIED: 02/20/2007
EXPIRES: 08/20/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$3.15
$5.04
$63.00
2/20/07
2/20/07
2/20/07
2/20/07
2200700000000000220
2200700000000000220
2200700000000000220
2200700000000000220
Total Amount Paid
$77.49
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 I
Electric Service: Approval required prior to utility company energizing service.
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
Springfi~ld, Oregon 97477
541-726-3759 Phone
Cj+--- of Springfield Official Receipt
L lopment Services Department
Public Works Department
Job/Journal Number
COM2007 -00250
COM2007.00250
COM2007-00250
COM2007-00250
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200700000000000220
Date: 02/20/2007
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
MY ELECTRICIAN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 028319 In Person
Payment Total:
Page 1 of 1
9:09:31AM
Amount Due
63,00
3,15
5,04
6,30
$77.49
Amount Paid
$77.49
$77.49
2/20/2007