HomeMy WebLinkAboutPermit Electrical 2004-8-16
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (54I)726-3689~ o~ 1;_
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ELECTRIC# PERMIT APPLICATION ,~ "'{ ..:\
City Job Numbet_~~"ro. r"")t( - 0 I tJ lO Date R" ~ I :J.. fJ!) y..- "<-~o~~ ~., 0' {:g.~"
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LEGAL DESCRIPTION ~~l f) A. ~~~~~~;~d1'nii~T7's..r~~I;~J~~':Rf~ltt~.lfu: .i ""~rt~Jittr};:
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_ _ _ Service Included '0 ~..,:-o~
JOB DESCRIPJJ.~. 1000 sq. ft. or less ~,. ~"':o",~
__, ~IO\1 {I J 'I- L .~~ . Each additional 500 sq. fl. or '"
.tN'5?T7l-_ -:5J;)Q.,V/ &.. afJtM.t 4YI / JW. tu portioli\\hn:,oJi-IG . 9. .
""" fa VlAV' [)i'J lL. . (.-.II".. N. Greg
"Pe'ritlits" mn~-Transferable and expire if work is Ea'j!) '~anufac~'''':rwme or on law requires
not started within 180 days of issuance or if work is ModGlli::Dwell\n~J:~r?J~({rby the Greao YOl{m 00
Suspended for 180 days.' Feiirlt9Aff 952.001: er. TIJ"se rUles 'l.Ulllif~'
r;-.:-'""..... _ .'.. H. . n~c:7- .",.",;.'"'1 ~pOg~,r,VIi'~"{ ..:?1J:~9--H'lrwfjlli~f!,.seI;fOrtJ:r7:C:-::-:-':-:-'----;1
2 . CONTRACTORINSTALEATIONONLY.'I B. 1,SerVlcesor.Feedersrd~~staHafIon .A11re~"",orRelocatlOn:": .
~1~c::~:~~::;'i~R:'~;;tJ1~~'JNC- . 2::~;g;;';;:~:egiff~t~SS/t::~~7~~~~~-"'Z5. 'a? ,.J
f"'l1 . '-'e'hr i_I II olf
I.. IJ II Ji"/.) " L/..... 201 Amps to 400J'.'mps800"332 ,,- Ilcal~ns.OO
Address .(f)t5 W,/f, '-t /fJC..~€f1 401 Amps to 600 Amps -~..,..q). $125.00
c::: 1'/ a II 7 //" 601 Amps to 1000 Amps $163.00
City (;;) Pt7 D. -,7771hone "/ tf 7. f/:J1?3! Over 1000 AmpslVolts $375.00
Reconnect Only $ 50.00
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Supervisor License Number
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. r. em ora f erVlces or-' ee ers...... : ";;.', ~i,t::.;,l: ._r~' ;..' . ~ .:.:
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InstaJlo~oW,~~ation or R~location
200~J's'Sfl~V 'NOON/:: OOfU' $ 50.00
201 Am'[M ~f100 ~PSZ'" 8f.t Sf' ;:(1 ..(fln 0$ 69.00
:.[ 'ff.~, ,jJ. I, c'v 0 - ".
401 Ampst060(JJ\h1l1t'X3 c/30~;, !").'.:t.$109i~~
o.~~~,~?~ ~~~;;;r !~~~ ~o~ljffJl,W:;a~?~'UZ~o.') . <. . ....,
D. ~:nranch'CireUll.<'- ,. T." ~:':..i"' 'f!!.tJ:j:j . FI]."'. .'"". ",.~,,'
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. -:';;" oil' - .
New Alteration or Extension Per Panel.J/J.o.
One Circuit $~~3 .00
ach Additional Circuit or with
Service or Feeder Permit
$ 3.00
Expiration Date
Constr. Contr. Number
Expiration Date
Signature of-Supervising Electrician -.
The installation is being made on property I own which
is not intended for sale, lease or rent.
prlir:::'r7{"]',:";n--:r;;::'-1l?ir::;;:~.i"'<l:~,,~,~7~""~~"J*~~r."::r:"C:i'~.T:i!;'~;r:"'" so:;
one :JVo~ \~l S3E. P::=:~~n(SerXic~!f~~Gl~~~1~I~~~J;:,:~~J~~~~0
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
. ~17:V:;-;;, t::.' ~~:.:: :~':~ ):!f,,!,~~;:...:n::s~Y'ry;1-;._-:~ ': 1,l.;~:':1:;~T:}~f~
4. 'uiSUBTOTALOF:ABOVE" ;.J',.,.,..,. "(.,T,,d~. "~.
','.?' /') lri!,,3i<fi,f,\ ' :i(;~;':i',- ,,' ~i_~..I:1i",.:-,;t,tl-:,;r,d'::: ,!~_11 ,'~.'"~,;,l::;:h~'I<, ",r":'
~,. ~ ~.......:"ll_......._,~"""",, __.......~,_ ,~>V',;,~ 1$....-')1, ~. ~..,.,.","_~.:J..
7% State Surcharge
10% Administrative Fee
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16J7/
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding Fonns/Electrical Petmit Application l-Q3.doc
.
. CITY UJ1 I)rlul'l'-oFIELD
Building/Combinati~n Permit
PERMIT NO: COM2004-01010
ISSUED: 08/16/2004
APPLIED: 08/16/2004
EXPIRES: 02/16/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 302 SA St
ASSESSOR'S PARCEL NO.: 0000000000000
Springfield TYPE OF WORK: Electrical Work"Only
TYPE OF USE: New
PROJECT DESCRIPTION: Service@NECornerofSouthA&PioneerParkway East Intersection.
Public
Owner: CITY OF SPRINGFIELD
Address: 225 FIFTH STREET SPRINGFIELD OR 97477
Phone Number: 541-726-3753
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
LRBRABHAM
License
8699
BUILDING INFORMATION I
Expiration Date
12/18/2004
Phone
541-747-6638
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
11U 11111:. I DEVELOPMENT INFORMATION I
THIS PERMIT Sh,-,~~ ~/" "'~" III~ "un,",
AUTHORIZED UNDER T~Jfa~~IJ;:IS NOT
COMMENCED OR IS AB.9iNltlQIiEilt~~aqd:
ANY 180 DAY PERIOO. Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
. I PUBLIC IMPROVEMENTS'
AT I t:1~ /.
Street Improvements: foIl .u, '.~i<"9(Ji, ',,"vv reqUire'
ow rules ado ted b ' s you to
Stor~ Sewer Available:!'Joti!ication Cent:" T } the Oregon Utility
SpeCIal Instruction: maAR 952-001-0' hose rules are Silt forn
009 010 through OAR
O. You may obt . . 952-001
Notes: calling th am copies of the rules t
n,,~h__ L e.center. (Note: thl'! t"'onh__ _ .
Sidewalk Type:
DownspoutslDrains:
--. "'C'ur"~-- ......
C . 1:;;1-" .....UI'ly !\lOllTlcBti,.., I
entens 1 bValuationDescriotiBn
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
S'
Total Value of Project
Paee I of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01010
ISSUED: 08/16/2004
APPLIED: 08/16/2004
EXPIRES: 02/16/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
, Feeo Paid'
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
8/16/04
8/16/04
8/16/04
Receipt Number
3200400000000000208
3200400000000000208
3200400000000000208
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 Inonectiono,
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.
~ ~'~L ~
Owner or Contracto~ Signature
'8'/ I (pi <::) '-f
N, 0---.
Date
Paee 2 of2