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HomeMy WebLinkAboutPermit Electrical 2004-8-16 l f~'" .t). t. " 0 '1 IN' 'D!'~' . 'ON' e,.... "','c. . .;.. ",~, , 1;.[:." ' ' 'K ~"J' i 'f,.1 ",<' . ,,' .. '. _. ,. ". _ .~':,',. '.. _",j! .,...," ., :.f;. ." #j;,_~ '-, _ . ~ ~""'l ,'.' ." ',,~ \1-;;:'~.. -.... '.!~_..":-."",,, '1,_ A ~ -:I", 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (54I)726-3689~ o~ 1;_ :;0 '? 'Z ELECTRIC# PERMIT APPLICATION ,~ "'{ ..:\ City Job Numbet_~~"ro. r"")t( - 0 I tJ lO Date R" ~ I :J.. fJ!) y..- "<-~o~~ ~., 0' {:g.~" 1. ~ioCXt~OF:,-;'~"._~-""-'''';'--; ~'--::;1~ ~.'~:.71,ii~ . l~COM.-rpllT,EPEEsCiiEjj: ..... -~E~ ""W~:'o),~~~,A~:~~~\~~.<?i~ .5eRVt;;~(iJ7ti: ~'; 0. " ~ i.;I1PJ"tu;:;o;;rc;;,-&~;;/f$k'=;'''\O~9~~~.!~;''~ LEGAL DESCRIPTION ~~l f) A. ~~~~~~;~d1'nii~T7's..r~~I;~J~~':Rf~ltt~.lfu: .i ""~rt~Jittr};: ,l__~.....~._......lot,,,.,,,, -L.'.(......'~""-... ",,=4._ }:; '. _ ",,,,.~,lS'~'l<.jj~.,t3~ _ _ _ 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 19f/tJ~ /q/IIO f.- !bqq /9/lf/o7'- Supervisor License Number C 11 :'T"~it!. ..-:,~ ,..-\',u:.ts' ,~,;:;.. :.~~f."F' ''''I>d'~t~''h -.;.~! ,.;,~ "- ., .~....~. ,"I: .,,'" ,-,' '. ~~ . r. em ora f erVlces or-' ee ers...... : ";;.', ~i,t::.;,l: ._r~' ;..' . ~ .:.: G-,hl,.<;;.L"",~.:.iiL,.;lli,I;.,I;:.-._rh""~,,,.jI..~~..igh."-;....~, .~;!..ii;;~~~~. ._~II: f ---- 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]."'. .'"". ",.~,,' --~~-.,,~, ----=.,~- ~~Hfl;"Q'l.s.Z~jT~d~:''''''-' <..1,..;.,.1- . -:';;" 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 fP3,- '/, ifl h,~ 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