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Home My WebLink AboutPermit Electrical 2004-9-27 2BFIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)71Jj~89 o ~ ELECTRICAL PERMIT APPLICATION _ / ~-9 o~~ CityJobNumber~e.od({- (Jff 9 L Date 7/Zb2'/O~"';{.o~ / -9.'~ ~ (9 7& . <-IJ . "0 IS' "I' 3. COMPLETEFEE~J:l u~Bb~~~ &0' (99, ~">. ~. 0,.;, ~ ~~. . &lS'@0'/; A. New Residential- Single o~Ul . Fal;>~Mng unit. Service Included ~ C' ') ~~:&-o~ ......, " O'~ o~ 1000 sq. ft. or less .00 lS'6> ~c Each additional 500 sq. ft. or ~ portion thereof $ Each Manufact'd Home or ,4 Modular Dwelling Service or $50.~ Feeder 1. LOCATION OF INSTALLA110N /306 C (Iv J~/VN IA L LEGAL DESCRIPTION f70~3Z5~'S. o 70-C~ JOB DESCRIPTION <;0 ./ _ ~IJ '-- {' J-tAJVG-e Permits are non-transferable and expire if work is ,.' not started within 180 days of issuance or if work is Suspended for 180 days. SF:!j;.~J~~:';GiPlElL.1O 2. CONTRACTOR INSTALLATION ONL'Y B. Services or Feeders - Installation, Alterations or Relocation: () __ n I New Alteration or Extension Per Panel t<ffi1~ K.JvrCi One Circuit , I Each Addit~'O .cuit or with C' Se . ra'aS ~it $ 3.00 Owners Name 5tt I r Icy G.tz..A: ot\ \9.'4'1 ~()t~Q(\ \o~ Address I 50b !-Ct/l'~J.~'9M'Jote~ed~~ \\\~~'~~\fce/feeder not included) -Each Installation ~1 \ \... ~eS 0.~o'9 "tnO~e rn O~\\ ~e~ '01 - 5"'~=?~ Phone _f'\\O'lJ (~$. ~~\et~,\Q\~~'~~'{ot\e' $ 50.00 ~O\\'\ca.'\~n't:O{)\.~ 1o\i\~~B' ~~on $ 50.00 OWNER INSTALLATION \~ Of\~\IO\) ((\a.~ 0 ~et. J1lABt~d'~ esidential $ 25.00 90.' eCe~ onU" , . The installation is being made on prope~oC'Jllwa~ \'(16 Olll5lM~ ommemal $ 45.00 is not intended for sale, lease or rent. f\U~'Oet ;~'(\\~NH~~~ Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: 4. SUBTOTAL OF ABOVE b ~S l(tt/ 61.0 7 3. '1-1- Electrical Contractor ~ UJK. 200 Amps or less 201 Amps to 400 Amps Address '3 ~c2S 3 BOSCA Gt' Ltv 401 Amps to 600 Amps NOTiCE: f THE vf~~rFPs to 1000 Amps 5 PFc.Ol~AS-EE~l Stlf[~f)t~':iMrT IS'~~~1000 Amps/Volts AU1HORlZED UNDER I Hl~ rt. \ f\bt'onnect Only OMMENC~-P~-'S ABANDONED FO . Supervisor License Ji~f' 80J)lY ~ID5. c. Temporary ServIces or Feeders )O~O/' 07 City Expiration Date Installation, Alteration or Relocation Constr. Contr. Number J I 7 7 70 Expiration Date ) 0 ~ 0 ) - D S' 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Signature of Supervising Electrician Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits City 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)lBuilding Fonus/Electrical Pennit Application I-03.doc $ 63.00 b 3.06 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 $ 43.00 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01192 ISSUED: 09/27/2004 APPLIED: 09/27/2004 EXPIRES: 03/27/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1306 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703253307000 Springfield TYPE OF WORK: Electrical Work Only Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: ..- ~! ~_..t"^ft 1~ reQUlres YOUato"J1 . Allt:.N,(\.JH1o ~.-.... -~1" I~, tonow ru lcPjHdfjt_Dl,t0 "forth NotIfication Center. o'':::.gh OAR 952-OO1fl.dewalk Type: AR 952-001-001 ~"U... th ruleS bY tn 0 obta\n COpies of e DownspoutslDrains: 0090. You may ate: the te'eph~e ca\\ing the center. (N Ut\\\ty Notit\cat\Oft number for the'?1r~g~32.2344). Center 10 -u TYPE OF USE: PROJECT DESCRIPTION: service change Owner: GRAY SHIRLEY M TE Address: 1306 CENTENNIAL BLVD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Contractor License Electrical t: EASTSIDE ELEC\f~~In\~RK 117770 NU ~\~ERM\l SHAll E~~~~[d~~Ji)mG INFORMATION I 1\-\\ \ZEO \.It,mER 1 ED rOR # of Units: ~U1HOR 0 OR \5 ABANDON # of Stories: Primary OC<0~~~~ PER\Ornt-3 Height of Structure Secondary Ol\~'J1a'\I~9 ~bJl: Type of Heat: Primary Construction Type VN Water Type: Secondary Construction Type: Range Type: # of Bedrooms: Energy Path: Sprinkled Building: n/a I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation DescriPtion' Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Paee 1 of2 Alteration Residential Expiration Date 10/04/2005 Phone 541-915-9828 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01192 ISSUED: 09/27/2004 APPLIED: 09/27/2004 EXPIRES: 03/27/2005 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 9/27/04 9/27/04 9/27/04 1200400000000001391 1200400000000001391 1200400000000001391 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 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 Pae:e 2 of 2 225 Fifth Street Springfie.ld, Oregon 97477 541-726-3759 Phone ii:~ City of Springfield Official Receipt lelopment Services Department Public Works Department RECEIPT #: 1200400000000001391 Date: 09/27/2004 lO:48:13AM Job/Journal Number COM2004-01192 COM2004-01192 COM2004-01192 Description + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Payments: Type of Payment Paid By CreditCard ROGER KING Item Total: Check Number Authorization Received By Batch Number Number How Received djb 045846 In Person Payment Total: Amount Due 4.41 6.30 63.00 $73.71 Amount Paid $73.71 $73.71 9/27/2004 Page 1 of 1