HomeMy WebLinkAboutPermit Electrical 2007-12-12
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INITIALS i-J'~
DATE );:;), I~ ) Or
SOURCE ~i\Y7 ~
225 FIFTH STREET. SPRtNGFtELD, OR 97477 . PH:(54t)726-3753 . FAX: (541)726-36S9
ELECTRICAL PERMIT APPLICATION
Co","" 7_007- 01 1(- 3 b
City Job Number
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Date
Jl-tZ-D7
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LEGAL DESCRIPTION:
n 0 'L > II.{ z..
JOB DESCRIPTION:
200 A S~IIL.
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c> C 'DO
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Permits.are non-transferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or .
Suspended for 180 days. Feeder .
Y'~~"'.'ri"i;,\;!-'":t'/'Jn~-~~~.a'if'fr."W-'''''~ft1_'''''""''''''1'''''t' :~'y"y;"~fY.-.:7~:,~"q l~~'d~T;*~~{':'--;;it0H2i(P,\i~~'i1JP;~r-7P'~;)fii)~1.~~*)f?}r?tt'~j:t~,:{'i,~~!~~;l,f:~~~:~1j'~,-:a
;~
,/C6NTR;4CTOR'INSTAiU'rj(i~loNf.;hf B. "Servlces.'or,Feeders ",.'InstaUahon;'Alterahonscor,Reloc"hon:,"'~
2. wh~'."~G'i.":-,.i;~',~-'d.~'.i~~,~~:;!J;i!;::'-i;;i\i'-~~~<.;':,~;~~':'::iS,~~;;':h5;;~:z.~2'",',Lij--j':'t'-iU.':..'1 . 1&:.;~:v:?t;;;.$;~1.i.~B>~;;;:*;h,;J!..';;B~1o:\tf::.:Q~-,:;;,~{;p;tr;,,1!~
t:lI;-d-.i:i1";\;-~".;.::it ,..r;'~':$,:~-::.;;,'e;;;"t:--:~~,,-':;;L:+
Electrical Contractor ~ ~~ f~ .....~ \0200 Amps or less I $""k~o "7 D
J I )N lequileS '10J\lli\'j01 Amps to 400 Amps $ 75.00
Address (~{) r<WtfjP~~I~~ 'o~ \'rIbI>>~onse\\O{~1 Amps to 600 Amps $125.00
to;I~~ IUles~n~~:.h-\'Iose IU\e~~~ 952-0s~Q Amps to 1000 Amps $163.00
CIty P.- U,:,~n\i\ica\IO~85~.nMP~~~o7'~~ lul~ vel' 1000 AmpsNolts $375.00
in OAR ",5 a'lobtaln te' \\'Ie fe1e.\l\'l \\ onnect Only $ 50.00
0090. .,<ou m centel. ~l-IO l.J\iliWl-IO\lltCa
"",lllng t~ ~ ~go}\' 2S44).
SupervIsor LIcense Num\miell61 fl. . _p.Ge'-SS2- c.
nU Ce e\' .
Expiration Date /1) / O~ . /J q
. 1
/1)- ,?:;z... r::
(- /-00
$50.00
Installation, Alteration or Relocation
Expiration Date
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600
D.
$ 50.00
$ 69.00
$100.00
Constr. ContL Number
Signature of Supervising ~lectrician
~.t2.,?l ,l'J)'"7 ' i~ New ~te~ation or Extension Per Panel
~..':Jf -r-..t,AAA/' One CIfCUIt
. - Each Addition~f~l!1R* with
Owners Name A~ .{{vt(_ L ~~~~\.\. ~~~~111~::~:- TI"'~v.w."..w,."*..,~.~,O~=,~~~~~.~~
Address 3:3 g- S ~ V/hA. j\~~\l~~:\~il\~~!~~~[5j{~,~~~AU.\icl.~~):;;B~~g~t~!~~~~~i
Cily {::=u...G,-.~'" Phone r:ntJIW\HICt. ~ I'ER\{)Dnp or iITIgatIOn. $ 50.00
p.~'i '\ 8\l ufll SlgnlOutlme Llgh~mg $ 5000
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
$ 43.00
OWNER INSTALLATION
The installalion is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
4.
7D
").60
7
-:/J-o
g6'5:-
8% State Surcharge
10% Administrative Fee
5% Technology Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building Fonns/Electrical Pennit Applic:ltion 3-06.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2007-0]836
ISSUED: 12/1212007
APPLIED: 12/12/2007
EXPIRES: 06/]2/2008
VALUE:
SITE ADDRESS: 135 38TH ST
ASSESSOR'S PARCEL NO.: 1702314200900
Springfield TYPE OF WORK: Electrical Work Ouly
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: 200amp service change
Owner: NORTHVIEW INVESTMENTS INC
Address: 33855 V AN DUYN RD
EUGENE OR 97408
contract9RTENTION: Oreqon law requires y&i~snse
BOB FISI;IJP.l3v""']~if&!.~dl8!:i bv the Oreoon Pfi~~~
~olitlcatlo~ttDjf~'1N~)lIMxTW~ih
mOAR952.. .. _. --J-.!!.._-_.-
0090. You may c~~t . ca~i!ls of the rules by
c.alling the cehjlf. W5!iS.. the telephone
number for the.;1I o~ lfill{W61ification
Center ill_" tI -2344).
VB Water ype:
Range Type:
Energy Path:
Sprinkled-Building:
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
'!?
I CONTRACTOR INFORMATION I
Expiration Date
01125/2008
Phone
541-689- 7973
n/a
Lot Size:
Sq Ft ] st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay'Dist:
# Street Trees Rqd:
Paved Drive Rqd:
NOTICE~'Io of Lot Coverage:
THIS PERMIT SHAll EXPIRE IF THE WORK
_:.:~:~~~1'1IT It' M/"\T
. AU~~'Jii'iH.W~ED FOR
C"I,:ltTL"~ .
ANY 180 DAY PERIOD. Sidewalk Type:
Downspouts/Drains:
Total:
Handicapped:
Compact:
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Datc Calculated
Paee I of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2007-0]836
ISS UED: 12/] 212007
APPLIED: ] 2/] 2/2007
EXPIRES: 06/12/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fe~~ P:,i~ I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Perm Serv/Fdr 200 amps 01' less
Amount Paid
Date Paid
Receipt N umher
$7.00
$3.50
$5.60
$70.00
12112/07
12/12/07
12112107
12112/07
1200700000000001493
1200700000000001493
1200700000000001493
1200700000000001493
Total Amount Paid
$86.10
I Plan Reviews ,
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 Reouin,d JnsrJC'c(('n< I
. II 11111111....1---..
Electric Service: Approval required prior to utility company energizing service.
By signature, I state and agree, that I have carefully examined the completed applicatinn and do herehy certify that all
information hereon is true and correct, and I further certify that any and all work performed shall he 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 he made of any structure without permission ofthe Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will he 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
Paee 2 on
225 Fifth S'treet
. ,"
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-0 1836
COM2007-0 1836
COM2007-01836
COM2007-01836
Payments:
Type of Payment
CredilCard
cReceintl
RECEIPT #:
8~
~.
City of Springfield Official Receipt
Development Services Department
Public Works Department.
1200700000000001493
Date: 12/12/2007
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
BOB FISHER ELECTRIC
. ,
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 554191 In Person
Payment Total:
,
,
,.
Page I of I
2:35:33PM.
Amount Due
70.00
3.50
5.60
7.00
$86.IU
Amount Paid
$86.10
$86.IU
12/12/2007