HomeMy WebLinkAboutPermit Electrical 2006-8-29
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . F<\X (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number Covi^ ZOO b - 0 ( { , ~
JOB DESCRIPTION M''OJ 'A 1000 sq ft or less
r:--:> I ( "",0;:Jf ~ Each addJtJonal 500 sq ft or
"--Jl>-...l~ c-u.L""-c. ~ "rt' _<:- -"!-,f:}, ~",' portion thereof
. "*' 0;- '0 ~~ ~
Permits Jre non-transferable and e:\p~#IC~gT"'<..I~ Cb<O ~'6tig Each Manufact'd Home or
not st.Hted within 180 days of Issuance ~,slf~ork ti' ro ,\> Q~~?dular Dwellmg ServIce or $5000
Suspended for 180 days <;?,o~ '0" e:-v ~ U ",,;:s' e,Q><:.' ItFeeder
~d < ~ """. -i., ~;-\ v' ,"',kf:_ e'~r xfjjO""......<vC:{ tt-"tCi)'I";.,'("'O.::h:.q}~.,g ~, ~\~~t" '" { ... f ~ "'~\1;f' (I.,,'" ~ ~'"I<.~i,,-' ~o- "r~11~'l-~ ",\\t.~~
2 :_SqNl;!~f(!}l~'~~1Jf~?{gff~,!y~I;:.~::;\ ,\""ql><f,,~ 'P.::-' !~~~1~:,[~~d,::s t I~:f~.it!?,~ ;It:r;dt!g~l,,!',~e~,~t:?Y:::~~
,,,W <t' e~ (J<::l ~'~O" ",-..J' ~ / b ....,.
Electncal Contractor,\~S:;\'>{\ ",P,'Yr/'''' .d>'j.rJcJ ( 200 Amps or less $ 63 00 .1>
~ ~O"'" ,;}O~'1;"- '1>" v ~0' ,0o,~ "r::rJ 201 Amps 10400 Amps " $ 75 00
Addre" j ()VD'O ~",'iil5d3C")f.e.,,v0,JI!}"'13 401 Amps to 600 Amps $12500
. ""'-00'n.<::l ---0'0"'\0" ~0\ ,- 601 Amps to 1000 Amps .. $16300
~ ~ fSJ "~ 0'<7'<\~1 . ~
City - /) \:l P<9one~ ,,,-0- ,~"'o3. Over 1000 Amp,Nolts .,., ~~$375 00
~v~ Reconnect Only ._Ch" .,~v ~~O
,-- '.' ,-~00;7' , ' '-',>.if; ""','~~ ~~<ii:'y~-,4-~~"l"!"l:!;'llW"i,t'
C "Tempor.r) Services Qr Feeo.r,[>i;""~~ ~c --{.,s["~.,,"1':L'\i",tR'~'\
~"'l ~ )(;~~_ '" "A~1',0_(.,;..tf'_~C>< Ol.-:"'7)v ~4:i ~i)h"""W'<#1OoM dt--.."t,;::
i6.:,.,'0 r::!,~ .'J)
InstalldtlOn, Alterai:1on ~~~....:...t..:,Y ~
200 Amps or less (/; .:0 ^~~ $ 50 00
20 I Amps to 400 Amps& i:>' ^ ^-. . $ 69 00
40 I Amps to 600 AIll&i bCJ "0.fJ:-' $100 00
. ~F~ ~
Over 600 Amps ~%gQYol&see "B" above
".j ! ;"C ~ ~,,"~~fJln-f(') '('k;';<~i.."-"'''~4f:.~2"'''~~''::!~/r;~j-t{'~
D 'jBr~mc~j ~~C~J&5-f~ ~~~~;E~~~~(;'! ~~}'~~~fu<l:'<~i$~:tr.:~?
New J\lterdtlOrf'~{E:\lenslOn Per Panel
...,- .......
One CirCUit ..if
Each Additional ClfCUlt or with
Service or Feeder Penmt
I'" - \ ~" ,,1' "".-t I'
1 LOCATION OF INSTALLATION ,j" ,';. "
36'ii" c.~;;::'~' h", ;"
LEGAL DESCRIPTION
IBc>l.O(OrZ Ol(OO
EXplratLOn Date
'--( ~qs--,
I (') / t)/ I C',
SupervIsor License Number
Conw Contr N umber ~ 1(0 t.( I,.J. L(
L.( /f?/o"/
Expiration Date
Signature of Supervlsmg Electnclan
JtA.L_)~: -
Owners Name '2D ~ -:P~d.V
Address '3 6tS"' /) c..lAC>II.-C> (~ '
C,ty _ ~ S?~.1
Phone
OWNER INST <\LL <\TlON
The installation IS being made on property I own whIch
1$ not Intended for ~ale, lease or rent
Owners Signature
InspectIOn Request 726-3769
Date
f5-Z"'-O~
r I .. < ,~ ,~! ",~..,:, , -<',
3 COMPLEIE FEE SCHEDULE BELOW
... .. ;; \.. , ",I" ...~, "" ~ ~ .. ,,~ ~
~l~(( c~~>- '"."'''' """l,~M"~'~"'''' 'l'''nr.{<f:t,~,"",'''''' ~y\:"~<:Wf,,...;r;r7
A "Ne" ResldentJ.aI - ~mgle\o\r I\.lultI-F dmlh 'per'd,\elhng Ufilt ;, i:.l~
~ ",,,. \~ _ ~ .... ~ xu.. ~~ "- _~~ < ),-"".~ ...,.l~ lh4.!i'
Service Included
$10600
$ 1900
$ 43 00
$ 300
~ Y",j'~"'-f~, ~ ~"'f~, 1':t,~1-\''''''~'''5~'1\A,;,: ";,e,i~"'\>'~" /).. ",--~.,~:t~
E l\hscell.aneous (Senlce/feeder not Included)1-Eat.h Instdll.ltlOn"
...~ <.,:. _"""'., , A ~~ ';; ri ,,~..... ~ "if 'r AC-.l' ~f_,1 {~ ~ w ~"".., ___ ",/1':C
Pump or lrngatlon
Sign/Outline Lighting
Limited Energy/Resldentla!
LImIted Energy/Commercial
$ 50 00
$ 50 00
$ 25 00
$ 45 00
l\tllOlmum ElectriC Permit Inspection Fee IS $-15 00 + Surcharges
~ ~.. P" f'7~,"," iA"'" W',
4 ,SUBTOTAL OF:WOVE,~;'
''^ -' ",-" ~-'.:: ..1~~\t} ':." ~ -",,~!..;,'M'" ~
8/0 State Surcharge
10% Admml!:>tratlve Fee
S' ~ ,Wf- FcC
TOtAL
-~'\ ,c.. x /'
~ '1 -' \~~
I,"J
$0'"(
070
71r
$ ,7'"
~
Shured Dnve(T )/Bulldmg FonmJElecttlCJ.l Penmt II"pphcatlon 1-03 doc
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
225 FIfth Street, Sprmgfield, OR
541-726-3753 Phone
54t-726-3676 Fax
54t-726-3769 InspectIOn Lme
PERMIT NO
ISSUED.
APPLIED.
EXPIRES'
VALUE:
COM2006-01113
08/29/2006
08/29/2006
02/28/2007
SITE ADDRESS 3658 CHEROKEE DR
ASSESSOR'S PARCEL NO 1802061201100
Spnngfield TYPE OF WORK Electncal Work Only
Lot SIZe
Sq Ft 1 st Floor
Sq Ft 2nd Flos,1
Sq Ft Bdse~nt()
Sq Ft Garag~r~ort
Sq F~,g'l~~"" ;>.'y'0 ~
Occopa~--'~:~d ,0-~,,~
,')..0 (\: ~^1\ ^o ~"
I DEVELOPMENT INFORMATION' v'0~ 'b~~...s~~'O,~~v
. ct- .{>,(;S ",REQUIRED PARKING
-~ ,'Q~
Overlay Dlst ~- ~'y ~ " Total
# Street Tlees Rqd 0"",<::S~c,\fi HandIcapped
Paved Dnve Rqd ~"> ~-o 'i:;- '>) Compact
% 01 Lot Coverage ~ 0- ); ~'y
· ,'0"",~~0)
I PUBLIC IMPROVEMENTS 1-1-'0'
S,dewalk Type
TYPE OF USE
PROJECT DESCRIPTION ServIce panel change
Owner
Add ress
0\0
\~e'" 'l()\\~\\\'l :l\
eo,\l 00 \0<'1
_" \~~ ~ ~ O\e~,e. ",e\, (\Cl\'
O~e'0- ^ n'l " -,,\0'" ',0. ~-' ,~o, '01
:<,\O\-' oo\l'loCONTRA€TOR,INFORMATlON ,
l>:\'\\:;.~ 0\00,'0' 0\e\ ()\'\I\V- \e"'u' \e\eV' :<>>-9\~
Contra'cto50 Ge \,()()\ ",,00 \'\Ie ~\o\\\\y License
\" .~W ~(\' '00\\' :-,.e " \~
DE;~t;K~~n~tiN;:;JEPH,EI'tSo ,\\,,\'1:'_,,1).4<\' t64124
\0 O~~ '{00 ~e qUBi1'I<I~DiNG)INF(lR~A TlON I
()()g 0\\09> \0\ \,. \'" y-
"\ \\0:0e\ (;e0\e\ # of Stones
o R-3 HeIght of Structure
Type of Heat
Water Type
Range Type
Energy Path
Sprinkled Buddmg
ROBERT PERRY
3658 CHEROKEE DR
SPRINGFIELD OR 97478
Contractor Type
Electncal
# ofUOIts
Pllmdry Occupancy Group
Secondary Occupancy Group
Pnmary ConstructIOn Type
Secondary ConstructIon Type
# 01 Bedrooms
VN
n/d
Front yard Setback
SIde 1 Setbdck
S.de 2 Setb,lck
Redryal d Setback
Solar Setbacks
Street Improvements
Storm Sewer AvaIlable
SpecldllnstructlOn
RepaIr
ResIdentIal
Phone Number
541-
ExpiratIon Date
04/0812007
Phone
541-726-8498
DownspoutslDl aIDS
Notes
I VafuatlOn DeScflotlOn ,
DescnptlOn
$ Per Sq Ft
or multlpher
Squdre Footage
or BId Amount
Type of ConstructIOn
Pd2e 1 of2
Value
Date Calculated
CITY OF SPRINGFIELD'
Building/Combination Permit
Status
Issued
PERMIT NO
ISSUED.
APPLIED.
EXPIRES
VALUE.
COM2006-01113
08/29/2006
08/2912006
02/2812007
225 FIfth Street, Spnngfield, OR
54t-726-3753 Phone
541-726-3676 Fax
541-726-3769InspeclIon LIne
Totdl Value of Project
Fees PaId I
Fee DescriptIOn
+ t 0% AdmInIstratIve Fee
+ 5% Technology Fee
+ 8% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount PaId
Date Paid
ReceIpt Number
$630
$315
$504
$63 00
8/29/06
8/29/06
8/29/06
8/29/06
t200600000000001341
t200600000000001341
t200600000000001341
1200600000000001341
Total Amouut PaId
$77 49
I Plan Revtews I
To Request an inspectIOn call the 24 hour recording at 726-3769. All inspection requested befot e 7 00 a.m.
wtll be made the same working day, inspectIOns requested after 7:00 a.m wtll be made the tolloWIng work
day.
I Renlllred InsnectlOns I
Electnc Service Approval reqUIred pnor to ulIhty compauy energIZIng servIce
By Signature, I state and agree, that I have carefully examIned the completed apphcatlOn and do herehy certify that all
mformdtlOn hereon IS true and correct, and I further certify that any and all work perf 01 rued shall be done m aceol ddnlc with
the OrdIndnces of the CIty of Spnngfield and the Laws of the State of Oregon pertaInIng to the work descnbed hel eIn, and
that NO OCCUPANCY Will be made of any structure wIthout permISsIOn of the CommuDlty Services DIVIsIOn, BUildIng Safety
I further certIfy thai only contractors and employees who are In comphance with ORS 701 005 WIll be used on thIS project
I turther agree to ensure that all requIred InspectIOns are requested at the proper lime, that each address IS readable from the
street, that the pel mlt card IS located at the front of the property, and the approved set of plans willi emalO on the site at all
tIrne~ dUring constructIOn
Owuer 01 Coutractors Slgndture
Date
P dge 2 of 2
225 Fifth Street
Sprmgfi~ld, Oregon 97477
541-726-3759 Phone
8PRINGPUD.D .
~~~
C'~ of Sprmgfield OffiCIal Receipt
L .lopment Services Department
Pubhc Works Department
Job/Journal Number
COM2006-01113
COM2006-0 1113
COM2006-0 1113
COM2006-0 1113
Payments
Type of Payment
Check
cRecemtl
RECEIPT #.
1200600000000001341
Date 08/29/2006
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
PaId By
DEREK STEPHENS
Item Total
Check Number AuthOrizatIOn
RecClved By Batch Number Number How Received
3229
In Person
Payment Total
dJb
Page I of I
105937AM
Amount Due
6300
3 15
504
630
$77 49
Amount Paid
$77 49
$77 49
8/29/2006