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HomeMy WebLinkAboutPermit Electrical 2004-6-1 , 225 HJ<ln STREET. SPRINGFIE , OR 97477 . PH:(541)726-3753 · FAX: (5 ELECTRICAL PERMIT APPUCATION City Job Number (..OiAI1?.ool./ -Oi) {,L/I../ Dale llo",il\\l 6-3689 "s \\'Ie \~ Ilse :O'(1\\\\eo.".~\C \an , ;; /. e" sll sllacI 0; :/0 L( _ OIlO",\n\l~~~:~O\ le<\lli1e " I. ,i " ello \ ___ 3. ~~ti:;j~,~.~-"'" :J(f~_:"~~.~:~J..~i,;{j~~ 200 Amps or less i $ 63.00 201 Amps to 400 Amps $ 75.00 40 I Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Phone 3'1-3-72--'7 7 Over~8~~psNolts $375.00 eO.~@'B;W~'f.'lj~ _ $ 50.00 ~ \f,'Il t ('.ter~,o .r~ \0 d5.'" ~eQP \~e ~... J;j~~;:"'~:'>\".!"-="'--"~'""~""'lf5''''''-'''.'-'''''''Hi ~ Supervisor License Number ,... "'()..'fS.>" ,.,~'O'l ~~ ~~17;',l'}~[~J!k~?1~~'1i!~1&ii~Yf.~~ll ~~~{\- ?>Ow. ~~ose ~ (1)\0'0 / 0 /~\~ ~~e; Ce~~~\()\\'ItOU~rar~\lation or Relocation I ,- ''''C~",,,. "f:i'''''' .-\'f\ 009 ...,.~lil \6',.f.:"'~ $ 50.00 tl..O'Q.~l;j,rfl:" 0'O'lP' ~o\9""~'J:--fess Constr. Contr, Number / 7~, ~&-'1-':I\6" \1 O~~~~ 400 Amps $ 69.00 .......,/ .~~\,,~ ~,.~';eOt,\~<J::~~ps to 600 Amps $100.00 ExpirationDate "-' ""- O~\'I ,U' ... ~~..-' r 'f.\<<Jl ri\~\ '" Over 600 Amps or 1000 Volts see "B" above. t\~ c,e . ~l""'~-"';\~~, ~.:rg~.>1f;~"'.:.,;:p~;ti_~l .::.t'~~...~~~~~,~, ,;;1;$;~~',.,:ri7 ~'~ Signature of Supervising Electrician D. ~,!!rJv~~.~~~!E~W..~~~~;i~l~~fi~FJ!~ffi::efQ0Nt~~ ~~~ ,~~ o$:Name " ~~ -- Address 2-'-\ (,,7 City 'S P ;c{J Phone Pump or irrigation $ 50.00 f 1\\t. ~~Outline Lighting $ 50.00 OWi'i'ER INSTALLA1J.Ql't.. \ \ r:.'I-.~\rr..t. \ ,~,\'T IS ~Qd;ted Energy/ResidentiaI $ 25 00 ~\1 \".... S\\r>;.... \.. ~'C.?t"\,, .' . The installation is b Si\lli:\6~~%'a~\~~'C.O iO\\.mllted Energy/Commercial $ 45.00 IS not mtended for sa ~ ~"r>.'OrM 'C.O Orr.. \S fI.'or>; Minimum Eleclric Permit Inspection Fee is $45.00 + Surcharges O. CG'~~t.~C "ocrr..\OO. ~""""""'.""."" -;:--",.,... '. ~~,.",,"-"m.... '", .:-",~ wners Signature: \" 0.1) Ot>.'1 ~.. 4. b~QRTOTA[;Pf'~OVE,:';.:~~F~~:-'::-;HJ}~ 7" p\lI.\" ,\u ."...._.~_."N' -.' ~ ""jA~_ _.~..!'r.";'.ci1~i:'" ,jt;_._,~-",<;,s7"~~ .J 1'\\.., --..- -"<,-~-- .~~:.....o<:;;._...-~";;>....,,,~- 7% State Surcharge '5 Z~ 10% Administrative Fee ?SO Q" 7~ TOTAL 07 - 1. lEfg:t:;1rrqS'PJ;~~!:,~~i1Q~ "Z- L{ Z 7 c...l Ei'WL '''' iAe"' lA LEGAL DESCRIPTION /703 Z7/Z 03200 JOB DESCRlPTION ~\Jlc..c: c.t-hAN'(...{-' It/ Cr/l.6.A:-& Permils are non-transferable and expire if work is not started wilhin 180 days of issuance or if work is Suspended for 180 days. ~,)oo'N!fiiAf:I;:~7i~1NStA,';"F,TftIJf:TION}(JiiL~ 2. ",:,-'i;;;::ce.~~~'<f'M.~'''''''''tf1,'~r;;p'''':'''''';':Iol',''';Y''')~I'~!l::.J:ti.,~~,...~ Electrical Contractor A't!MHO/'/'i Ot::"d. .Arc. " ' Address .2/ 7t> l/I/. L ~ fi ve . City E"'''Iene - U Expiration Date /CILvM-L C/GM/.-JU-tE Inspection Request: 726-3769 ~,="""""".~"""..,,.~..--.:~t:"e-"=."""'""'-""'''' A. "N'e.l':Resideiitiaie:..,S eLo: 'iil'~l'ami("'etrdwellin' -UniGioj,' ._.',-"'..,..,..""......",,,..".. ,~""~, ,.., ."Y"P...""..,..,.. g....'___,,~ ~",."",,",. . p..u.\tib 1 . . . _..........-.;io ~.a Service Included 1000 sq.,ft or less Each additional 500 sq. ft or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19,00 $50.00 B. ~.~rti:S~~E{g;fJr.r~Eij6iit1i.riMXi1&~t~~46f"R~lli~mlii~}~ ~~\'k~~~~ii!:~t."=~d::t'0>~~~~'~-':-'"'If=_".~,'f,~i"'->':'''-''''J.izt62.1!."""'!>;;:..-:;W4>;,~~".~'.r[,"",,~ bl -' New Alteration or Extension Per Panel One Circuil Each Additional Circuit or with Service or Feeder Permit ~ ~ $ 3.00 $ 43.00 ',2 E. ~~&~~ii~ib~(~~~eJ~~lE:ri~Firi~fiid';'d~ltfEi1flffi'~'tKll~tro~ '~~'. ~"""'_"''''~''''''''W'J'''':..''!ri.~:lt~''''l,.~~'';,~'''''''+;'?');;:~:'~~',;o)~;;.;;.~~j Shared Drive(T:)lBuilding FormslElectrica1 Permit Application I-D3.doc ,/ - . CITY 01' ~rRlNGFIELD ' Status Iss u ed Building/Combination Permit PERMIT NO: COM2004-00644 ISSUED: 06/0112004 APPLIED: 06/0112004 EXPIRES: 12/0112004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 2429 CLEAR VUE LN ASSESSOR'S PARCEL NO.: 1703271203200 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Service change and 4 circuits Owuer: KRAAL BRIEN E & SUSAN J Address: 2429 CLEARVUE LN SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor REYNOLDS ELECTRIC License 17252 Expiration Date 02/08/2005 Phone 541-343-7297 BUILDING INFORMATION I # of Unils: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Slories: Lot Size: Height of Structure Sq Ft 1st Floor: A.,:r;.:ml~~oregon law requires you I FI 2nd Floor: ''Wiil~r pe: ~ Basement: foliJ:Iw l.<i 90pted by the Oregon Uti t G IC t Kan T . I arage arpor Notif!~~ ft!1ter. Those ru es are set Other: in O~IHi\ t:,i%t-flm1.2,through QhR 952- upant Load: <102n Vn" m'JlUlbu"n "nn~'l n1 the rules bv I DEVICIlCllBNOml~Rt\'ll{tllI~ j3lephone nurr.ubY TJI t.r& t.1\J~L~ r J,r"l~ I~otification Overlfii?B\?l: Is HIOCI-332-2344). # Street Trees Rqd: ' Paved Drive Rqd: % of Lot Coverage:' ' ' REQUIRED PARKING R-3 Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS I NOTICE: Sidewalk Type: THIS PERMIT SHALL EXPIRE IF THE WORK DownspoutsIDrains: AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Notes: I, Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Dale Calculated Total Value of Project Page 1 of2 / - . '--11 i' OF ~nuNGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2004-00644 ISSUED: 06/0112004 APPLIED: 06/0112004 EXPIRES: 12/0112004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspeclion Line I Fees Paid I Fee Description + 10% Administrative Fee + .7% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $7.50 $5.25 $12.00 $63.00 6/1/04 6/1/04 6/1/04 6/1/04 Receipt Number 1200400000000000834 1200400000000000834 1200400000000000834 1200400000000000834 Total Amount Paid $87.75 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 Reoll i 'cd Insnections I 11111 1111 I I 1 Rough Electric: Prior to Cover 2 Electric Service: Approval required prior to utility company energizing service. 3 Final Electric: When all electrical work is complele. By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance wilh 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 Ihe 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 Pa~e 2 of2 / 225 Fifth Street SpriiIgfi~ld, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00644 COM2004-00644 COM2004-00644 COM2004-00644 Payments: Type of Payment CreditCard 6/1/2004 ~ RECEIPT #: Gr~,'!I.!!'l.Fl""!>',"""'_" ':, W1L. : ~"",-~-~~'.~~.---.' j ...y of Spririgfield Official Receipt .velopment Services Department Public Works Department 1200400000000000834 Date: 06/0112004 Description Perm Serv/Fdr 200 amps or less Add, Alter, Exlend Circ Ea Add + 7% Slale Surcharge + 10% Administralive Fee Paid By ELLEN REYNOLDS Item Total: Check Number Authorization Received By Batch Number Number, How Received djb 000399 001596 In Person Payment Total: Page 1 of I 1:10:20PM Amount Due 63.00 12.00 5.25 7.50 $87.75 Amount Paid $87.75 $87.75