HomeMy WebLinkAboutPermit Electrical 2004-6-1
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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
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6-3689 "s \\'Ie \~ Ilse
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" I. ,i " ello \ ___
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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~
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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.
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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
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Expiration Date
/CILvM-L
C/GM/.-JU-tE
Inspection Request: 726-3769
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A. "N'e.l':Resideiitiaie:..,S eLo: 'iil'~l'ami("'etrdwellin' -UniGioj,'
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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~
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Shared Drive(T:)lBuilding FormslElectrica1 Permit Application I-D3.doc
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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
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'--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
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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