HomeMy WebLinkAboutPermit Electrical 2003-3-21
225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (541)726-3689 h following
bmitted has t e
ELECTRIC# !ERMIT APPLICATIO/y ) T~e fol~ng proiec~~~:~Uire specilic land use
CityJObNUmberUJCC?t:b~ -ro\~kJ ~ 21:~~a\ddoesn . ~
1. r~~~~~~ljj~~~!!Ji1f~i~~~!*&N::^~:;::;^ '^] 3. [~W&?.J1g#~' 1 ''":~H1t~1i~"::":~l t~-./y":,p~-{ ,-- H_~;
(\ale
'" '.''':'''f'''fc (rzach$jg~at~~!L" ,7;; , J .. ' ---..,-- ------
A. ;Ne~Tfl~~JW~~tiiIT~:::Si~~I,e:'~~~~u~~':Fam-i,!y ,perdwelli~g ~~it.
i
~~ t)~A~.\~ &\-' Sp.c\~; C)lU-US
LEGAL DESCRIPTION
~4D0/ CSb
.
JiO:::n 3~
JOB DESCRIPTION
O~ ~Ywr+-
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
-.:~'~_~Z~"".':'---::--.~."":""'.~~~>'<';'.,....,.". '."_'_' .,
I: :::;);;;-':)":Vt;;;;~;;, ;:i~:,;,::/::;,~"::;,,;;,,:.(;,,,,:
, CtlINFRttCE{R@
2. I ':"';- " ; ';"....,
, .. .,~.~,~~~..;m..'._'.;_~'."" _" "";"<<";'~'" ',. ','.;-" ~~_.
"-::n:r:;TI::';;:j~i:'.~J&rf~M*E~{:':"i;,:::
.. i/i..;Jf)NI!:Y i
,::,:,..,<..~.."/-",
/
Electrical Contractor
Address
t' \: :. ~,\ ~ lVt~.\JiU~O:llciVl: .'C:\.{li,1 ":'\". .~:". ',l-
" I" \..1 "lIlt-" 'HJQ\)tSI'HHlthl:J(l(j \;,' \'
Ciry,l IU"" : , ~'~ ....\", I . ':" "'PIiOlie "'::;) ,1.., ;"'J
\.j~:'l~n,;.......dC'~ a vL: ,t,-..:. : n~;S~ ;' .l~)~. ::ii \;; ~~): ~:
;~, r) I\.~ ",,'''''l)':' _\""~ (' 'I' wr Ipi" ;-...../, '-, 'n~?..n,'~
. . \.. r . .1, ,r. "'''';' l . ......;. . .1. ,;_
~()Pq "';QfI 'rtit-" ,,",h'\-;~ "":7':~";~ r,;; f~:-:~::: ~;;)G :'
SiipetvisQf Lipe'rtse N~mbe: " .. ., . _
c8.11:~~ \.hr) cc~!.~rr~ \' ~" )l.~-;:. V~, 'j :.,-:;",:..,. :",;i~ .,;j
I.' .
''"'II 1;'''~ 'rr\- ~'"'' ~(v...,,,, 0 w,;~., \1,)"'!':"~~;C!~
Expiratiori'Date'" ,....,;j... , '~,L'!, ,',~" ." .J ..
~- '\
'~/nrH:> ~'-. ; -~ i' I: j-..: T'~-~: ':.!->,.
e of Supervising Electrician
Owners Name f~lD~\~~
Address ~3 ~!^\~ ~-
City ~~~.\t\L Phone '1L\L\ ;<1P-jD
OWNER INST ALLA TION
The installation is being made on property I own which
is no i d r sale, lease or rent.
\
\
Inspection Request: 726-3769
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.
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
OW(Jrl'C~Q1psNolts $375.00
RerPllge~l'1\~ $ 50.00
C.~ii0~~.-
I~~YIa\W}.,OAij~~lOO. Reloca9ion 0 FOR
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1 000 Volts see "B" above.
D.
New Alteration or Extension Per Panel
, One Circuit /
Each Additional Circuit or with .
Service or Feeder Permit
.tfi U? ~
$ 43.00 7 ...../-
$ 3.00
E. ~!~~~~~~x~~~i~~~~~ii~ti~:~,~~~~iij~~:w:'::::"":,'m~~~~..;;~~t~!~~;iori~i
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
43 C5b
d. . C5V
3 ./5'
Lj'S-D
--- _ ... r--
.::;, d... . <?J ....)
Shared Drive(T: )/Building Forms/Electrical Permit Application 1-03,doc
7% State Surcharge
10% Administrative Fee
TOTAL
.
,
."N~~~. >~_~_~_"
.
.,
3/21/2001 r -. -
1:41:41PM~~
.
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Receipt #: 2200200000000000624
Date: 03/21/2003
..
Line Items:
Job/Journal Number
Descri\>tion
Amount Paid
COM2003-00 190
COM2003-00 190
COM2003-00190
COM2003-00 190
Add, Alter, Extend Circ
43.00
2.00
Minimum/Adjustment Electrical
+ 7% State Surcharge
3.15
+ 10% Administrative Fee
4.50
Line Item Total:
$52.65
Payments:
TWe oCPayment
Paid By
Received By
Check Number Confirm No
How Received
Amount Paid
Payment Total:
I
52.65
$52.65
.
Check
ERIC M. GWALTNEY
nJm
2095
In Person
Page I of I
cReceiplrpl
Wi~q},i'mi9ti
-- -::-""~,.._'------..-'. ,'- ", -''''.
~
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERl\fiT NO: COM2003-00190
ISSUED: 03/19/2003
APPLIED: 03/19/2003
EXPIRES: 09/19/2003
VALUE:
.
SITE ADDRESS: 4343 DAISY ST
ASSESSOR'S PARCEL NO.: 1702323406100
Springfield TYPE OF
Heating System
TYPE OF USE:
PROJECT DESCRIPTION: Install gas furnace ans associated piping and ductwork
New
Residential
Owner: GWALTNEY LAUNA RAE & ERIC MATIHEW
Address: 4343 DAISY ST SPRINGFIELD OR 97478
I CONTRACfOR INFORMATION I ' .'.' ~ _ . '
0~V'llu\!lJ ~"",VLH:\",,,,_: -",'. .
c~nfJ~eE~m~aHALtc6YmQEtlfr THE WORK f\i~~:.:~~:~I:If.~i~F,~:~e~~t.e!(~&p~~~!i~:1?~tt:!~';Phone
Menhani-m'RIZED UNDEK:~t~di(Mc i~>l (Hd-1 }~007l ?" -'J"-',(\ '..,'_(~,~{~~/2,9P5 ~;!'-'~_{I~JI-461-4821
o RUT N".MI\.n. ..1o<11\Z:1I\ awA RAE & ERIC MATTH ,~~ ~ I , \,... ,l. .,
WP'f",,"n~tI,Ir.l=n OR b~t{O'I'\'t'Ut.h~,t't\.~"'~ ,,,",,' ~,~.. ....~.....h...:,. N....' , ,.',.',,, -'1,~,,;
ANY 180 DAY PERIOD. I
~.. -- "-" '-" - ". ~. - ;
BUILDING INFoul\J[!.tmTON .,......""'"'e {~ ~t'" ,." "01_~'n"'!""
~lI.l'ftrJ.l1 ,\ ~ ,..;'~,....._~.. \! "'1:,...;.:;, ~.,,; '.Vl.....;;:"-'
"(""I., 'l-l'''~''''' f.... .., f~~ 0.":"-......,...7"' ; ,....':-;-\, .:')'";;":'~3.t~OT'
Z'_,. "~,,", . \ . . .., ". \4.<,. ..I.. ", L ", .. ....\.
# of Stories: " """'." ;, '; _rNLotTSize: /' (\
~, ,.' \.' ~. _, . -, . J f ..! '. -. . I
Height of Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport:
Energy Path: Sq Ft Other:
Impervious Surface Area:
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy
P"rimary Construction Type
Secondary Construction
# of Bedrooms:
VN
SETBACKS
I DEVELOPMENT INFORMATION.
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
IPUBLIC IMPROVEMENTS I
Street
Sidewalk Type:
Downspouts/Drains
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
Square Foota2e
Value
Date Calculated
1 of 3
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2003-00190
ISSUED: 03/19/2003
APPLIED: 03/19/2003
EXPIRES: 09/19/2003
VALUE:
Total Value of Project
I Fees Paid I
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Appliance Vent
Furnace - up to 100,000 btu
Gas Outlets 1-4
Minimum/Adjustment Mechanical
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date
$10.00
$4.50
$3.15
$6.00
$12.00
$4.00
$23.00
$4.50
$3.15
$43.00
$2.00
3/19/03
3/19/03
3/19/03
3/19/03
3/19/03
3/19/03
3/19/03
3/21/03
3/21/03
3/21/03
3/21/03
Receipt Number
1200200000000000854
1200200000000000854
1200200000000000854
1200200000000000854
1200200000000000854
1200200000000000854
1200200000000000854
2200200000000000624
2200200000000000624
2200200000000000624
2200200000000000624
Total Amount
$115.30
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.
1 Underfloor Mechanical. Prior to insulation or decking and including required testing.
2 Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
3 Rough Mechanical: Prior to Cover
4 Final Mechanical: When all mechanical work is complete.
2 of 3
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2003-00190
ISSUED: 03/19/2003
APPLIED: 03/19/2003
EXPIRES: 09/19/2003
VALUE:
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, hat the permit card is located at the front of the property, and the approved set of plans will remain on the site
at all i during constr ction.
(JjJj1" l), ,
V fL1('_
Owner or Contractors Signature
~
~-~/h ~/) ().~
Date
3 of 3