HomeMy WebLinkAboutPermit Electrical 2004-1-27
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,CITY OF SPRINgFIELD, qREGq~,_. J,--/,;,%"
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERnf~4PfkI~TION M
City Job Number ~UlJ\'(l)t t> Date \.~~~'V \
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LEGAL DESCRIPTION l
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JOB DESCRIPTION
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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
let~/IJtA/7147-
$ 19.00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50.00
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The installation is being made on property I own which
is not intended for sale, lease or rent.
Electrical Contractor 200 Amps or less
U"I:VVIKI: I:Lt:v I Klv, IN'Arr 201 Amps to 400 Amps
P.O. BOX 23154 f ENTlON:(M};}rA,mns to 600 Amps
les d ~l:ftjr/aW r~R,u
Yc;.YJ1~9)ion C a ~.A.1ri!ljSM~'Or~~ou to
Phone ;; rf~52_00entf(fverfl~ct<e1}BWJW~Qn Utility
J090. You m1-0R1t1ooQM~Y~ are set fort
Cj:/Ii ay Obtain ~. I'\A 952-~
Supervisor License Number 33 93 -nLiH1b~~ :~:t~:~el~lIrii;~!~~~:
'"' -,., . regon Utilit}f M ~~ one
10 -- / - 0 r ,..,.,~ 1Iml'aUll;tip~~~f&it~6hlQ'oRelocation
200 Amps or less ).
Constr. Contr. Number .~ 5hb? 7 201 Amps to 400 Amps
, 401 Amps to 600 Amps
Expiration Date /' / / 20 0' ( I
,7 .- Ct/ - T Over 600 Amps or 1000 Volts see "B" above.
Signature ofSupervis' g Electrician D.liti~~~\mil!wil
,/ f~ NOll New Alteration or Extension Per Panel
q #~I.~ ,..~t.. One Circuit
Own,,, N 1jI;b II 'iUr~' tJf~~S~llll €. ~:~~~:~~~;~~:~' with ---Jf $ 3.00
Address '?9'ZC:. /71 !fJ~DO:Offl r:'PI. """"'~Il!!l..~lll:
70. '7 l( ell t /f7/)'yj/DAy..., I.~ ABA ~ 'M.<'~o1ii""""'''''MW'kA"",';dil0&6$'1ii,%&Ji**\0,>!",,,,g,,
51 ?/--;I C;lr ~ne' 7r/ !l!lfJD. IVD~YJlr i!Gt'tfl)~t $ 50.00
SignTOC~e LI~hting $ 50.00
OWNER INSTALLATION Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
{
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
t3rotJ
Address
City
Expiration Date
$ 50.00
$ 69.00
$100.00
$ 43.00
s :S,OO
City
Owners Signature:
4.
7% State Surcharge
10% Administrative Fee
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1/1-, 32-
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application l-03.doc
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e CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2004-00108
ISSUED: 01127/2004
APPLIED: 01127/2004
EXPIRES: 07/27/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4389 DAISY ST
ASSESSOR'S PARCEL NO.: 1702323404600
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Electrical Service Change
Owner: HARRIS HUGH JAMES
Address: 3825 RICHLAND SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor
LIVEWIRE ELECTRIC, INC
License
56697
Expiration Date
05/16/2004
Phone
541-344-4928
I BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Str~et Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
, REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
ATTENTION:CSiatwiltl2liYp@qUlres you to
follow rules ada.oted bv the Oregon Utility
uow.nspoutsillraW!j' t f ~
\Iotification Center. I nose nJlt:l:S a.re se 0, '
n OAR 952-001-0010 through OAR 952-00
0090. You may obtain copies of the rules \
_ "'r. _ i~~ WORK calling the center. (Note: the telephone
NU' ""'~. \1 S\-\p..ll t"r \7\[ ':\M\ \~ i~U \ IIUo:..,I:,.;, or me uregon UlIlllY l"vL;f;vQ~;u"
1\-\\S PERM 0 \.It,mER 1\-\\S PE ,~alU1ltion Descri tion C'l'\tM i~ 1-R('\n-1~~-~344).
p..\.I1\-\OR\IE \S p..8I\NOO:.~
. . __O~A~nI=NCtOOR ,.....n. $ Per Sq Ft Square Footage
DeSCription \.; 1'J'\TypeOof~(mstli1tction It' I' B'd A Value
F\N,'l '\ 80 1\1 I \,.' or mu IP:er or I mount
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Date Calculated
Total Value of Project
Paee 1 of 2
,
e
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00108
ISSUED: 01127/2004
APPLIED: 01/27/2004
EXPIRES: 07/27/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$9.60
$6.72
$33.00
$63.00
1/27/04
1/27/04
1/27/04
1/27/04
Receipt Number
1200400000000000114
1200400000000000114
1200400000000000114
1200400000000000114
Total Amount Paid
$112.32
I Plan Reviews,
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 Reauired Insnect\q.ns ,
1 Electric Service: Approval required prior to utility company energizing service.
2 Rough Electric: Prior to Cover
3 Final Electric: When all electrical work is complete.
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, 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
Pae:e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Depaa lIIIent
Date: 01127/2004 11:05:21AM
Amount Paid
63.00
33.00
6.72
9.60
$112.32
..
Receipt #: 1200400000000000114
.
Job/Journal Number
COM2004-00 1 08
COM2004-00 1 08
COM2004-00 1 08
COM2004-00108
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Item Total:
Payments:
Type of Payment
Check
Paid By
LIVEWIRE ELECTRIC
Received By
lIb
Check Number
Batch Number Authorization Number
How Received
Amount Paid
9501
By Mail
Payment Total:
$112.32
$112.32
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