HomeMy WebLinkAboutPermit Electrical 2003-8-18
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CITY OF ~._~UNGFIELD, OREGON \...)
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . F1"~t0(54t~~~ilti811s submitted has the tollowing
ELECTRICAL PERMIT APPUCATION ~~~'r~~a~nd does not require specific land use
City Job Number (0"'-1'2.001_007 B" \ Date Z/Ilf/01 Zonin" CDvZ-
, , 4/ '
3, ICOMPLE1"Ej,J!:E SCHEDt.JLn b.t!.L.AI, ::'.2-0'"
""UU'VIILU\,.I 61l:llldlUrEl ~~
2, I CONJ.'RACTOR. INSTA,fLA,!IOJy ONLY I
Electrical Contractor flj",C E/'" r;/-r/ /',
Address 1 C; 7 [(3 )Jtd'-/:7 9 r.S.
/ 601 Amps to 1000 ~J\~
City FLlJ-'h-.P Phone '7y/-at/f'Y OverIOOOAmp~4Y9~'i.~\\'l
, Reconnec{eQ!ilf o~ e\ \O~,
\,,~ n~0QJ ,p.~()
J k -? 0 J.:Pr( Ioy\-d Si '"' ,..~~.l<', ".'
y~ / 7 5 ,o~il"'0sw."o~'!rY.lt~~e~i>fJ'Kee~ers
, \o~' ~oQ" -<,'r\o<:i ~o,~ ~ \'<" '$;',0(". ~
/0 - J - 0 $.I ,.&;:\'" e'" 0' ~staUatioli', l1Je~tit'Jlro? ~",Io~ation
1'-' ~ \\}~ Ge~200')~ s'09~ess\~0 ~o\\'~ $ 50,00
Constr, Contr, Number .dO -~/tJ:3 &\\~,c'a.'i.~~7:()()201r~:.s:ffi<1t'O'QJW~s-,o.o.'\' $ 69,00
~o" ~"" ~"'" ,.,W' ('~\ "'?...
J 01" ,\o\} ~Q}?~,s;to 6BOZ~nips $100,00
/v - - 0.3 ""C). n\'<" ."'~, . ,~Cj " "
I)";r ~'i,\~~ ,pyer ~OO,AIiips or 1000 Volts see B above,
c'l> A\'O'D-ieBl~;'ch Circuits ;
~\}\" ,
New Alteration or Extension Per Panel
One Circuit $ 43,00
Each Additional Circuit or with I . '?
Service or Feeder Permit _11 $ 3,00 ~
'''\l''''
. " " '..', '. ',' \\';.~' -:\ q. , '" , ' ..
E. r(\1iS~ellalleous~se't~'\<<lSilD~~~~lfde~)'--Ea~hln~falIali~n~
\,.\. v' S '('{t"'" ~()f'
\)~P'o~~~'ti~\,'i\ \~~ ~\)<;J\'.'i;.\) $ 50.00
~ IS~btl~1J~l% I>-~\>I $ 50,00
\\~\f~~l~~\~~al $ 25.00
~~!!ea'l,i)~e:ommercial $ 45,00
Minim\l.'i\'t:ft,~tric Permit Inspection Fee is $45,00 + Surcharges
4,ISUBTOt1EOfAlJ()~"'ic" t. h
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1. I LOCATION OF INSTALLATION
Z b '7 f G-M-So,v UI
LEGAL DESCRIPTION
170:3.3 bll
JOB DESCRIPTION
Sf-lit. .I ::1. C,~+-
Permits are no'-transferable and expire if work is
not started within 180 days Qf issuance or if work is
Suspended for 180 days,
1010 If
Supervisor License Number
Expiration Date
Expiration Date
City
HA1U>wJ(" ~'5. ~'\,J'
269 ( G-A,Qf;Od U.!
S!'I; ;:)
Address
Phone
OWNER INST ALLA nON
The instalIation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A, I New Residential- Single or Multi-Family per dwelling unil.
Scrvice 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,I Services or Fe.ede~s - Inst~ll~tion;Alt~ratioi1s or Relllcation:l
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
(
{,,3
$ 63,00
$ 75,00
$125,00
$163.00
$375.00
$ 50,00
1
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)!Building FormslElectrical Permit Application, 1-03.doc
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00781
ISSUED: 08/21/2003
APPLIED: 08/18/2003
EXPIRES: 02/21/2004
VALUE:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 2691 GARSON LN
ASSESSOR'S PARCEL NO,: 1703361110104
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
PROJECT DESCRIPTION: Service and 1 circuit
Owner: HAROLD PETERSON
Address: 2691 GARSON LN SPRINGFIELD OR 97477
I CONTRACTO.lUNFORMATlON I
13'" 'l~0\~\I.'!
Contractor eo..'I>\~ 0'" ~ '00, License
ARC ELECTRI<;;, \'?>~ ~ ^ O~e~(e "'~".OO . 115113
~O~e\6;~ Xlii "Bmr.DING iiiFGRMATlON I
(\\0 ' ~o~~ -1iX'v' ~o'l>~' _ 0' '-' 'va~X'v' \0'"
# of Buildings: -:.(\<;;.~ \}\0"" '3' o",\e~' \ 0 ~ of!;fjf;~erles~,-\~\v'?>"
, Primary Occupancy G~up':~ \ . o~ C.~,3.00 .,;\'" v H~lgh,t ofiStructure
,-",\'~ \\ (l'" ",,<> _\'" ,\,'''' . "'.
Secondary Occupancy "r~~,I!:> S7: ^;-! ov e~' ~~~p"e'~llsat:
Primary Construction \llyp(el~~ 9 0'1> WN ve"''' ~eQj\':"~.ts"h:rype:
Secondary' Construction.<rype,b.-{ ~ "S'-e \X'e 0 V'CRange Type:
# of Bedrooms: r:JS-!J vv.'i,\'0 \,o~ \e~\"" Energy Path:
fC'Xle c.a'"
(\\J
Contractor Type
Electrical
New
Residential
Expiration Date
07/11/2004
Phone
541-741-0494
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
I DEVELOPMENT INFORMATION I
. ~wro:D PARKING
Overlay Dist: \?'C. \r \~i\~Q\
# Street Tree~~t. ~t>.\.\. 'C.'j..'il ~ 'il'C.?~\ wcapped:
Paved D"vE,y\~it: a~\"'i S "'C.? "'i't\\ ~\"Q~t.\C mpact:
"\ C, 'ilt.'" " U~v ~t>.\"V
% of Lot Cil~~'r'~llj\\\lt:v Q? \~ ~
~U\ 'i~Ct.'i) t.?\Q'i).
,f-~~~, ,,7/" 'il
I PUBLIC IMPROV~~~TS I
SETBACKS
Frontyard Setback:
, Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspoutsmrains:
Notes:
I Vallllation Descriotion I
II II ,
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Total Value of Project
Pa2e 1 of2
Value
Date Calculated
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00781
ISSUED: 08/21/2003
APPLIED: 08/18/2003
EXPIRES: 02/21/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fpps P3id 9
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Eo Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6,60
$4,62
$3,00
$63,00
8/21103
8/21103
8/21103
8/21103
2200200000000001420
2200200000000001420
2200200000000001420
2200200000000001420
Total Amount Paid
$77,22
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 Reoul:m~ Insnp~tinn11
1 Electric Service: Approval required prior to utility company energizing service.
2 Rough Electric: Prior to Cover
3 Final Electric: When aU 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 eacb 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
Pal1e 2 of2
. 225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00781
COM2003-0078I
COM2003-00781
COM2003-0078I
Payments:
Type of Payment
Check
..~..""- .
WIt,' c._~~.'._.'."'.'".''' ".. . :.::
,'.'-C',. .,
~:" '.. 1
,. I
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'''''''''__,,''_'U 'r-v"- -,
Receipt #: 2200200000000001420
Description
Penn ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
ESTATE OF ARC ELECTRIC
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfielil Official Receipt
Development Services Department
Public Works Department .,
Date: 08/21/2003 9:10:10AM
Amount Paid
Item Total:
63.00
3.00
4.62
6.60
$77 .ZZ
How Received
In Person
Payment Total:
Amount Paid
$77.22
$77.n
.
.