HomeMy WebLinkAboutPermit Electrical 2006-11-7
225 FIFTH STREET. SPRINGFIELD, OR 97477 ., PH:(54I)726-3753 . FAX: (541)726-3689
Date
.'
ELECTRICAL PERMIT APPLICATION_
City Job Number COtA-'\ e.oO (; - c) 14 t ~
1. l:ioCA:TIONOF. IivST..'.WL.'."i 1.A.c."TIOiVf
~~'~'S- '.{J"'. ".,d,,' 'if'~qr
LEGAL DESCRIPTIO~ '
170 Z 33>C>O t> 110D
JOB DESCRIPTION: f=:\y.e& ~ 'Qo....~
-~~
3. r::C;QMIt!/~'fi~fEjfS~iIE:QViE BELOW
i
'1
, A. l~ltI!:~li~~~i~,e~:~,~~~l&1~~t~i-l."ami,y~p~~;:~~,,~llingu nit., ,', I
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
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
2. lr~~~&iqfq~i~~r~?{r~g~,~':,j B. ~:~~tl~~1~~:F~~d~~~;:?~i~1B{~~t~~n, AI~erati~~~'ot, Relocatio~:, .J
Electrical Contractor HI. I P)~t'~,C,~Q.vl~gc.li' )OWO Amos1or l~ssou [0 $ 63.00
4 'u ,_..., '~I ........,.e 0 i ad r~lt'1J 'e~ y
, .0, Jp)lclN ruL~adopted biWlltetfB~6\qodtmf~ $ 75.00
Address 3~316 k I ~i~:L~:~~er. Tho~glrfiffiPJ~PcgogetIf18ftt $125.00
r'\ .\\ l) in ~R. 52- lll:IIp010thR9~~t,n~AC?~1g~<2bJl1J'~ $163.00
City '-.:0~ Yl~hontJOo I .- '.-n ~~btain c9~f\bd03P~~p,sLJY18Msu) $375.00_
\J l calling the center. (NJ\~~offi1~cl&qg~hone I $ 50.00 SOfN;
, '"'Z '1~~er(5rthe Oregon~ijli;V~R~~.fjea~~t1,;""\""'~J",,t'"'7r'. ." .
Supervisor License Number ~...r~ntor is 1_8(;<(Hi~igJlJ>~,~rf~~lS\Y,l;~~~:2tt!j'\~~,~~r~;i',:c- ". ......,
Exp;rntion Date !f2P./ 07 . [n'tallaoon, Allmoon 0' Relooaoon
, , , 200 Amps or less
Constr. Contr. Number ,;;;r:.;-.:.. ~I , (l __ 201 Amps to 400 Amps
, , , (, I, I.- f;/ 401 Amps to 600 Amps
Expiration Date ~ ' , ~ 9++G-E: Over 600 Amps or 1000 Volts see "B" above.
Signature of Supervising Electri?ian THIS PERMIT SHALIl'_I~~~~ '
AU TH 0 R 12 E 0 UNO E R I1llYg\ltl("1\~YrrofsE~fQ,sion Per Panel
OMMFN .Fn OR IS flCVJWrfHi{ffiifFn F.l)Q
NY '~/80 AY PERIOD~a'cl'1.1XcMlli'offal <5lttuit. or with
f. ' Service or Feeder Permit
L~~ i-~f ' E.
, I
$ 50.00
$ 69.00
$100.00
?~Q -.~,
Owners Name ~l~ \
"z,tl ~(~l
Ci~ fi <-...'v(.-4.- / P!fne
. 'elt
OWNER IN:ST ALLA nON
"j
. ,
$ 43.00
$ 3.00
Address
eo~,~(i~~~~~{~y,~~;~,~!~i~:~lU:~~~J~~~Ch '1 ~iall~ti911':J
..
Owners Signature:
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
5"0
L
..>
zs-o
4.
The installation is being made on property I own which
is not intended for sale, lease or rent.
8% State Surcharge
10% Administrative Fee
5% Technology Fee
Inspection Request: 726-3769
, TOTAL b( ~
Shared Drive(T:)/Building FonnslElectrical Permit Application 8-06.doc
~" '67~ ct
S~" I\I?-O ~mn
_~~8~~!l!~1'1~9!j
i"
,.1"
'I
.
.CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2006-01425
ISSUED: 11/07/2006
APPLIED: 11/07/2006
EXPIRES: 05/07/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5335 Daisy St 98
ASSESSOR'S PARCEL NO.: 1702330001300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Service reconnect
Contractor Type
Electrical
A -,-,.. r- _
f,../ -, v I/U .
SANTIAGO EST A TES ASSOCIA 'f,ES~r!e@ rUI IV. UregO
11211 GOLD COUNTRY DR STE io@tificatio es adOPted ~ Jaw reqlJlr
GOLD RIVER CA 95670 ~~9~R 95;~~nter. rhn~_the Oren~~~~i.J 10
- -v. YOu Ih_~ . -uUl0 th~_ - 'Ules are' 'JI/I/cy
I C0NmIM,€,TOR 'INILQR1YL<\:TI(!)~1 R Set fOrti,
. ....'I/oer~ -....',cer. (N /,"0::; Of th 952~001
C Orthe 0 orc" .. e liE' ,_. . D
ontractor Ce. rego Jt.I,~.ens'~/e 'XPIf"tlOn ate
MY ELECTRICIAN INC nter /s 1 ~8nn n...(~1'50fJ' Nnfif:_honel1/20/2007
I BUILDING INFORMAiio~i'44). '-Cl.I/On
Phone
541-729-1454
Owner:
Address:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:'
R-3 NO n c H.eight of Structure
THIS tr.ype of Heat:
VB AUT: PEfNif'}~f, Type:
HORll1lW~?!f~p..f1: E .
COMME r!t~eliglil~a : XPIRE /F '
ANy 180 ~ S~~~I,~'1tdi6'&')ER~~~ '*oR/(
11 ~':'k_ .\.1~~..!.\.. Jt)~ur
I DEVELOPM'fJlllU: INFURMM
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pae:e 1 of 2
-~~~~,~ltilg;~;
~
l,
r'
.
.CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: cOM2006-01425
ISSUED: 11/07/2006
APPLIED: 11/07/2006
EXPIRES: 05/07/2007
VALUE:
Status
Issued
225 Fifth Street, Springfie.ld, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
~f~~ P~
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Service Reconnect
Amount Paid
Date Paid
$5.00
$2.50
$4.00
$50.00
11/7/06
11/7/06
11/7/06
11/7/06
Receipt Number
2200600000000001554
2200600000000001554
2200600000000001554
2200600000000001554
Total Amount Paid
$61.50
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.
Electric Service: Approval required prior to utility company energizing service.
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 ofany 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
Job/Journal Number
COM2006-01425
COM2006-0 1425
COM2006-0l425
COM2006-0 1425
Payments:
Type of Payment
CreditCard
cReceint I
RECEIPT #:
Description
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By .
EDWARD GUIDRY
aOf Springfield Official Receipt
opment Services Department
Public Works Department
2200600000000001554
Date: 11/07/2006
9:18:15AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 39778A In Person
Pay~ent Total:
Amount Due
2.50
4.00
5.00
50.00
$61.50
Amount Paid
$61.50
$61.50
.
Page 1 of I
11/7/2006