HomeMy WebLinkAboutPermit Electrical 2008-2-14
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225 1'H' 11:1 STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPUCATION
CItyJobNumber COM zoor -oc> -ZZ '-( Date
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LEGAL DESCRIPTION:
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Service Included
JOB DESCRIPTION:
C~.A~(f:"
/
Permits are non-transferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular DwelImg ServIce or
Suspended for 180 days. Feeder
2 Ei~6N:lf@.~~'PI?!%Sf;'tf'f~Tiiljr~!iif1 B. '''"~~'a~~~''::;Rclit~t1~li~~1j
. ~,::..1>{4_.~~~3,"'->;M,~ W~k.::7.~.:,> ~ A~,~,>':':x,~<z 3~< ~0$';\l,"' 1.:, i ~)\' "&4,"~_>-fw",_'.,\\_'}h~0s;>L....1"'",;,_ ~"...::~"" ~
ElectncalContractor ~ (.Uv\. [(-ec.L-JC 200 Amps or less \0 $~O 70
2~~~u\f4m)~ $ 75.00
Address ~L( ~1C~OC;(b. ~rnON~ Oter~~O~'M~6rth $125.00
'"l~V4- ru~s,t~~t e 1ft~ECl!%~e1. $163.00
Phone ~~~~~.o01~~~ ' ubiS bY $375.00
\n OAR \itti . av ob\dlfil~~~~ \ephone $ 50 00
//J~Q090~i~cen\~; Note'.. ~~,..~"
7 /1 f \he \,AI ~~&~".~,~~~';fti.{1~::'.~~,':..
"'" cen\et is '\
10 - I - 10 Installation, Alteration or Relocation
/ / 200 Amps or less
Constr. Contr. Number (0 f ~ ~ S- 201 Amps to 400 Amps
q ".- 401 Amps to 600 Amps
Exprration Date - 07 - 0 ('\
Over 600 Amps or 1000 Volts see "B" above.
Slgnaturil OI;1ItuP rJ sing1Electrlcian __ D.
New Alteration or Extension Per Panel
~ X; One Crrcuit
fd Each Addttional Circuit or with
/ Service or Feeder Perm.tt
'" : ." Ie r/-tl-W<>L' 1-4
ddress L;z.S-~b 27i\,.. ~+ E.
St>r~
S~VL
>~~f
1000 sq. ft. or less
Each additIOnal 500 sq ft. or
portIon thereof
$106.00
$ 19.00
$50.00
CIty ~Q
- 'J
SupeTVlsor LIcense Number
Expiration Date
$ 50.00
$ 69.00
$100.00
$ 43.00
$ 3.00
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U eal: .4i';ilCh,Ios'ta
l' ~(r",..,"'w;},..,~~~\'=W,f~,-"^t""$#~
" 1
,,'>
R-'
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Owners Signature:
Phone
Pump or rrrigation
Sign/Outline .
$ 50.00
$ 50.00
$ 25.00
City
OWNER INSTALLATION
8% State Surcharge
10% Administrative Fee
5% Technology Fee
Inspection Request: 726-3769
TOTAL
Shared Dnve(T')/Bwlding Forms/Electncal Permit Apphcation 8-06 doc
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2008-00224
ISSUED: 02/14/2008
APPLIED: 02/14/2008
EXPIRES: 08/14/2008
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SlTE ADDRESS: 2536 27TH ST
ASSESSOR'S PARCEL NO.: 1703244103009
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Service panel replacement
TYPE OF USE: New
Residential
Owner: HA WORTH FRANK W & SABRENA L
Address: 2536 N 27TH ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
JEM ELECTRIC INC
License
]61235
BUILDING INFORMATION I
ATTENTION: Oregon reqUires you 0
# of Units: foll.~w r~les adopted by th~Qre{l@le's!tiJity
Primary Occupancy ~~Fat'on Ccwtjr. Those r~EStbttl'bre
Secondary occupancy~~~~~52-001-o01 ~ througlpmfiJ~2a$01.
Primary constructionup,~ii. OU ma~taan copie~tl!l~@~ by
Secondary Construction. .Yk~~ the can er. (Note:E~' e
# of Bedrooms: n roger for the Oregon Util ~Ng:' ti9ft
Center is 1-aoo-aa2 ed Building n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS J
Street Improvements:
Storm Sewer Available:
Special Instruction:
NOTICE:
THIS PERMIT SHAll EXPIRE 1F THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Expiration Date
09/07/2008
Phone
541-729-1074
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
Notes:
- I Valuation Description I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Pal!e 1 of 2
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-00224
ISSUED: 02/14/2008
APPLIED: 02/14/2008
EXPIRES: 08/14/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L Fees Paid'
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
Amount Paid Date Paid Receipt Number
$7.00 2/14/08 1200800000000000134
$8.40 2/14/08 1200800000000000134
$3.50 2/14/08 1200800000000000134
$70.00 2/14/08 1200800000000000134
Total Amount Paid
$88.90
I Plan Reviews,
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Insoections ,
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 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 Department
Job/Journal Number
COM2008-00224
COM2008-00224
COM2008-00224
COM2008-00224
Payments:
Type of Payment
CredltCard
cReceml1
RECEIPT #:
1200800000000000134
Date: 02/14/2008
DescrIptIOn
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdmlDlstrattve Fee
Paid By
JEM ELECTRIC
Item Total:
Check Number AuthOrIzatIOn
ReceIved By Batch Number Number How Received
dJ b 465114 In Person
Payment Total:
Page I of I
8:47:18AM
Amount Due
7000
350
840
700
$88.90
Amount Paid
$88 90
$88.90
2/J 4/2008