HomeMy WebLinkAboutPermit Electrical 2003-11-21
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~~I;e ~ 1:1 as submitted has the following
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~~~~l112'g..gg89 10t requ~ specitic land use
~~;=ERMIT,::Z~~ -;1;j;,~~;,~~;~~~~~
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LEGAL DESCRIPTION A. ~;..~!i~~~-~!!!,~~.~gI~.~9~~~.~~~;~;~~"PJW~.~~&~~~!{m
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JOB DESCRIPTION'
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Permlts1arenon-transferable and explre.lf.,lYork,ls It' "v
not started:withili(f801a~y'S\;('is~U'aH~~ ~'i!'~~ik)St'1'('1
S d d., '180d~- 'I'~r I ho,;e rUlvS ar" "" '
uspen e lion' ays.l':". ..
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Electrical Contrictor _tChristensdntiEleetH'catID:
llUIlH..ca Ivl - r..... ""In ~ ,"
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Address
1 ?qR Bethel 1)riv"
City
Eugene
Phone 541-688-6121
Supervisor License Number
3759 S
Ex.piration Date
10/01/04
Constr, Conn__ Number
26-34C
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or '
ponion thereof
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
I
$50.00 60, (J"U
B. ~!~t~l,:,~6~,n~rt~},:1!i~fi~f&f~~~~~,'1i&,~,"~
~&~.:...~~ ...~~~ -. ,."""~t;.o"","'J;n~"t:.:r.~~!"'~ ~,'=-" ...c__ ,."...:t'':''f',>~c;r~~
200 Amps or less $ 63.00
20 I Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsIVolts $375.00
Reconnect Only $ 50.00
NOTG'C~'E-(~O"'''''''''-'''''IE-''''''''~'''''''~.Jl'~~~\~~~''\'l
THIS? U ~c>l'tie=es 0Ii ,e~ueE~l"f~<>ll!1@"'~"'il>""""'P-._~
AUl HORIZeD UNDeR \ HI~ tK~, r
C 0 I ,. ,InstaUa tion,. A:Iteratioli:'Oi ReWciitI~l
VIIVIt.I'i\)LU Ul' ,.... ,.~
ANY f~H9 ~p~'q!(li;sSD.
201 Amps to 400 Amps
40 I Amps to 600 Amps'
$ 50.00
$ 69.00
$100.00
Expiration Date 10/01/04 0 600 Am 1000 V Its "B" b
ver ps or 0 see a ove.
n (\ () _ ~J(1,.~~"~~'1:(f-~;g;:1l1li;J~;r1l'~~il
Si~~Orfsurrismg Electrician --\J _ ~D.~~:~::~~::~~:=~~:~r- ~~~~~~~'A1
iJ L l)"'-:J----:- T o_-y Olaanan One Circuit $ 43.00
, Each Additional Circuit or with
, / \ , L Service or Feeder Permit $ 3.00
Owners Nam~\<:Y\ "--' O~ ..
Address .q.,ctS 'FrZ/inIC1ln' ~lvtJ-..-~o
CityG O,r--,u::; Phone GILl?- - 'f~
OWNER INSTALLATION
The installation is bemg made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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. "~,,,!.S.t~~!l!~~L~~~$~!!~.!:!~!a2\<~~!~~,~~l.!lJ,~~~~
Pump or irrigation $ 50.00
SignlOutlme Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercia1 $ 45.00
Minimum Electric Permit Inspection Fee i:; $45,00 + Surcharges
4.' ?fSUBT5TXEOE~OVE
~Rr~~~,~~'~~ ..,..".
7% State Surcharge
1 0% Admmistrative Fee
,,!~ r-- (J0
J,~(\.
~..,... SO
~5.
5.CJU
~~~.5'o
TOTAL
Shared Drive(T:YSuilding FonnslElectrical Permit Application l-03.doc
FAX NO, 5416886528
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p, 01
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225 UJ> U1 STll.EET . SP:lUJ'(GFIELD, OR 97477 . PH;(5411126-37S3 . FAX: (5411126-3689
ELECTRICAL PERMIT APPUCATION
'--' City lob Number DllIe J J -..If) - ()~ .
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LEGAL D~SCRl}'110N#
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JOB DESCR1l'TIOJi
PermitS are non-lransfqable and expire If.work Is
not started within 180 days of issuance or If work Is
S ""pended for 180 days'-
.11'.......'""'":'",l. ..,._'~_"~,..."'~_~..JJ" l'l. -',',-,'_, """",'"
2,1 ~Ji,"," .,' , I, ,
Electrical Contractor. 9Jristenson ElectriC:
Address
1298 &tol-u.l 1),.,,,..
City fugene
Phone 541-6811-6121
,.-.,' Supervisor Wowse Number
3759 S
Expira1ion DIItC iO/Ol/04
COJISII'. CODII'. Number 26-34C
Expiration Date 10/01/04
JfrJ;'":: ~-
OwuersNam.c ~.L;j t.Hu.
AdclrCll. .1/7y~- m-,/L../ .d-/'.
City ~ PhoIle ~1_~
.'
OWNERlNSTALLATlON '
!he iIlslllllatiOD is being made on property I own which
is llOt iIl=dcri for sale, lcaoc or rcuL
Owncn Signature:
........'
Ilupection Request: 726-3769
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.~ ~"Ei.,...;, ,!!L!it.~~~.hm .~.,__~!1;l~I~
Semce Induded'
1000 sq. ft. or less
Each addi1ional500 sq. ft. or .
portion thereof .
Each Manufa<:t'd II_o or
ModuW Dwelling Se:rvieo or
Feeder .
$106.00
$ 19.00 '
S50.00
B.~~~~l\i"'ti't~~~~~"'~,...:
~~\\",~~
200 Amps arlCls I S 63.00 ,y!!!
201 Ampato400Amps $75.00
401 Amps to 600 Amp. $125.00
601 Amp. to 1000 Ampa' $163.00
Over 1000 Amps/Volts $375,00
Reconnect OuJy $ 50,00
c.~~
~ :~:1Ms"~G3~,r r.;:~~?f~~~..~..i'.M.1,~,'!-'~~~~I;l:
IlubUatiQII, Alteration or Reloeati'.n
200 Amps or 1.... $ 50,00
201 Amp. to 400 Amps $ 69.00
401 Amps to 600 Amps' $100.00
Over 6OO'Amll. or 1000 Volts .ee "B" above.
D,
New Ai.ter~UoA or Extension Per Pano!
One Circult
Each AclditiODa! Circuit or with
Se:rvicc or F~ PClIlIit
$43.00
$ 3,00
E.~~:.'
Pump or irrigation , $ 50.00
Sip'OutliDc Wghtina $ 50,00
Limited EncrgylRcsidcntial $ 25,00
Limited Enargy/Commcrcial $ 45.00
Mb1Imwn Electric Permit Ilupection lice 1:' $45.00 + Surcharges
4_'__ 6y!1l
7% State S~haJgc ".IlL
10"10 AdmiDisttalive Fee t; ?:L
TOTAL 7~, ~
Shau'a:I OrivlS(T:VBuildiDa FormsIElcoui~ Permic Application 1~3.doc
L(130 170ce 01
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225 Fifth Street y
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01154
COM2003-0 1154
COM2003-01154
Payments:
Type of Payment
CreditCard
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Receipt #: 1200200000000002502
Description
Manufactured Home Feeder
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
CHRISTENSON ELECTRIC
Received By
nurn
Check Number
Batch Number Authorization Number
000228 083878
City ol Springfield Official Receipt
Development Services Department
Public Works Department
Date: 11/2112003 lO:11:38AM
Amount Paid
Item Total:
50.00
3.50
5.00
$58.5U
How Received
In Person
Payment Total:
Amount Paid
$58.50
$58.5U
.
.
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CI1l'Y OF SPRINGFIELD ..
Building/Combination Permit
PERMIT NO: COM2003-01154
ISSUED: 11/21/2003
APPLIED: 11/18/2003
EXPIRES: OS/21/2004
VALUE: $ 5,000.00
SITE ADDRESS: 4795 FRANKLIN BLVD SPACE 6 Eugene TYPE OF WORK: Manufactured Home in
ASSESSOR'S PARCEL NO,: 1803%t?q~c\l8Ires you to Park
ATTEN nUi\!:uregon th Oregon Utility TYPE OF USE: New Residential
PROJECT I?&itC;!tmr:ION:\UIMI!'!Ii'~a!~~;I!.l'W[>,~,n~(P.I\'mbing connection only. NO OCCUPANCY UNTIL
I t'f'cation centfELEGTRICAI:.Pr!,RM1:r.IS'OBT AINED.
o , I . . ........-4 f\ thl"l"\llnn Uf"'\n ::J..J'- v.....
OAti l;I:>"VV' -", pies of the rUle,;
Owner: (;~~~R.'rLOP,!'Z obtain co .. ,_ h"np
Address: '4795'FRANKLINdBL:I;D;NEUGENEtrOR') 97403
calling UI" v ":: ~ __~ IlIilitv Notification
numt;er ,UI ,''v ~,-~ "Q2.'JQ44\.
r ,~'^' '" 1_P.!lO-... . I CONTRACTOR INFORMATION I
,
Contractor Type
Electrical
Manuf Home Inst
Plumbing
Contractor
CHRISTENSON ELECTRIC INC
OWNER
OWNER
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
"
Street Improvements:
Storm Sewer A vaila'ble:
Special Instruction:
Notes:
License
458
BUILDING INFORMA nON I
# of Stories:
R-3 Height of Structure
NOTICE: Type of Heat:
~i1S PERM/lW<;,~eJ~~YP-V
AUTHOHIZE[~~~,~~~1Y~~:,PIRE IF THE WORK
COMMENCE Energy,Path:IS PERMIT IS NOT
ANY 1 An IH9 2r~!~~BANDONED FOR
I DEVELOPMENT INFORMATION'
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS'
Expiration Date
05/~1I2007
Phone
541-688-6121
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impe:rvious Surface Area:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDrains:
Pal!e 1 of3
'.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Manufactured Home
Total Value of Project
$5,'~00.00
$5,000.OU
Manuf Home
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Manuf Home State Issuance
Manufactured Home .Connection
Manufactured Home Placement
+ 10% Administrative Fee
+ 7% State Surcharge
Manufaciured Home Feeder
Total Amount Paid
.
. CI1lY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2003-01154
ISSUED: 11/21/2003
APPLIED: 11/18/2003
EXPIRES: OS/21/2004
VALUE: $ 5,000.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
5,000.00
Vahe
Date Calculated
ll/18/2003
~ F",,< P'\ilU
Amount Paid
Date Paid
Rec,~ipt Number
$20.50
$14.35
$30.00
$45.00
$16U.OU
$5.00
$3.50
$50.00
ll/18/03
ll/18/03
ll/18/03
ll/18/03
11/18/03
ll/21/03
ll/21103
ll/21103
12002000000000U2485
12~0200000000002485
12~0200000000002485
12~0200000UUUUU2485
12'~0200000000002485
1200200000000002502
1200200000000002502
121)0200000000002502
$328.35
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection rl~quested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be lDade the following work
day. .
I R"oW"rI Inonections I
1 Manuf Home Set Up: When installation of all piers or stands is complete.
2 Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc. have been installed.
3 Manuf Home Plumbing: After home has been connected to water and sewer.
4 MH Service: Approval required prior to utility company energizing service.
Paee 2 00
.
. Cny OF SPRII'n:d<lJ!,LJJ
Building/Combination Permit
PERMIT NO: COM2003-01154
ISSUED: 1l/21/2003
APPLIED: 1l/18/2003
EXPIRES: OS/21/2004
VALUE: $ 5,000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 sh.1I 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
:~~t":~:'~~wX\ Nl'^- \\h\\as
Owner or Contractors Signature Date
Paee 3 of3