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Home My WebLink AboutPermit Electrical 2004-1-28 " 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX:l~~~7t26-3689 .' OWing prOja t ELECTRICAL PERMIT APPLICATION :onin9, and does ~o~~ SUbmitted has the tOI/ . L' . PPrO\lal sQUIre spec.,. OWmg City Job Number COVl'1 ZOO l( ~ 00117 Date 0 I - z- r - () I' I IC land use ", M~""'j'.;r'<":1('tt\'".1:Yt;"'1;,"'"~-::'-': tt':;::~"",":c..:;~::,,.,?;\~...~,,:~...~q')t:;~"".'?Jt?..,"}itl~~ . \1;",", .;;tJ"'-:.'" """.',""':I,~V.,~;,~' .::- '"":n.-w~~;'~:~;,f:,:""1'~-" ',.. _J;. tZ......">J'i,~;,-c:~':"l;.t.~,'SP. 1. ,"LOCATION.oF,JNSTALLA110N\"t;',1f,\~,;.I'f'i 3. ,:'COMPLETEFE .BELOw.;.:\-",;;. ..; ~':', "~''''i[g ;?bl57J;;;;;';r;~;;"J~":"''''\'"''=!ct['''' ''''''''';.'''''''''",'''.""l.';i('uil::;~;;~~'';:;''t::e ,"'~' ,""1~ '":'tj/ , tc:e'.".'" A ~N":'~~:l1*~~1;j;19~-'S~'k~'IW~~;n~~.-t-'~'i:1t':~'i"~;;~',.:.~. '-"lliri~'-.'< . '.{~ LEGAL DESCRIPTION .. J;:~~".~.sl.,.,.~P:t~~t;<~~_~9.k:~~~~~,c:~~..l'.B:J1J1!3.:~Jh~i~.~;.~~ 170~ ZZL{l.( (')C,f-,C)O Service Included JOB DESCRIPTION 14655 [N?rM/, MeW I:JSA g;j"jJI1NcL Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ~O. WTAA'&fOR}iN.~.STABE17i~ 2. ~:~(tlv':W;fili~~~~~f{~i;':&.i~ii."'-" ,"-~~-. .. Electrical Contractor L. R. Brabham, Inc. Address 68 West "Q" Street City Sprinqfield Phone 747-6638 Supervisor License Number 4944S Expiration Date 10/01/04 Constr. Contr, Number 8699 Expiration Date 12/18/04 Signature of Supervising Electrician //~ L/~~ / / . ~" Owners Name f,lchflfl..D /(/I?~(JA- Address ~05 GmnR.-.ft!.Je/J1 ,@ , citrSfJK/I1r;f-!dJ 'r~~?n? 717' 3/Atf OWNER INSTALLATION The installation is being made on y,"y...J I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 1000 sq. It or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder . . ." , '. c. J, . . .' __. ~~~:'P;2'l:<.iN'~""~',,~jJ,~~'-';":~~~~~ B. ~~Jl~]i!!"J:J~~~~AL~!1s.~1U~~,\l!.w,!,~~~ 63. to $50.00 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to I 000 Amps Over 1000 Amps/V oils Reconnect Only I $ 63.00 $ 75.00 $125.00 $163,00 $375.00 $ 50.00 c. ~:rrrlrHo~f~S~Bi~9f3F~d~~.f~~~~ '>>~~~~~~.::.~~~~~ Installation, Alteration or Relocation 200 ~mrmON:Oregon I~w reaUlrE&5.~t.O 201 ~M\J j8~~opted by th9 Orog$l69\GOhty 401 f8tIlMYifiB9lems.ter. Thofle ruleS as:I(J{f.I\d'o,rt . ov~~~(tootr~(t!\~r~~9~~95.~:O,. ". ..' D.~Il,.~i~, ' ~,~_ "'lllin'Ci'i\1e:c9n. . . . . . New AlWrattoll pr Exteoston er..P.al\.....' Notification number Tor lilt! U,,, v' ,-.;; my One CirCUIt ('~~+",;" 1_ROO_~'l?_?::I4t$)~3.00 Each Additional Circuit or with Service or Feeder Permit $ 3.00 "~~~~~"'OO~~'W'~~~"'Y~'~~l-~~.:t"-:~;:;"N,~~~:~~~ E. ~1\1;!~."-~9.~=1~(~~m~~!i~e5]~~~~'fj~~~l2ll~ Pump or irriH~otICE: $ 50.00 Signloutline1itiklit!i~~RMIT SHALL t^t'ltir$l~o1klE VVUHI\ Limited Ene&Y.tk~f;deh'J.P UNotti I HI:> PH5%\T I:> I~U I Limited Ene~k~~~rcflR OR I~ !:bl\l~iJ~l~f~oFlJH I\I~Y ll:lU OAY PERluu. Minimum Electric Permit Inspection Fee is 545.00 + Surcharges """'''~=''''''""",",''' 4.l1'SUBTO'TA'Lb, 0 ~;!:it~~~;-,?,~~~\~:~~;P;t;:'~" 03, &0 Lf, tfl 0,30 73,7) 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:yBuilding Forms/Electrical Permit Application I.03.doc . .' Vir Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-00117 ISSUED: 01/28/2004 APPLIED: 01/28/2004 EXPIRES: 07/28/2004 VALUE: SITE ADDRESS: 2605 GAME FARM RD ASSESSOR'S PARCEL NO.: 1703224406600 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Install125a panel Owner: RICHARD KIRSCH Address: 2605 GAME FARM RD SO SPRINGFIELD OR 97477 Contractor Type Electrical Contractor LR BRABHAM , # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Phone Number: 541-747-3644 I CONTRACTOR INFORMATION I License 8699 BUILDING INFORMATION I Expiration Date 12/18/2004 Phone 541-747-6638 R-3 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: VN Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: ._.1 to I DEVELOPMENT INFORMATION.'~regon laW re~~~~~ Utility" AI \ t;... . clOpted bY tl1e RE_I,!U~ RlmKING II W rules a 'Th se rules al ~ -00 Overlay Dist: to. ~ . n center. \ 0 \l;l\!JI1:R 952 # Street Trees Riili!ICa~~2.001.001? thro~~'tY\dfcapjielr:S l Paved Drive RqlIpAR .....ay obtaIn cop C:omp'!\~hone o 'fou ,.. {Note: {h"-' .'. . n % of Lot cover1~~tailin9 tl1e center. gon Utility NotlhcatlO ",bar tor tl1e.ore An('l_~~2-2344). nU ._.,~1_ I PUBLIC IMPROVEMENTS I Sidewalk Type: DownspoutsIDrains: NorlCE: THIS PERMIT SHALL EXPIRE IF THE I ~~;:~~~I,~~q UNDER THIS PERMIT 1~3~~ = -....... ..~~u un I" flllANLJONED F I Valuation De4~'bfta\l ttAY PERIOD, OR $ Per Sq Ft or multiplier Square Footage . or Bid Amount Value Date Calculated Total Value of Project Page I of2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-00117 ISSUED: 01128/2004 APPLIED: 01128/2004 EXPIRES: 07/28/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Ff'f'S Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Perm ServlFdr 200 amps or less Amount Paid Date Paid Receipt Number $6.30 $4.41 $63.00 1/28/04 1/28/04 1/28/04 1200400000000000124 1200400000000000124 1200400000000000124 Total Amount Paid $73.71 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. I Reouired Insnections I I 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 Pal!e 2 of2 . 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00117 COM2004-00117 COM2004-00117 Payments: Type of Payment Check ....;. Iili~rji.ruu>.."".,.,..,...,,.., I' , _"". ~ i '. . ,. " . , , ,..",,~. ..-;>""--'''') .,;" Receipt #: 1200400000000000124 :r Description + 7% State Surcharge + 10% Administrative Fee Perm ServlFdr 200 amps or less Received By djb Check Number Batch Number Authorization Number Paid By LR BRABHAM 30267 City of Springficid Official Receipt Development Services Department. Public Works Department . Date: 01128/2004 2:29:53PM Amount Paid Item Total: 4.41 6.30 63.00 $73.71 How Received In Person Payment Total: Amount Paid $73,71 $73.71 . .