HomeMy WebLinkAboutPermit Electrical 2004-1-28
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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
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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.
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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
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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
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4.l1'SUBTO'TA'Lb, 0
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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
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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
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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
.
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