HomeMy WebLinkAboutPermit Electrical 2005-4-7
<225 Fd-TH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number (j)W1V::>O; -00"3 '7? Date
200 Amps or less $ 50.00
iOD:t:itii>[!o 400 Amps $ 69.00
49tl~ps:tol600~ps' EXPl _ $100.00
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D,C!iJ~~ts. ". '. , ~. '
AT> .; 'Hon;v n"n'nn ' ,
. /J New lterlltlb'n'O~'E"tension Per Panel
d........" ~ /: ~ One Circuit ) $ 43.00
/' ,,;:/ , J Each Additional Circuit or with
, Owners Name \CJl.-t{,.IG"~ vi .A-I/A~ Service o~ Feeder Permit , $ 3.00
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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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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ElectricalContractor L.R. Brabham, Inc.
Address
68 West "Q" Street
,City Sprinqfie1d
Phone 747-6638
SuperVisor License Number
49'448
Expiration Daie
10/01/07
Conslr. Conlr. Number
8699
Expiration Date
12/18/06
Signature of Supervising Electrician
OWNER INSTALLATION
The installation is being niade on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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Service Included '" ~ '%
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1000 sq. ft. orless . q ~~~.,.
Each additi.ona! 500 sq. ft. or ' '" "{; /.~"
portion there9f. ~ 9.00 """''o~
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Each Manufact'd Home or , ' " ,~
Modular Dwelling Service or
Feeder
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'rn' /--, " :>6'_;""";_'''t'''':'.:~..-~
Notific~tion Center Th' ' '--' "
2Qq 6J!/ t; .. ose rules are se$~
21lJOOm~:1il~l-o~1~ thro~9h OAR 9Sa-6&.OO
401 tstim,t<\Rgo1!saln coplell OJ me ru'!l~~~o
l:i cemer. (Note: tlllllelepnon"
60J'ltlln/ua;oftQQl\~gon Utiliti iJ.kfi....j!'ll3.00
Over 1000 €xnpt6Yl>.!~-aoCl-332'2344). sffi.oo
ReconneCt Only , $ 50.00
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Installation, Alteration or Relocation
1/ ')
Pump or inigation
Sign/Outline Ligbting
Limited EnergylResidentia!
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding Fonns/Electrical Pennit Application I-03.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF ~rK1NGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00399
ISSUED: 04/06/2005
APPLIED: 04/06/2005
EXPIRES: 10/06/2005
VALUE:
SITE ADDRESS: 2923 Gamefarm Rd
ASSESSOR'S PARCEL NO.: 1703224105101
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Add I circuit
.. Owner: WALLACE G KATHLEEN
Address: 2923 GAME FARM RD
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
License
8699
Contractor Type
Electrical
Contractor
LR BRABHAM
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Iustruction:
Notes:
Description
Expiration Date
12/18/2006
Phone
541-747-6638
I BUILDING INFORMATION'
ATTENTION: Oregon law requne1i y~ ~
follow rl ~l1'6i.l'!ed by the Oregon Utility Lot Size:
R-3 N 'ficati e~n~!l!t'tOO!Wl'ules are set forth Sq Ft 1st Floor:
. otl 9 _\lm~r~'thrOU9h OAR 952-001- Sq Ft 2nd Floor:
VN In OARy a'ier liin copies of the rules by Sq Ft Basement:
0090.. o"-.rn~~ ~~e: (Note' the telephone Sq Ft Garage/Carport
calhn9t!H~~V't>'Nli.: n Utility Notification Sq Ft Other:
numbesfa.l~~g!/rI\l!;.2_2344). n/a Occupant Load:
?,';'~'p.r I~ 1 8tm.s~
I. DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dlst:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
OTIC'" ~t- lUC }.NOB~
N ~. i R~hbb '.ISldew~lkifype:
-RMI :lt11-': . ~ JnHK
T\1\5 JifUZW Y~f1E~ ~~5 ,~[t(hown~poutsmrains:
AUT "'t.\FW ~ \\& /i~'ij $B HJ'R
C~~~l!;1"",,, ,I\. Y .c.bQ.lm).
_~~@i'I'l' rt\\\OO.
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Value
Date Calculated
Pa2elof2
.
. CITY OF ~rK11~ljNELD'
Building/Combination Permit
PERMIT NO: cOM2005-00399
ISSUED: 04/06/2005
APPLIED: 04/06/2005
EXPIRES: 10/06/2005
VALUE:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fp.ps PWlU
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
$4.50
$3.15
$43.00
$2.00
4/6/05
4/6/05
4/6/05
4/6/05
Receipt Number
2200500000000000398
2200500000000000398
2200500000000000398
2200500000000000398
Total Amount Paid
$52.65
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.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefuily examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and aU 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
Pal!e 2 of2
.
225 Fifth Street
Springfield, Oregon 97477
541-726-1759 Phone
.
"!'~'A!N, Q.,!~",c'_" '_ '_,""". ~.,
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..Jillty of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
2200500000000000398
Date: 04/06/2005
3:45:45PM
Job/Journal Number
COM2005-00399
COM2005-00399
COM2005-00399
COM2005-00399
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
Payments:
Type of Payment Paid By
CreditCard LARRY BRABHAM JR
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 716054 In Person
Payment Total:
Amount Due
3.15
4.50
43.00
2.00
$52.65
Amount Paid .
$52.65
$52.65
'I
'i
'I
4/6/2005
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