HomeMy WebLinkAboutPermit Electrical 2006-12-7
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CITY OF SPRrNGFIELD, OREGON
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRIW PERMIT APPLICATION . 1.' /
City Job NumWl/2I5lk - () ~f:; Date );)/07 () (,
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LEGAL DESCRIPTION
1103 d-::;). /.10 dO(JD
IiOB DESCRIPTION
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Permits are noJansferable and expire jfwork Is
Dot started within 180 days ofissuance or iCwork Is
Suspended for 180 days.
City ~_
{;S6- / r'l1.
Phone
Expiration Date
4 7 Be; 50
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Supervisor License Number
Constr. Contr. Number
Expiration Date
Signature of S~R!1"isin
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Owners NamJl1J/YlMf14 &P/}0/
Address ~ ('viD1f'J ~ 1~
City~~L P~~ - '1
OWN~ ~STALrJ'jf;[7
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3. l€e)MeIffl'll"'r"'n'S~HEDWnEiBE:llen~
Service Inclnded
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
200 Amps or less
201 Amps to 400 Amps
lll'TI!,r.;.
401 Amps to 60~Amps $125.00
601 Amps1i6flOOOfA'n\iis SHALL EXPIRE IlSr6:i!OONORK
Over 10QQ~;O;-rj1pWm@ UNDER THIS PFf$~'7?;O.o.; NOT
Reconnee\51~I,~ENCED OR IS t,8.',~:82~t~H~R
$ 63.00
$ 75.00
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 680Affi~U(j1Wo-vO"'Ia($waa.'1'~~WJres y~u. ~O
D.~nl'li'''1Wi!j11W~~'~
f\jolirrtlfiOo~ .
. Ne'TrN.,~fligJSft~J\~,*,ll1tmll!~I\I!.oAR 952-001 ./ ./ :>
Oneffl~.t You may obtain CQoie' of tSel3:003s b\ 7'...5
~acli ,,'l\\iWl~ ffi~'eh\'fl~i~Note: ll'ifl te~eJ.~,Qne. J v'
"erv1cM~8Wff6fWl~ Orego,. \Jiilfl'y ;~otlTicati~
I ,"'- ...........H~li~I.'lS" I<c,~"..;tJ.'J"",~>3."i 1:' u, ' '" ", "
E. . MiscellaDeOUS1(~ie~.~~~~eleaer=~ID.~I~~I~d) -Each Installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges
4.
& I. U\:l
3.0:?
4'06"
{o./O
l'iP1o State Surcharge
10% Administrative F
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc
~ 1J5 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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<& of Springfield Official Receipt
.Iopment Services Department
Public Works Department
RECEIPT #:
2200600000000001663
Date: 12/07/2006
9:23:35AM
Paid By
RAY DEMAY/AMERICAN
EAGLE ELECT.
Item Total:
L:heck Number Authorization
Received By Batch Number Number How Received
Amount Due
43.00
18.00
3.05
4.88
6.10
$75.03
Job/Journal Number
COM2006-0 I 566
COM2006-0 I 566
COM2006-01566
COM2006-01566
COM2006-0 I 566
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment
CreditCard
Amount Paid
njm
048479 In Person
$75.03
Payment Total:
$75.03
cReceintl
Page I of I
12/7/2006
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-0I566
ISSUED: 12/07/2006
APPLIED: 12/07/2006
EXPIRES: 06/07/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3050 GAME FARM RD
ASSESSOR'S PARCEL NO.: 1703221302500
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Relocate circuits from outside panel to inside panel.
Commercial
Owner: IMMANUEL BAPTIST CHURCH
Address: 3050 GAME FARM RD
SPRINGFIELD OR 97477
Phone Numher: 54-726-7814
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
AMERICAN EAGLE
License
153834
Expiration Date Phone
12130/2008
I BUILDING INFORMATION.
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Euergy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basemeut:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION I
Frontyard Sethack:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
I\lUTICrsidewalk Type:
THIS PEBMJJs~M.1J/hfai.Ps\RE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
N ATfENlIUi\l:ult::yurl laW requires you to
otes:follow rules adopted by the Oregon Utility
.. . _ . _. _ ._ _ ~._ __.o.JI'_-"t
I'\llVLI"\#QUVII ",..........,. (,._...._.... '" __.. ._t..
in OAR 952-001-001 0 through OAR Ig~-Mq.\ion Description I
0090. You may obtain copies of tl, ~ . -. -- -..
D . r:allingthe.cenestetINote: Ihetelel$~e;fSq Ft Square Footage
escrIpliOn f Ty,pe \l.nstruclIRR Nt'" ,'. .
number or tile r yUII UUI Y 0 'olCIDilttIpher or Bid Amount
Center is 1-800-332-2344).
Value
Date Calculated
Page I of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01566
ISSUED: 12/07/2006
APPLIED: 12/07/2006
EXPIRES: 06/07/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Total Value of Project
Fl'l's~
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$6.10
$3.05
$4.88
$43.00
$18.00
12/7/06
12/7/06
12/7/06
12/7/06
12/7/06
Receipt Number
2200600000000001663
2200600000000001663
2200600000000001663
2200600000000001663
2200600000000001663
Total Amount Paid
$75.03
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 Rl'ouirl'rllnsnl'l'tiono.
I r r'liII "iiIiiII
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, 1 state and agree, that I have carefully examined the completed application and do hereby certify tbat all
information bereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordioances 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 witbout permission of the Commuoity 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 readableJrom 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
Paee 2 of2