HomeMy WebLinkAboutPermit Electrical 2003-9-16
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:.'0 CITY OF S,--"UNGFIELD, OREGON 0
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LEGAL DESCRIPTION
170327'1/ OOtOt
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Permits are non-transferabl.{.nd expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726,3689
ELECTRICAL PERMIT APPLICATION The, following project as submitted has fhe following
. ., Cl_lb -0" zoning. and does not reqUire specific land use
City Job Number CCWI 2.0'0 J ~O 6 '90 Z Date I ,., approval.
. _ , _. Zoning J'i'L,
3. :fcOMPLETEFEESflJtf.EDULEHELOW 0- II{ /03
cKW
Authorized Sig~8ture
A. New Residential - Single or Multi-Family per dwelling unit.
Sen'iee Included
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
Constr, Contr. Number
Expiration Date f-6 -O~
:t)ij;/~m'~
Owners Name h-
Address :3 cI 0 w FIJ I fL", t:1/
i-.--.--~---_.~---._--- --~-~--. ~-- -_.,,--. r-..--~-"_.- ~._._---_._---~~
2 CONTRACTOR,'f-STALLATION ONLY i B. ! Services or Feeders - Installation, Alterations or Relocalion:
E'lec~caICi~71/Y/~ {k;.. ::::::;:;Am~_m- -:::~
Address 9 401 Amps to 600 Amps .~ $125,00
, IY:;.( .,,![ r7_/7LI760IAmpstoI000A<~&tlle"''j~~.,~~\oJ $163.00
City {'(t.;)...v\.- \ Phone ) J (] Over 1000f,f.lP!if.VoUsOle90(\ \:'-'0(\ $375,00
Re~o'!'lect 0nIYJ'j \\\e \eS a,le '" r n nO' $ 50,00
~ .( \ \ '(;.1'1 \ \~~o.O:2\e~\,\o",e ,\.I ~Of>,f~ -:~~\0"'l... _. _ __
Supervisor License Number /Q ) P- \\O~<;;!I\€'Tempilrary,~er\vic.~or F~e'ilers",o(\e
\0\ ',(\ ....=::00.''''.,' \'Ie"''''''' -~e~" ;--' d_._.,_
/1, , All \\\\Ca,\\c;,r)_(\O~ - .~i(\ CO~~. \\\e \e .,'iCa,\IO(\
Expiration Date / (/'"C/'- ,,-\0 p..~ \histaIlation'PAlleration or. RehicaUon
, ,0 .~, I l"'" ".el. \.' U\I\I\~' AA')
1362179 0"0.'200 AwpslQr lessd~O(\ n"-'2.~ .
't u "::') 1"....)) \.\ . n (H ....f"\~'3..:>G-
Ca,\'201 AmpsYt0400 Amps
(\\.I\"'40P~~ps'tol~OO\ A-mps
Over .?Q<l_AmpsorlQOO_Vo}ts see....B': aboy!,.
D. l_~ranc~ ,~ircu!!~ _
$ 50.00
$ 69.00
$100.00
New Alleration or Extension Per Panel
One Circuit I
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3,00
City
s.?f':.1)
Phone
r--- ~-- ------------------
E. :!~c_"*~~E;:s ~ervi~e~f~~e~(~~i;ttHEdWl~'1l,~lInstauatioll .
pum~~ !rl~~~m1 5\1~LL V\1\J p~~Ml1$\rotegl
S,gnlOuhm 'lCh';!)g\JNOER ",.."I'IM~O fGli\oo
CI.\ n HU l'L.'C 15 ~'O,..;,,,t."
Limitetl'~ergy~li!eHn"'1 $ 25.00
LimitJd~rJ~~~\lhr.ilaIOO. $ 45,00
1\1'-11 l"6""'"
Minimum Eleetric Permit Inspection Fee is $45.00 + Surcharges
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
7% State Surcharge
10% Administrative Fee
~pO
~
5'Z if
Owners Signature:
4. I SUBTOTAL OF ..wovE'
Inspection Request: 726-3769
TOTAL
Shared Drivc(T:)lBuilding Fonns/Elcct~cal Pennit Application 1-03.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF 1)r K11~ut<lJi.LD
Building/Combination Permit
PERMIT NO: COM2003-00902
ISSUED: 09/16/2003
APPLIED: 09/16/2003
EXPIRES: 03/16/2004
VALUE:
SITE ADDRESS: 477 FAIRVIEW DR
ASSESSOR'S PARCEL NO.: 1703274100101
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: One circuit
Owner: HOUSING AUTHORITY & URBAN
Address: 300 W FAIRVIEW DR SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION ,
'lUV'
\.I1(eS .....lil\!
Contractor ~"" (eO: oLlcense\
-" 'a Q(eg . '0'
BEAR MOUNTAIN ELE~(I'R1<; !;",~e . nf!36298nl"
,\.... ..~.. I ....~._ "_',_
P.\ \ \;:." r BlHLDlNG.INFORMAl'ION I\\eS \.
'\0"" (\.I ,-eD'v' Q\WUV~ O~ ,\IV' ne
\0' . D{\ V -,,~ '!>S "nO"
,n\\\ica\\ '2..0\!l\0f.~to~!~S;O?\~ Ine le\e;. aliO{\
1'o.\R8p,,f\ l)!J (1\,Wigtit~f ~,t!,ictur"ti NO\I\IC
\ "0 '<0\.1 TypelofHeat:, \)\1\1 ,,"AA'\.
.....u. \"~' r:. "CI!UV' 2~c..~
VN ~"i{\g W,ater.Type:'O_3'3
Cv\' \C" ,,- ,'nv
lI'Oe( ~~~ge.,TYi>e:
I.'Il C Energy Path:
Contractor Type
Electrical
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Sethack:
Side I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Expiration Date
08/06/2005
Phone
541-895-8833
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
"\,1"\0"
I PUB"J~IV.m,~OVEMRNTSIII.P\RE If ;;~ IS NOl
1\-11S PE\\NIIO' ~I~OER 1 \-lIS f;5~wa9'f1YPe:
\-IORlIt U (>.'O(>.NUU\~t.
(>.\)1 ~tNCEO OR IS DownspoutslDrains:
COMI'J 0(>.'1 PERIOD.
(>.N'I '\80 ,
I Valuation Descriotion ,
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Type of Construction
Total Value of Project
Paeelof2
.
. Ll1}' OF ~rtul~'-d'l.l!,LD
Building/Combination Permit
PERMIT NO: COM2003-00902
ISSUED: 09/16/2003
APPLIED: 09/16/2003
EXPIRES: 03/16/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
I Fees Pair! I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
Receipt Number
$4.50
$3.15
$43.00
$2.00
9/16/03
9/16/03
9/16/03
9/16/03
1200200000000002134
1200200000000002134
1200200000000002134
1200200000000002134
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
~~ '
I Reouirer! Ins~ctions I
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
By signature, 1 statc and agree, that I have carefully examined the completed application and do hereby certify that all
information hcreon 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 hcrein, 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 projcct.
1 further agree to ensure that all required inspections are requested at the proper time, that each address is readahle from thc
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
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00902
COM2003-00902
COM2003-00902
COM2003-00902
Payments:
Type of Payment
Check
~-:~'''''''9.f','~'O',O'' !,,'
....' .
WB' '
'-"'.""".,. .-.,' ""-.'- ,.'
Receipt #: 1200200000000002134
Description
+ 7% Slate Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Paid By
BEAR MOUNTAIN ELECTRIC
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 09/16/2003
8:36:37AM
Amount Paid
Item Total:
3.15
4.50
43,00
2,00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65
.
.