HomeMy WebLinkAboutPermit Electrical 2005-2-25
;-
. SPRINCFIELD '~ij
225 FIFTH STREET . SPRINGFIELD,OR97477. PH:(541)726-3753 .F~(~.v726-:f~":$~~~~'
ELECI'RICAL PERMIT APPliCATION. '<l :\~ Qo.ql<<l'M'''',;1>,. ~"
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CityJobNumberCOW\'Z.oo,-cro-z.:J1 Date Z-ZS-o 'S ~ % "' 'h.
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I. fiocATiON,'OE;nVSTcf\.I;t'!4:f,j6M,:>,t%~~ 3 'iCOMPu'lj,}i.Ek'S","L"j ~'E.zj~J~:~{;:~~(:1
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LEGAL DESCRIPT[ON A. @~~~side.!!ti.'!!;';;:~,!!g!~ !ri ~I!t, " ,~" ;~I.!1~g).'!.!t!~"'"
i 70:3 ''27 J ( 00 ? 00 Service Induded "- '?o-'o~
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,: "'.00 ~
8. ~~~~~r.L~t~~~~jg[iFl.m1!l~~~~[<&~~~~~
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200 Amps or [es,-$> $ 63.00
~:;., .JI.... t>-;
201 Amps tOc400,Amp.&". $ 75.00
V..; -:-1. t')... v~ 'v.
40[ Amps to 600kmps "0 $125.00
to; ..);(' / Q~a I":
69J'A1yj,~IOoa,.;.':~};S?.o1. <9.90 $[63.00
Ov~OO-O;,A,mp,jN~",,<, <90'6 "J~. $375.00 _
Recon~~ ~l 06 0)'0 ~o :Y q ......, ( $ 50.00 ~ - C>
0", ,..~ "J" ~~~90.'
C "";r''';'''~a>.s",~Q...,J A _c. _!:~~h""'~lil",."",...~,'""..,""!.fttil"
fF<1 empow ~:b ~~~ ~,,'.r'a~~~I<I'.tm'~)'~:;\;
. ...~ -./.J:' \1. v> ~ Z'I'., i ,.....';-:C~~I.~j>,oj...f,.::f'I
- U J'.. ~o 0-6>. <9.so 6~ Q>...c5> ~~:o
Installation, A?~a'tl~,?.AA~.~ .so<91' ~A
<{;> ~i~~''% ~ -0"'" '.
200 Amps or less \2", ~ c5>i> "'t" "b. ~50.00
Constr. Contr. Number \1';:::lS~.. 201 Amps to 400 Amps~O~~,::OQ" "'.so" 7. $ 69.00
l:"O~ 40[ Amps to 600 Amps ~ ~~:.,c5> 7 $100.00
Expiration Date a! f'l'1s/ os -:'v 0.0,... 1:'.-:. Over 600 Amps or 1000 Volts see ~,. above.
I c'o. 0y, (0..9, , ","', _'""~""";"'g:"'''''-;';:;'''il<,";>i,!~''"_",,,,:l\<'-;i.\'''' ""..."""1\ t,.;J!
Signatu(hre~of Supervising E[ectn~' cian -f/tt/,'11,,'11,_ ,::!?/,()'11,~ SYA/ D, ::l!!!.!!Dffi((;'.rClll~i,"~~R"'l\\";:'\l'$''"'.M-i;;'V....,.>~,.l~~('''''',,,,o-~all
r <iv(., 0 v. . F.-\ New Alteration or Extension Per Panel
""~_ 0 /?fo ^ /IIO!; (&ne Circuit $ 43.00
// - / ~ '11" /);"I1,s '9 1'.J!~rypddl110nal Circuit or with
c/;,(.rs J CrIlv.... S <'9/.) -fir. '~emce:or Feeder Penntt $ 3.00
AddreersSSNa;, ~-.., (3" Jr 15 () 7W\"""'c_s~ :~~. ~til~;",Vt.<(s.,e'~~~r.~i;:riotTh"cliid~a),'i;.E;;~h"i;ft3illtii~~\'
"A"'~'~ ~;.;,:~ ~i?/;().""S,j;~~'-~~"'~~'<~""='-~' '-' ...~
City"" ,.::,4: Phone Pump or irfigan6n $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercia[ $ 45,00
Minimum E[ectric Permit Inspection Fee is $45.00 + Surcharges
JOB DESCRIPT[ON
l2.c--c..0v\"'- 1.=-.:.-+
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$"eo'NTifAcroRliN"Sfj!,VT!iTIO'.MoNEE?~
2. ~"'JtA:.-'1fir'~''''1'<-"'' _~~. ,,~_,..,.:_.,-(-.....;~~."'--i":"*"":<"''''''.''''.~.~~
Electrica[ Contractor k, ('\(-'oir1.~, i:;\"r*v\(
,
Address
::;;)ns '-0 ;:J"a, AllP
City E.LlOJn~
Phone ,3i.\-:">,j;;lq,
Supervisor License Number
::)'3 ~(J ,~
Expiration Date
I r-, I hi! iY,
, I
OWNER INSTALLATION
The installation is being made on propeny I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
1000 sq. ft. or less
Each additional 500 sq, ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50,00
4. f[~;:~1i!~~€i~;J:~~}~~~B~
50
'"3 jO
5,",0
58~
7% Slate Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding FormslElectrical Permit Appliclltion 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 SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00233
ISSUED: 02/25/2005
APPLIED: 02/25/2005
EXPIRES: 08/25/2005
VALUE:
SITE ADDRESS: 926 CLOVERLEAF LP
ASSESSOR'S PARCEL NO.: 1703223100900
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Reconnect only for repair of broken meter lug
Residential
Owner: VERN SIMMONS
Address: PO BOX 1307
RANCHO SANTA FE CA 92067
I CONTRACTOR INFORMATION I
C ""'i".l.h'"l:1.l to E . . D
ontractor w reQU'lJ ";;;;Ue\i Xplratlon ate
REYNOLDS ELE<;'TRIC".,,' ore90~,~~ .he OrlJl81 _~'.~n 0210812007
Illl BUlLDING'INIIQilM'ATib~'i:.952.001'
I" . ii '''U v' " b"
" ,;,1\catlon ,;;:: _0010t\'1ro ,"'''' tneru\es J
O!\R 9~of'slor~~~iln copies 0\ lepl'1one
R-3 '~090. 'iolIagl\t\lrSf.r~ftQt:e'.:\'16 ~oti\icat\on
ca\\\nQI\YPl'~1lii'~gon Ut\\lW 344).
VN b~r\'fy\le: 800-332-2
num ~ar~jie1-
Energy Path:
Sprinkled Building:
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Phone
541-343-7297
nfa
Lot Size:
Sq Ft ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
.J;aY~4 Drive Rqd:
NO ~A.IOf'Lot C9,vera2e:'XPIRE IF THE WORK
THIS PERMIT ",HI\L1. t OT
., 'To o~n"cn 11~ln~~ THIS PERMIT IS N
I piiBbi6iMf.!!9~EMENlfS'IJOONELJ l-UK
ANY 180 LJAY t'tKIUU. Sidewalk Type:
DownspoutslDrains:
I Valuation Deseriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Value
Date Calculated
Pallelof2
.
. CITY U.l' ~rKlNGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00233
ISSUED: 02/25/2005
APPLIED: 02/25/2005
EXPIRES: 08/25/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
F..... P'\WJ
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
$5.00
$3.50
$50.00
2/25/05
2/25/05
2/25/05
Receipt Number
1200500000000000254
1200500000000000254
1200500000000000254
Total Amount Paid
$58.50
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 R..nuir..'~ I.,.npt"tinn. .
lrrl~
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 tbat 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
Page 2 of2
225 Fifth Street
: Sp!;ingfield, Oregon 97477
541-726-3759 Phone
~~: Job/Journal Number
'flCoM2005-00233
COM2005-00233
COM2005-00233
Payments:
Type of Payment
CreditCard
,
".
I".
1';':1
1"'.
~1 ',i
l;::~
'J
2/25/2005
.
RECEIPT #:
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
ELLEN REYNOLDS
l!J'!~'__ .
Wi..................-.....................
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.. r :iIIi.Ii: j
.,-f ..)
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.Jiii.ty of Springfield Official Receipt
.veIopment Services Department
Public Works Department
1200500000000000254
Date: 02/25/2005
Item Total:
(;heck Number Authorization
Received By Batch Number Number How Received
djb 086651 In Person
Payment Total:
PaRe 1 ofl
1l:31:S8AM
Amount Due
3.50
5.00
50.00
SSlt.50
Amount Paid
$58,50
S5lt.50