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HomeMy WebLinkAboutPermit Electrical 2005-2-25 ;- . SPRINCFIELD '~ij 225 FIFTH STREET . SPRINGFIELD,OR97477. PH:(541)726-3753 .F~(~.v726-:f~":$~~~~' ELECI'RICAL PERMIT APPliCATION. '<l :\~ Qo.ql<<l'M'''',;1>,. ~" . __ ~ 0 O(p9.: CityJobNumberCOW\'Z.oo,-cro-z.:J1 Date Z-ZS-o 'S ~ % "' 'h. o-tP- ~\ "'~:c;91P . I. fiocATiON,'OE;nVSTcf\.I;t'!4:f,j6M,:>,t%~~ 3 'iCOMPu'lj,}i.Ek'S","L"j ~'E.zj~J~:~{;:~~(:1 ~"~.~-""..--"....;.'._.j;;._.~..<.-._._,...,y,~._.,,,~:,l:,~ . :.J::.:..... .-.,.~-_.~~-, ,,.,..~,, ~. ~-~?",..,jPc'~~};J.jo"~:",,,';Jl~ 'f Z b C(ov6<L/~ ,-p -'\~, ~'\ LEGAL DESCRIPT[ON A. @~~~side.!!ti.'!!;';;:~,!!g!~ !ri ~I!t, " ,~" ;~I.!1~g).'!.!t!~"'" i 70:3 ''27 J ( 00 ? 00 Service Induded "- '?o-'o~ ,(] '"' ~ ,: "'.00 ~ 8. ~~~~~r.L~t~~~~jg[iFl.m1!l~~~~[<&~~~~~ '~ 200 Amps or [es,-$> $ 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..................-..................... ". ,,",., ': " " .. r :iIIi.Ii: j .,-f ..) ..'.. . 'w'" ._ .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