HomeMy WebLinkAboutPermit Electrical 2006-1-24
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CITY OF SPRIN~,_.ELD, OREGON
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DATE "l,:,~^
SOURCE~
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number COM ?..OO~- ~ ~ d.-
Date
I. " LOCA110N OF INSTALLA110N
3. :COilPLe'TE-FEE scmviiiiiuLmV-
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LEGAL DESCRIPTION
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/ 70 ~ ; </<.f,J;/, 0 "d.'-Ioo-
JOB DESCRIPTION
A. ' New Residential- Single or Multi-Family per dwelling uuit.
L _, .._., __._~__ _ ..~- .-.-.- - -.--,. -- - ...- - -- -
Service Included
N\l-\ f F_'C.:l:>E.\2....
1000 sq. ft or less
Each additional 500 sq. ft, or
portion thereof
Each Mauufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
[' - .-- . -. - '---' ..-.-. .- .-:
2. ~ COl!!~CT()R.JNS!ALLATION ONLY 1
Electrical Contractor 4 ..J. ~ ~ " C 50-1 5
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$50,00
SO.IX'
B.! Servi;"~ ~;Feede;s -=-In;t;;;i~;ion, Alle;~tions ;r Reloc~;ion; .-
'~"---' - ------~- . -- - - ---_.._. . "'-.----- -.
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~ Signature of Supervising Electrician
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Installation, Alteration or Relocation
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200 Amps or less e,c, ",0 \)011--0, ,\~ $ 50.00
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201 Amps to~OO A!l)ps c;~\",,\\ $ 69.00
401 Amps"tb'600~mps-c'o'" \.' $100.00
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.~,e~~9~Js~~~Qog.~01~ see ..~.. a.bove.
cP)'liJ.lranch"CIf~U1t~,'O. \" ..'
.<~~~:~e,":~w"itef~~:'O~~~~::si~~-;e;;~~e~~-' - ---- --'
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. ")~O ~o On'itCircuit , \' . '" . $ 43.00
, 00\" 50 iE~ch"'A'ddit;6nal Circuit or with
E.\.( ~ O'r 'S~ice 'O~le'eder Permit $ 3.00
OwnersNam.G.e.",_~"~u.....E..:Y ,... t:>EA\1'<b\)~9'~~~1.0'\""'~ _._______ .--.--,
. Address ":> '('ct'C) 'C"~ l'-l.'1<-L..l K ~,-0 t>. E:,t,J\iiscelia~eous (Service/feeder not included) -Each Installation,
\" --"- - -- -- ---_._-_.._-~
Phone l '2...(o-~:z.. 7C:::. Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25:00
Limited Energy/Commercial $ 45.00
200 Amps or less
20 I ~ps to 400 Amps
l?", ,,'ii \ -<"'40~ Arii'ps to 600 Amps
, \'i: \" \S \'
/ ''Y>-~'i:.. ~*601~tpPS to 1000 Amps
City J~ 1 p,) Phone kif'}.. .'f~\~if.q.", '('i:: ~\.Qv~r 1000 AmpslVolts
, ~\\"ft.~,<!:~J:rfj;~t~'$~~",~'V\J Reconnect Only
~ S -y'i:: 1Y'V ~ ,S r- -.- .---- -- -
Supervisor License Number,\'-" J0~'r~~",co.\\)'V' C. Jell\P?rary S.e~vic~ OI:.Fe~~__
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W .
Constr. Contr. Number / (?d ') ") k.
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$ 63.00
$ 75.00
$125,00.
$163.00
$375.00
'$ 50.00 .
) Address
Expiration Date
Expiration Date
t/Zq';' 7
city:E 0 G. ~ IZ.-
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Inspection Request: 726-3769
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4'I_SUBTO~~?F~~~:_'~~=-~-=1 50.co
4.CO
5.00
s~,ro
8% State Surcharge
10% Administrative Fee
. Owners Signature:
TOTAL
Sharl:d Driv<<T:)IBuilding Forms/Electrical Pcnnit Application 1-06.doc
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CITY OF ~rKll'\juFIELD
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Status
Issued
Building/Combination Permit
PERMIT NO: cOM2006-00094
ISSUED: 01124/2006
APPLIED: 01124/2006
EXPIRES: 07/24/2006
VALUE: $ 13,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection LIne
SITE ADDRESS: 3998 FRANKLIN BLVD SPACE 1 Eugene' TYPE OF WORK: Manufactured Home in Park
ASSESSOR'S PARCEL NO.: 1703344202400
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Placement permit.
-" Owner: GREEN VALLEY ENDEAVORS LLC
Address: 3998 FRANKLIN BLVD
EUGENE OR 97403
Phone Number: 541-726-8236
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I CONTRA:CTOR INFORMATION I
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Contractor Type Contractor .;o\\\\;. ~o.*\\ ;(\\\ License
Electrical FATHER &<SON,SOF ORJ:GON INC 100726
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ManufHome Inst n(...FAJID,!lR-,~';l!ON~,W'-UREGON TNC 100726
~(S\~'~'i:.\\~~S~ '0~~ {" ~~' I BUILDING INFORMATION'
,'0'\ '0(J\\\ x.\J \;.\\\\:J' 00 ,O~
# of Units: ~'0\ 't..*\;.~rv ~ <( # of Stories: \\e'" ~ \i~' 0\";' Lot Size:
, Primary OccupancY19jloup~o\:J \J Height of Structur~~o..~ \e0,o'" ",,<' ~ ",,\ Sq Ft 1st Floor:
Secondary Occupancyt.Gj..;up: Type ofHeat~\\'Q.~ X-e 0 ",?}e C!J<:''/..: .'" \;Sq Ft 2nd Floor: .
Primary ConstructioD Type Water ryp.~? '0'\" e \J.e 0\>-<:0 ,,\-c ,v ",Sq Ft Basement:
Secondary ConstructloD Type: R~~~.~.TYp'!::~\,<,O<; 00r!;;' 0' ~ i\~""u.' \~q' Ft Garage/Carport
# of Bedrooms: .Energy;Path:. ,,'S'\ (\,<:''' e,e . ,\,~O>Sq Ft Other:
'X:'\".... . ~ r:.'V ~ 'V O'\" .~, . \0'
,.:\-<\ Sp'rinkl!:.d.B,!!!di~g:,G :l.e.\:.~a' '" Occupant Load:
r ......~ ......(:\ 3'''\ ._\()' ,.,..\0 H~\ .,0.
. Expiration Date
06/29/2007
06/29/2007
Phone
541-689-5090
541-689-5090
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
,..... ".~ ....
I DEVEEOfMENTaNFORMATIOWI
'. ",V' ....U. 'S'e . ,-,e ~ \''O~
\ 'O"~"'I,.('oo.Di '0\" \\'"
, ve~_a~,.........st~,,.,(\\.1O
# Street.Trees'Rqd:
\,.
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
.
I PUBLIC IMPROVEMENTS I
Street ImprovemeDts:
Storm Sewer Available:
Special InstructloD:
Sidewalk Type:
DownspoutslDrains:
Notes:
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Paee 1 of3
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. Status Issued
225 Fifth Street, SpriDgfield, OR
541-726-3753 Phone
541-726-3676 Fax
.. 541-726-3769 Inspection Line
Description
Tvpe of Construction
Fee DescrlptioD
+ 10% Administrative Fee
+ 10% Administrative Fee
+ 8% State Surcharge
+ 8% State Surcharge
ManuC Home State Issuance
MaDufactured Home Coon - Plmb
'. Manufactured Home Feeder
, Manufactured Home Placement
Total Amount Paid
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. CITY OF ~rKli~uFIELD
Building/Combination Permit
PERMIT NO: cOM2006-00094
ISSUED: 01124/2006
APPLIED: 01124/2006
EXPIRES: 07/24/2006
VALUE: $ 13,000.00
I Valuation Descrintion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
~ FpPo.l:IilLI
Amount PaId
Date Paid
Receipt Number
2200600000000000116
2200600000000000091
2200600000000000116
2200600000000000091
2200600000000000091
2200600000000000091
2200600000000000116
2200600000000000091
$5.00
$20.50
$4.00
$16.40
$30.00
$45.00
$50.00
$160.00
1/24/06
1/24/06
1/24/06
1/24/06
1124/06
1/24/06
1/24/06
1/24/06
$330.90
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.
ManufHome Set Up: When installation of all piers or stands Is complete.
Final Maouf Home Set Up: After all required inspectioDs are requested and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc. have been Installed.
ManufHome Plumbing: After home has been connected to water and sewer.
MH Electric: When blocking, setup and plumbing inspectioDs have been approved and the home Is connected to
the panel.
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Pal!e 2 of3
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CITY OF SPRINGFIELD
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Status
Issued
Building/Combination Permit
PERMIT NO: cOM2006-00094
ISSUED: 01/24/2006
APPLIED: 0112412006
EXPIRES: 07/24/2006
VALUE: $ 13,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
By signature, I state and agree, that I have carefully examiDed the completed applicatloD aDd do hereby certify that all
Information hereon is true and correct, aDd I further certify that any and all work performed shall be dODe 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 permissioD of the Community Services DivlsloD, Building Safety.
I further certify that only contractors aDd employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to eDsure 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. -
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Owner or CODtractors Signature
Date
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Pal!e30f3
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
c,
Job/Journal Number
COM2006-00094
COM2006-00094
COM2006-00094
Payments:
Type of Payment
Check
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1/24/2006
RECEIPT #:
Description
Manufactured Home Feeder
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
H & H PRE-OWNED CLIENT
TRUST ACCOUNT
6
2200600000000000116
Received By
jmp
Check Number
Batcb Number
Page 1 of I
Mity of Springfield Official Receipt
Wnevelopment Services Department
Public Works Department
Date: 01124/2006
Item Total:
Authorization
Number
2603
2:35:5IPM
Amount Due
50.00
4.00
5.00
$59.00
How Received
In Person
Amount Paid
$59.00
Payment Total:
$59.00