HomeMy WebLinkAboutPermit Electrical 2003-12-18
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9 proJect as submitted has the tollowing
does not require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541)7~gc~~. LD (C,
ELECTRICAL PERMIT APPLICATION ZOning
f\_-'1f\M.,I\IIt'>-:l. Date Date .. \~-\9. .O~
City Job Number \:.a'\t/~ \
Authorlzeo Signature ct><.1... J
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LEGAL DESCRIPTIr IV"'\
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JOB DESCRIPTION
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Per~l~ts are non~transferable and-expire i~ork i~.
not started within 180 days of issuance or if work is
Suspended for 180 days.
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Address -2( ~C) Qhl (j S+-
City _fll:ff1~ Phone 0 ~-5lfCft;
Supervisor License Number .. 717 tj Lf >
Expiration Date 10 - 0 ( - C \.(
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Electrical Contractor
Conslr. Contr. Number
Expiration Date
Signature of Supervising Electrician
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Owners Name I~~
Address 4t'\1]), M
City ~~one
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature;
Inspection Request: 726.3769
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Service 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
S50.00
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B. . ~e~~~~r~~M1~!~ll~~~t~tW~~~J:.i{i~~<,~tlOnif~:, '
200 Amps or less S 63.00
20 I Amps to 400 Amps S 75.00
401 Amps to 600 Amps 5125.00
601 Amps to 1000 Amps 5163.00
Over 1000 AmpsNolts J~]5:00
Reconnect Only ,,,,nUIT'''' 5 50-,00'
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1-'" Ic""'" \I\U-'- \'It)1" ,- S \
. "0\111 (Il rpq'\9(. ",'0\10 \\'Ie (\\Ie
Installation; A1teratio'bor,Relocation, 0\ p\'lOl\e
20bl\\m~~:~;e;'s()U\ - 0~1,~l\ ('~:J~~,ne le\~50;06)Ol\
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201 rAII!P~ .tb~400 ~'PP'~l\\9!' or I IIIII\\) /l,s..~?00
401lfi.\hps;tci,600\~ml's e OteQ C'0-"'''-'''/-;) SIOO,OO
......... ,t\u\~"_:...~J' .
. Over 600\A1Yi~~ or.IOOO'Volts see "B" above.
D. .. '11'NIf~il €i~@"~llflA~"a.~_"
New Alteration or Extension Per Panel
One Circuit \
Each Additional Circuit or with I
Service or Feeder Permit ~
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S 43.00
5 3,00
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...... ...~~'..~ ,;",,,,,,,:,,,,;<;v,,,,,,,,,,",,;t:';._~:"'~-.:-jt - - ~~.......~
Pump or irrigation S 50.00
Sign/Outline Lighting ,,~oll S 50.00
Limited EnergYlRe~9fi\~IW 'H-It. ::-~'~i $ 25.00
"\\)1\~t;;lited\E'et~k}~~rn;8i~~\i ';:o'~ S 45.00
\~, 'Ie. Pt\'lW\l~ !l\~\I\t.~ \t\'';):;''''Ntll'lV;'
Minimum "1~efriC'PerJlli"Tn'~etlbri"'Fee is $45.00 + Surcharges
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7% State Surcharge
10% Administrative Fee
4\0 ?V
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TOTAL
Shared Drive(T:)IBuilding FonnsIElectrical Permit Application 1.Q3.doc
Status
Issued
.
. CITY OF SPRINGl'lJ!,LU
Building/Combination Permit
PERMIT NO: COM2003-01I23
ISSUED: 12/18/2003
APPLIED: 11106/2003
EXPIRES: 06/18/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4012 JASPER RD
ASSESSOR'S PARCEL NO.: 1802061407700
Springfield TYPE OF WORK: Heating System
TYPE OF USE:
PROJECT DESCRIPTION: Install heat pump, air handler and ductwork
New
Residential
Owner: ROBERT LEBKOWSKY
Address: 4012 JASPER RD SPRINGFIELD OR 97478
Contractor Type
Electrical
Mechanical
Phone Number: 541-741-2303
I CONTRACTOR INFORMATION I
Contractor
ROBS ELECTRIC INC
COMFORT FLOW
License
156678
460
Expiration Date
08/14/2005
06/27/2005
Phone
541-686-5444
541-726-0100
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
R~aryard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
"
R-3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
VN
I DEVELOPMENTINFORMATION ,
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_\O~'.O\ 19" \)'1 '# Street ,Trees Rqd:)
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p;.\ \- . IrC 3L1o,.. -"I\o,Paved:Drlve-Rqll:,s 1
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\U, 1\0(\ G ~_OO,\Q \ "o/?;p.!,Lot <;o0e~~ge:'?;
'IDi,\\ca oS:>_.OO ')1'<'" C'J ~~. ,',,9 1..1 ~"calio{l
r \b..~ ~ ."".\1' Q. J~h) -... _L' t'...\~\\\l
DO\:lO. :~~ \\V ,,,e-I P.UBUlC'IMPi{OVEMENTS I
callI, \al I"~, \.\ ,."..
.."",)BI ,_, ,c. Sidewalk Type:
{Iv'" r-'
REQUIRED PARKING
Total:
Handicapped:
Compact:
DownspoutslDrains:
:~~~r~6 ~~~~~ ~~~R~~~~~lEI~~~~
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Pal!elof3
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspedion Line
Description
Tvpe of Construction
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Air Handling Unit Up to 10,000
Heat Pump
Minimum/Adjustment Mechanical
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Total Amount Paid
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01123
ISSUED: 12/18/2003
APPLIED: 11/06/2003
EXPIRES: 06/18/2004
VALUE:
I Valuation Descrintion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
)?pp< P~itll
Amount Paid
Date Paid
Receipt Number
$10.00
$4.50
$3.15
$8.00
$12.00
$25.00
$4.60
$3.22
$43.00
$3.00
11/6/03
11/6/03
11/6/03
11/6/03
11/6/03
11/6/03
12/18/03
12/18/03
12/18/03
12/18/03
1200200000000002429
1200200000000002429
1200200000000002429
1200200000000002429
1200200000000002429
1200200000000002429
1200200000000002627
1200200000000002627
1200200000000002627
1200200000000002627
$116.47
I Plan Reviews ,
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.
1 Rough Mechanical: Prior to Cover
2 Final Mechanical: When all mechanical work is complete.
3 Rough Electric: Prior to Cover
4 Final Electric: When aU electrical work is complete.
Paee 2 of3
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01123
ISSUED: 12/18/2003
APPLIED: 11/06/2003
EXPIRES: 06/18/2004
VALUE:
Status
Issued
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 examined the completed application and do hereby certify that 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 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 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
Pal!e 3 00
2i5 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01123
COM2003-01123
COM2003-01123
COM2003-01123
Payments:
Type of Payment
CreditCard
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Receipt #: 1200200000000002627
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
djb
Check Number
Batch Number Authorization Number
Paid By
ROBS ELECTRIC
000253 018714
City of Springfield Official Receipt
Development Services Department.
Public Works Department .
Date: 12/18/2003 8:12:09AM
Amount Paid
Item Total:
43.00
3.00
3.22
4.60
$53.82
How Received
In Person
Payment Total:
Amount Paid
$53,82
$53.82
.
.