HomeMy WebLinkAboutPermit Electrical 2005-7-12
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22/ FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541~\m~g~,~ sig+~~p is'~ S:J
, ELECTRICAL PERMIT APPLICATION / _ /- - -' _. ", '-;
City Job Number WwtZOO ,- ere::> 'iSgg' 'Date 7/IZfOj
I I
I. LOCATION OF INSTALLATION 3, COMPLETE FEE SCHEDULE BELOW
Q CITY OF ShdNGFIELD, OREGON C \,
, ',-/'
.?37? r::rA.,,/E;?
LEGAL DESCRIPTION
i <K02.0GZL(
R~ f 9~1/'
02.2.00
A. New Residential - Single or Multi.Famil)' per dwelling unit.
Service Included
JOB DESCRIPTION - 1000 sq, ft, or less $106,00
A....../ j './ Yacb additional 500 sq, ft, or
700fT''' Sf;<l.vl..(.f:- v..fyrM<:- L_] C-.( <GA\nonion thereof $ 19,00
- Permits are non.transferable ;nd expire if work is Each Manufa~t'd~' 6!lYOU,':O ' '
not started within 180 days of issuance or if work is .....I~~n.~ifft '~\\l~ " , ,~'O 00 '
Suspended for 180 days, ,.'f1Er. I, eed""ted by t\i I a'R<&e.\r~ ~ - S SlJhm,'toCf'ffas' fhe 10110wlng
II..... .ue auut' efl. es ,,, reQUIre SQe I ,
_ ,- -- - - 10 un I - r "thoS 'u 952.00 . --- - CIIC and Use - .
2, CONTRACTOR INSTALLATION ONljotif~C:~~~~]~~~'U\~~~~1tJM~~ Alterations.or R~location:
.~. ... JoO"" obtalOCople I phone I b"-?
Electrical Contractot.....--h'1e0' ~/..!L..........,::7~ij~~El'tol(jq~e: thete e'fcation $ 63,00 ?
, calling ~~~~~r~ \iill~ N~t" ' $ 75,00
Address ,4??<~ /.L!J-Y.?"'-hJ/ht> ..r'/ l\u(t\berl\l~~re.'1~f34 ). $125,00
~8r fmps to 1000 Amps $163,00
CityL"~,fL"...... Phone tFT5'~? tf'tf<f Over 1000 AmpsNolts $375,00
Reconnect Only $ 50,00
Supervisor License Number
"3 ;z.:z. f? S'
0'/
Expiration Date I/)
~ ""'7
62.777
/2 ,/21'/ 6-6
Signature of Supervising Elecfrician
Constr. Contr. Number
Expiration Date
c-~ pr~
Owners Name ~ ci1-A swn...J
,,? ~ q '? _77K~ /-4!J
~
City S'f/-I'J Phone -"~l- Y9?S"-
Address
OWNER INST ALLA TION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726.3769
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50,00
$ 69,00
$100,00
Over 600 Amps or 1000 Volts see "B" above,
D. : B;al1~i.\iiirc'tiits ----,- -1-;.,.u~'WriRI<-' -' -- '
"r;v1'''''' '.; \-1I>.LL-EXI'IREr-III". ,e. i
New Alle~iiljo.r:.\'r~EJt.R,sion,geTlPaneIERM\1' IS NQ
" ,. 0 UNUt" II"~' r"R
OneCir9MTHORIZE QQ IS II.n~I\Ir\ON\;'$'43,OO
Each Additioilal'tilG5i'ilor willi"
Service ~'ii~~der'Penilii I'EH\OO, ] $ 3,00
p..\~ \ 1vI.:i -
1
E, , Miscellaneous (Service/feeder not included) -Each Installalion
1__- "_ ___ _ _~ . ___. _., --_..__ --- -- .,;..-
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50,00
$ 50,00
$ 25,00
$ 45,00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
72
r;oy
720
81/ z;:L..
7% State Surcharge
10% Administrative Fee
TOTAL
Shan.'CI Drive(T:)/Building Forms/Electrical Pennit Application 1-03.doc
. CITYU.l' ~r.Kli~u.l'IELD'
Building/Combination Permit
PERMITNO: COM2005-00888
ISSUED: 07/12/2005
APPLIED: 07/12/2005
EXPIRES: 01/1212006
VALUE:
.
Status: Issued
225 F1ftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspectio~ Line
SITE ADDRESS: 3393 JASPER RD
ASSESSOR'S PARCEL NO.: 1802062402200
Springfield TYPE OF
Electrical Work Only
PROJECT DESCRIPTION: 200amp service upgrade and 3 circuits
TYPE OF USE: Alteration
Residential
Owner: DA V1D JOHNSON
Address: 3393 JASPER RD
SPRINGFIELD OR 97478
I CONTRAeTOR INFORMATION'
Contractor License
CHRIS MILLERS ELEqJM~U to, 62377
rTCtrI'ION: Ofe9~i.Jm~~~ATlONI
P' ulesadoptes9nlelio.f-. 001-
# of Units: 101~~W ~iOIl celltef. 1h~fOJ(il\f\Shl};'il~:~~s b'i
Primary Occupancy <Nil\l~?a 952~U001? t 0 ~'iSigbtlo'J ru 119
Secondary OccupancY\1l 01\.R'( u m~'i _obtalll c ~~"\l.~Q~~P., on
Primary Construction ~)l1l9., 0 tneV~lltef. lNO i\\~l!:at\
Secondary Construction callIng , r the oregon .. e:
# of Bedrooms: l\UmbefCO nter is 1.800' ergy Patb:
e Sprinkled
Contractor Type
Electrical
I DEVELOPMENT INFORMATION'
Front yard Setback:
Side 1 Setback:
, Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Street
IPUBLIC IMPROVEMENTS'
~Oi\CE: !\ll tXP\~g \f 1\W V>!~\'\9~1"
1\-1\S ptRMI1 s\-1 HtH1\-11~ pg!1M.\1 \~ ~
!\U1\-10RIltD UNO is' AB!\NDOt'@ fQ~
cOMMeNCeD OR.~ 6...._v'
~MV ~80 DP-'{ p~W\.L
Storm Sewer Available:
Special Instruction:
Notes:
I Valuatinn Descrintinn ,
Description
$ Per Sq Ft
ormultip6er
Square Footage
or Bid Amount
Tvpe of Construction
1 of 2
Phone Number: 541-747-4935
Expiration Date
12/2112006
Phone
541-895-3660
nla
Lot Size:
Sq Ft 1st Floor: '
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutsIDrabts
Value
Date Calculated
.
.
CITY OF SPRINGFIELD
Status: Issued
225 F1fth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00888
ISSUED: 07/12/2005
APPLIED: 07/12/2005
EXPIRES: 01/12/2006
VALUE:
Total Value of Project
L.Fp.p.s Paw
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid Date Paid Receipt Number
$7.20 7/12105 1200500000000000980
$5.04 7/12105 1200500000000000980
$9.00 7/12/05 1200500000000000980
$63.00 7/12105 1200500000000000980
Total Amount
$84.24
I Plan Reviews I
To Request an inspection caD 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. wiD be made the following
work day.
~Rr,rJ~
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When aU electrical work Is complete.
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 wID 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 wiD remain on the site
at all times during construction. "
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
.
Springfield, Oregon 97477
541-126-3759 Phone
.
Job/Joornal Number
COM2005.00888
COM2005.00888
COM2005.00888
COM2005.00888
Payments:
Type of Payment
CreditCard
'(
7/12/2005
RECEIPT #:
,............ '"""" nn",,,, "nT """'ITT/:I c:nQI"'ITlf" IJ:ln" .10::10
.~
~
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
1200500000000000980
Date: 07/12/2005
Description
Penn ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
CHRISTOPHER MILLER
Received By
djb
Item Total:
Lbeck Number AuUlOlizatiOD
Batch Number Number How Received
631248 In Person
Payment Total:
I of I
lO:Ol:40AM
Amoont Due
63,00
9,00
5,04
7,20
$84.24
Amount Paid
$84,24
$84.24