HomeMy WebLinkAboutPermit Electrical 2005-9-12
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 OH2' ~ ~
ELECTRICAL P/:RMIJ:MPLICATION . .' ,
City Job Number l ' .~.' \ '-\ Lo Date~ UinS - () I,). q..3
,
I. I LOCATIONOFINSTP-LA..TION 3. I COMPLETEFEESCHEDULEBELOW ~
LEGAL :~~~N A. I New Residential- Single or Multi-Family per dwell~
\f) ()7~'?04-~ D..o~ Service Induded
1000 sq. ft. or less
Each additional 500 sq. ft. or
pO';li.~rJt!1,:,:~~f Oregon law requires vou to $ 19,00
,EaCli.Maliufaciid1fllfrfi'eloY the Oregon Utility
"MiidulafJDwelliI\gISe~te'6rrules are set forth
.;1 E~e,der;152,001,001 0 through o.',rl9€2 99ti50.00
nO'.l.H.IU Ut~y, VVlQ.;11 vU)J;G.;)utthe-r~
B. ~e.rvices or Fe d rsa . .' ffi'ii'iWns or Relocation:
r.:2'0'0:<l'Ahp.r for 'the Oregon Utility Notificatio$"63 00
mps or ess 800 332 2~" ') .
201 Am~1~\id'd7..J;ps - -,;.. . . $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 Amps/Volts $375.00
Reconnect Only $ 50,00
CITY OF SPRINGFIELD, OREGON .\
. -i () c.j / 5 c. I Temporary Services or Feeders
07 c/f6"'':'
/ D - l-aiI:'j',. SI 1~';iallation,'Alter.tion:or.:ReIO"c',jiio'JIORK
\11 t't:n\~'n I v. 1/ .......... -.."
:"U1Ht9lq,~!!'Esl9N@R THIS PERMIT IS ~pT $ 50.00
CO:"\ltPrlli"v~3 \9;~OP~1\i)ji>s,NDONED rUK $ 69.00
A"y 401, Amps tOi600'Amps $100.00
l'i IOU Uf,l I l..lllv"",
Over 600 Amps or 1000 Volts see "B" above.
D. I Branch Circuits
New Alteration or Exteosion Per Panel
One Circuit
Each Additional Circuit or with
OwneisName ~~ ~..~ Service or Feeder Pennit $ 3.00
Address .\ \0 ~ ~ ~1J nr&. E. I Miscellaneous (Service/feeder not induded) -Each Installation I
City ~hone '2.<r,4.111J
OWNER INSTALLATION
..
JOB D~CRIPTION
Permits a~ns~ ~ifwork is
not started within 180 days ofissnance or if work Is
Suspended for 180 days.
2. I CONTRACTOR INSTALLATIQiy;QNLY I
....;JCJ'<<c( C-oI'111 eC/!',on,;
Electrical Contractor ,E(~ "r,..;" t!.t,""',n4.~i
Address
_'lJO
"fA.. JI,'<;
Sf. JF0
City
GI.f 4p /I~.J
Phone L/ ;PI- (. '-I '1/
,
Supervisor License Number
Expiration Date
, Constr. Contr. Number
/&oo:>otf'
7-/'D"
Expiration Date
Signature of Supervising Electrician
a~.L/ &~.,~
The installation is being made on property I own which
is not intended for sale. lease or rent.
Owners Signature:
lospection Request: 726-3769
$106.00
ffJ .CJJ
,/;
$ 43.00
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is S45.00 + Snrcharges
4.1 SUBTOTAL OF ABOVE
7% State Surcharge
10% Administrative Fee
I ~O ,OV.
~.'50
s,nu
~cn.~
TOTAL
Shared Drive(T:)lBuilding FonnsIElectrical Pennit Application I-03.doc
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.
. CITY OF ~nuNGFIELD .
Building/Combination Permit
Status
Issued
PERMIT NO: COM2005-01243
ISSUED: 09/12/2005
APPLIED: 09/12/2005
EXPIRES: 03/12/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3838 Kathryn Ave
ASSESSOR'S PARCEL NO.: 1702304306500
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Temporary Power
ATTENTION: OregW.fvV(n;~~ y~~lVtion
follow rules adopted by the Oregon Utility
tl.l.....+:l:'"''''+j.......... r-,........+...... Th""r-.....I'l"r>r- "'..c,f:"otf"'...."
Industrial
Owner: MTN INVESTMENTS LLC
Address: 59 E 14TH AVE
EUGENE OR 97401
in OAR 952-001-0010 through OAR 952-001-
0090. You may oblain copies of the rules by
calling the center. (Note: the telephone
IIUIIIUt::1 IUI Lilt;; Vtt::~Ull V1.lI11Y l'tULIII"'C:UIUII
I CONTRACTORllNFORMNIlI~f.;l44).
Contractor Type
Electrical
Contractor
GOOD CONNECTIONS
License
160508
Expiration Date
07/0112006
Phone
541-434-6491
# of Units:
Primary Occupancy Group:
, Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
BUlLDING'lNFORMA TION I
181<; Pf-RMIT SHALL EXPIRE IF THE WO~~
# ~rl~t~f!~':7ED UNDER THIS PERMI!--"'!!l\i.!',
H~\~~~.or!j.,~fuCtureK is ABANDONEDS'!Jl\t 1st Floor:
Type of'Heat:tU U Sq Ft 2nd Floor:
Water tY{i'eDAY PERiOD. Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: nla Occupant Load:
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01243
ISSUED: 09/12/2005
APPLIED: 09/12/2005
EXPIRES: 03/12/2006
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
Fp.p.~, Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
Amount Paid
Date Paid
Receipt Number
$5.00
$3.50
$50.00
9/12/05 .
9112105
9112/05
3200500000000000547
3200500000000000547
3200500000000000547
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 Rp.clllired Insnp.~~
Temporary Electric: Approval required prior to Utility Company energizing pole.
. 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.
~../Q...- ~ ~lfu;~
Owner ~;:Contractors Signature
cq ~ 1z..~CSl'5
~Ar-
Date
Pa2e 2 of2
, 225 Fifth Street
.~ Springfield, Oregon 97477
541-726-3759 Phone
...
':"'
Job/Journal Number
COM2005-0 1243
COM2005-01243
COM2005-01243
Payments:
Type of Payment
Check
"
,.
~A
"
<~~
"
..
":l'
9/12/2005
.
RECEIPT #:
.~.
~
~ty of Springfield Official Receipt.
.velopment Services Department
Public Works Department
3200500000000000547
Description
Temp Power 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
GOOD CONNECTIONS
ELECTRIC CO.
Date: 09/12/2005
1:34:01PM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 3027 In Person
Amount Due
50,00
3.50
5.00
$58.50
Amount Paid
$58.50
Payment Total:
$58.50
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