HomeMy WebLinkAboutPermit Electrical 2004-12-10
. I .. . SPR1NQP1BLD .tij
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72s.1~ ~'. .
ELECTRICAL PERMIT APPUCATION ,,/ o<j' o~..;.." "'~ ..,
CityJobNumber f'O.....,..=cJ'<_ {)/S-cJ/Date /2-{{;-U'1 . '1'''0 '& ~,o-OO:~g.{',
o~. '\. "?. oS' (\..
,.... '\. ... '" t'~
200 Amps or less
201 Amps to 400 An:IPs'
.~ov' .
401 Amps to 600,Amps
r\u\\~ (""-
60 I · ""';51(0)1000 Amps .
I ('A. I I \:t~'~ "~--
Phone l; n\ . l.i1 I ;).. e&'V'er 1090\~mpsIVollS" , $375.00
O~ ~ \'<'\~ ,\.....
\O~. Reconnect'0ilI>:~t $ 50.00
.A~~~ ~ 'l>OO'?~.- ~'(\O"_-;"u<0\' ~ -
Supervisor License Number Lf ()l~ 5 ~',;,,~ (vW ce~~~~S't~~~~~
'Iv ~\~\C,'O\\0~~_00\- 0'0\'0\\' \';'\O\C ,:,
/0 II I .\ f ~o ",I>..~ 9'i:i ~'I>';'In~~~ladoe,.'A1te~adon or Relocadon
.~ ",- '-to\) ...P. ....(P:<0 I'). ,v
(l 090. \'(\e 200.Amps.or,less
Constr. Contr. Number ,;llo - III L/ L.- 0 r~'i\,,9J I \0'20r Ainps~ 400 Amps
~e .....,~,
I I "v.~ U401 Amps to 600 Amps
Expiration Date 1 1 () l.JI 0 600 A 1000 V 1 "B" b
ign~ " ver mps or 0 IS see a ove. .
'i ~'~ M ~;;:~
V' "/ Each Additional Circuit or with
Owners Name (J ~( 1 J!)OO Service or Feeder Pennit $ 3.00
Address p, f\, ~If. 71 It> ~ '7 _ E. ~M-.t~u:.~'~' ~ _~~_'0iI'=::'"~~ ~;~~Ti~Ji
,L . t If' In\:. ,,_
City l'IlI+.p 01-- Phone )(j ~- <//2- T "lP.ilri$'&:'irrigationP>,LL t'l.I'IR I'tOM\1 \S tf'sb.oo
J i\Sig.VOii8ili~&i~@gR i\-llS "0;'(.[\ ~OR$ 50.00
OWNER INSTALLATION pLilili\~'do~hb/ResiilCnti.uP>,\'lu ..- $ 25.00
0.,,~t..^tN\"'C:v '-':.:.....,(\".
lClID1ted Energyf<::.._......J $ 45.00
^ MY '\ 8\J U"I ' -
MIniDIum Electric Permit Inspec:tion Fee Is.$45.00 + Surcbarges
4.1$~~ ,4/)~
7% State Surcharge ,'? !/7)
10% Administrative Fee ;;- ,() ()
5f.~O
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LEGAL DESCRIPTION
/7025UDu 0'2...(02-
JOB DESCRIPTION
UDoll.{.,f Wob,/l.. oM1u-
Permits are oon-transferable and expire if work Is
not started wltbln 180 days of Issuance or if work is
Suspended for 180 days.
2.il[;~~L~.~~~
Electrical Contractor (h l.ISf4uOYl Vd 0)1c'
eJ <- fu../ \).,...W.e.
Address ; a. 11 (-
City ! UA..~ ~
Expiration Date
The installation is being made on property I own which
is not intended for sale, lease or rent. '
Owners Signature:
Inspecdon Request: 726-3769
y\' MD ~nb
3 r?l'iSjoMJjEi:.Tii!i
';, ""-. '.-. .
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
(Iii
$ 63.00
$ 75.00
$125.00
$163.00
$ 50.00
$ 69.00
$100,00
TOTAL
Shared Drivc(T;)lBuilding FortnslElcctrical Permit Application 1..Q3.doc
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01501
ISSUED: 12/1012004
APPLIED: 12/09/2004
EXPIRES: 06/10/2005
VALUE: $ 5,000.00
.
Status
Issued
225 Fifth Street, Springfield, OR '
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3852 KATHRYN AVE
ASSESSOR'S PARCEL NO.: 1702300002102
Springfield TYPE OF WORK: Modular Unit
TYPE OF USE:
PROJECT DESCRIPTION: Temporary Modular Office Installation
Owner: HEIKEN TERRY R & SANDRA E
Address: 90904 MARCOLA RD SPRINGFIELD OR 97478
, CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
CHRISTENSON VELAGIO INC
License
64137
NOTICE: , BUILDING INFORMATION I
# of Units: T~~~,~~RMIT SHALL EXPIRE !tomtolilt "R
Primary OccupancJ~Group:IZED UNDER THIS PElJm~" ~t w\S:ture
Se~ondary Occup~~Y\9!.~\%ED OR IS ABANDO l' eo" at!
PrImary Construclio/y Ly~e n ~ J. .FrlliYpe:
Secondary Constr~lion'T~pe~Y PERIOD. Range Type:
# of Bedrooms: Energy Path:
Sprinkled Building: . nla
I DEV"Lunt'lENT INFORMATION.
Frontyard Setback: Overlay Dist:
Side I Setback: # Street Trees Rqd:
Side 2 Setback: Paved Drive Rqd:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks: ATIEN'flul\i;()regon iaw requires you to
;V;;V\lW I u;v~ ...~v...~.....~:..., :I:~ ~_' ,;;;":,,,.:,_ ~!f.t.:
Notification Center. TlJoS~~W~"'9i\l~I.lENTS I
Street Improveiii'elilGlR 952-001-0010 through OAR 952-001.
OQ90 You may obtain copies of the rules b)
Stor~ Sewer A~all~~\fing the center" (Note: the telephone
Speclallnstrucl1on. 0 U II" N t'f' t"
numberforthe regon t Ity 0 Ilca Ion
Center is 1-800-332-23441.
Addition
Industrial
Expiration Date
07/14/2006
Phone
541-688-6121
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Total Value of Project
Pace I of2
Value
Date Calculated
.
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01501
ISSUED: 12/10/2004
APPLIED: 12/0912004
EXPIRES: 06/10/2005
VALUE: $ 5,000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
I "fl'" P'Iid .
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
Amount Paid
Date Paid
Receipt Nnmber
$5.00
$3.50
$50.00
12/10/04
12/10/04
12/10/04
1200400000000001727
1200400000000001727
1200400000000001727
Total.Amount Paid
$58.50
Plan Reviews I
Structural Review
12/09/2004
12/09/2004
APP TCM
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 ReoIJir"1 T~
Temporary Electric: Approval required prior to Utility Company energizing pole.
Final Building: After all required inspections have been requested and approved and the building is complete.
By signature, 1 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 he 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 he 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 2 of2
225 Fifth Street
Springfleld).Oregon 97477
541-726-3759 Phone
.
t]:~;~.: '
~-.,
_ of Springfield Official Receipt
Wvelopment Services Department
Public Works Department
RECEIPT #:
1200400000000001727
Date: 12/10/2004
2:19:09PM
Job/Journal Number
COM2004-0 150 I
COM2004-0 150 I
COM2004-01501
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Temp Power 200 amps or less
Payments:
Type of Payment Paid By
Item Total:
Check Number AuthoriZation
Received By Batch Number Number How Received
Amount Due
3.50
5.00
50.00
$58.50
Amount Paid
Check
CHRISTENSON ELECTRICAL
djb
1104
In Person
Payment Total:
$58.50
$58.50
12/1012004
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