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Home My WebLink AboutPermit Electrical 2004-8-6 o R III 9 I: I . ~ 225 FlFfH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX; (Sil(,l)726-3t890'0<o:9",~~, " ~ ..r.. ELECTRICAL PERMIT APPLICATION . ~o'^',\ o~1>" "o~~.... City Job Number CONt..."2..CO~~OO\"l3:>Date OB-Ob-o~ "0'&, ~"~""6<;. ~ 0~ ~ . ,,-..... ~. ""'___' .. '1~~F'~-'Sjl'~,~-q& .~""~. ~ ~,lo9:"l'~~~~'!!' ~:l~~ 3. f:COMPflETE,FEE.SCHE ' E ,,> I;'.it~,....~""i' ml~..:W~~~;i!,~ca:.J::"~~I.::o:.o.~~~_N"J~~'\.. '''~ :\1i;.\iJ:~;:::~:~~15i;:.. ," 'YJ:;,"'~ '" ' ~~ ,?,C' ~.... ~",'" < ~,,~.~~.s,;;,;;;.; , , ,vell~'unif?<.o'i'" ,', __"-c~,~~f.~~,. ,"R~ . ..-..-...,.~.~.".j,.."..,.. BufM DILl ~ (p~t ,& p-I ':0~'*- Supervisor License Number '11)l1 "> ,"'Y:-X':~c., ~\:)'\ c. !f=~Y'~E."{l~l2~'t~~~ Sv'\~ ~' \:)~ Expiration Date I D II 10 '( ,..{3.~ ~~~,x)> X . I \,..V ~J~\.)' Constr. Contr. Number <' :J)~.& "'-~'?-~ ~''V':9:.~~i~ '\f':.(/,V> ~~. Expiration Date ,},.~ r 'X'fll..Vf;ljY1y~ , '0'-",Y:-\.)' ~\J~ ~ \ S' ) fS "',:'1' I 'Yo .,,~ 19n i re 0 upervlsm ectnClalV " ."".. ....-0" ~A~ r ~ OwnersNaml moho-wit, VMLlJ Address~5'S~ .1/(, ~v l1''' City Sfn11j.tJdJl Phone '7~I-#Lf?~ -. ~. ... Installation, Alteration or Relocation 200 Amps or less $ 50,00 201 Amps to 400 Amps ~...o $ 69.00 40 I Amps to 600 Ampse, ,,0 -\)~~ IS' $100.00 ',\6 ~ ~,(, ~...; oyer~oo_A~PS or l:J)O l~e~' ove. D. 1IrBWiThIi:Ci(5m~~~ r~'9.$a'(l .,.. ;c"f-.~-'~~ ~..~~ N ew A1terll'tiO)\li.r..E~~f?o~'t>~"'~ll~elS>(' t"\'v e" 0" >>'-b o~- ri}v '(p' One..C::jttui~ "-,"0 ,0 'e'" 0~ ~~ $43.00 - c....G..'"" ),V -1... ~:O~ ~~ ~ ~u AtlditiWlahOircuit orl/,with;:\ 1>:\'1 /1 ! ), I "-,<<..'S~~~e<if.:pj,ea1r \l~t?~ -\)~' rl,,,!>f>< tr $ 3.00 G. tJ 0 [oULL- \,vOy ~ ~~~ \,~ ~'j; ,q;~~ji~~~~l~~t:h~~~~1IJJ~ V-oO "S' '" ',,,, '<J>uniDQr,Jri aiffin ~e' $ 50.00 ~vP :\\.. ~i' 0~ Slgnl~tlin"t L~ting $ 50.00 >>. LimitedEnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 7% State Surcharge If, f 3 ~ 10% Administrative Fee Co '7 0 ~~\t:l'\ TOT~~~,<,_..~,_,^"~'~ 1. 7fi7oCA.'fidN7JEi1i;fsT)itt!4.7.f6N~~~ ~~"''i''l.~Ji.~;;;l!K1ti4i'iti'__~'il:''~~~ 3f S ;).. .J< t<. ~ /'" Lj VI LEGAL DESCRIPTION II 0'- -;0 00 0'<. ~O-z... " JOB DESCRIPTION' J\JeM P> I fll. JI.A'L.- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. . 1~.-.""""':iP:;j.;1jo.~~. ".'- "",..",~'" ," ...,; :!fi:""3(~'~1.::'Ji 2 ,COlfTRAC::FORINSTAt!1!ATION.'ONEY." . ~~.....~. -'r.;;~.~ .',", Electrical Contractor rALI. <; r~'S <Il1.. 2VQ.f.-' City f}Cjy &. 4 ht..R.... Phone Address OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, leas:::lL Owners Signature: ~ Inspection Request: 726.3769 jot.. 00 1>0'1 'f .,.... 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufac!' d Home or Modular Dwelling Service or Feeder A. ~N~~1tt~~fR@~~~Th1H:"'iffi .~.iC,.~...~~:-~~~-~~.'~ Service Included $ 19.00 $50.00 B. ~fi{e~~rct~~1~il:'ti1i~im"ati~~fuffli6i1 1'A~~~"'o; '. ,'~""JIf&s:,~: ~";'~~'itt}i ':;v.-ioil'S;:;-.f.~ - . ~-. ~ ' 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsIVolts Reconnect Only / {0:3 ~ $ 63,00 $ 75,00 $125.00 $163.00 $375.00 $ 50.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.,ff'SUiiTOT:ii'l!bE:".~OVE""~-~ / It; {)t.- ~~.~~~w.w~1~~~-1lZ.../. :::--- ../ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2004-00973 ISSUED: 08/06/2004 APPLIED: 08/06/2004 EXPIRES: 02/06/2005 VALUE: SITE ADDRESS: 3852 KATHRYN AVE ASSESSOR'S PARCEL NO.: 1702300002102 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: New Blower. Owner: MORA WK VALLEY GRILLE WRKS INC Address: 90904 MARCOLA RD SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I License 458 Expiration Date 05/01/2007 Phone 541-688-6121 Contractor Type Electrical Contractor CHRISTENSON ELECTRIC INC # of Stories: Height of Structure T,Ype of Heat: '\)\WlJter Type: 'Xv~ ~~1!3I.ge Type: ~ '\ :'0 \'0 nergy Path: ..J'X%-\~((.~ <\ <.; prinkled Building: (;1' .... ~ .,c::...v , 'O'Xv....."S((. '\:'~'\\\i~DEVELOPMENTlNFORMATION ~'\.o~ ~~. -~\\ ~\) ....." "" \)~~ ~ \~'\'\ o~~'" '\) 'IS Rv {:> ~. ,j.,e 00 1>.,0 ~.: Frontyard Setliaf~:' ~'t~ x..'\) \) ~~\) Overlay Dist: ,e~O,eC$ ,e ",e ~\)\) "... Side 1 SetbacR~ ~\'Xv\) x..,\\\j ~ 'X # Street Trees R!l.l\:~ ~e e'" 'I>' S(- C?J'=' .$-0'" Side 2 Setback: ~ - ~~ 0.'0 '\) Paved Drive Rjd: "", ~ e,Ji 0'<" ~0 ~ ~000 ~ -'\)~' \" ~('O-'" ,; ~ _'I-' ^" \0 Rearyard Setback: ~..J.. % of L~~<Sover"g!i;f0o o'~C$ ",0' '\.0\e,< ',c,~ Solar Setbacks: 'i' :\,0 l,.o~e" \)~' o<<,e -S-e V-o'l-" ..~ """C?J <\.~,..."\. (". ",., .~\ "........ I PUB\>ic~IMiRov;EMEl1liS:I~~~ ~~~;;;'2-'O~ ,\v &"- ,,<y .c>' 10'- eC$ ~!?l :;.0"" ~ -J ,) {!o C,e 0' ~Sldewalk Type: " 0'<" -1,0 ~e :;<00, \' \0 "C?J\)' '10<0 ,o~ '" e' ,,,, Downspoutsillrains: \)" #' e' 10'" c, ,s." ve 0\> # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description BUILDING INFORMATION I 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: I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Value Date Calculated Total Value of Project Paee 1 of2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00973 ISSUED: 08/06/2004 APPLIED: 08/06/2004 EXPIRES: 02/06/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I Fpps 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 $6.90 $4.83 $6.00 $63.00 8/6/04 8/6/04 8/6/04 8/6/04 2200400000000001018 2200400000000001018 2200400000000001018 2200400000000001018 Total Amount Paid $80.73 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. ~pd rnso~ Rough Electric: Prior to Cover Final Electric: When all 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 1 further certify that any and all work performed shall be done in accordance with the Ordinances of tbe 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. 1 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 aU 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. in. L 11 ,. Owner or Contractors Signature r; / ~I tJLt Date Pa2e 2 of2 'r i . 225 Fiftlt Street Springfield, Oregon 97477 541-726-3759 Phone . .........~._'!"'.!'!,I!-'--. ~' " -.... .':. i .. ... JIiY of Springfield Official Receipt .elopment Services Department Public Works Department RECEIPT #: 2200400000000001018 Date: 08/06/2004 3:00:33PM Job/Journal Number COM2004-00973 COM2004-00973 COM2004-00973 COM2004-00973 Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 63,00 6,00 4,83 6.90 $80.73 Amount Paid Check CHRISTENSON ELECTRICAL jmp 1069 In Person Payment Total: $80.73 $80.73 8/6/2004 Page I of!