HomeMy WebLinkAboutPermit Electrical 2005-10-18
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541\726-3689 g - .~:~
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ELECTRIC#- PERMIT APPliCATION .
City Job Numb~"2.cstJ6 - 0 I Ljs1 Date \/1I _ Y ~ - LC')d~lZed S'gnalura .
3. ~ C.OMP~TE 'tEE s6jii#5f;~'BJJLOW":, ,. . '.,
( 1. ,P:;Qf:ATIQj\To.t IN..sj-AtMno.N t; i .'..'1
of (If) W(hJ D\ ~
\ ~EC;;~ES31P4oa em ~O'{ n . A. ~:~~~e~:::::~~f"" Single OfM)liii-Faniilyper d\Velli~n\,.
JOS DESCRIPTION 1000 sq. ft. orless $106.00
") """"" . f\ C . " Each additional 500 sq. ft. or . to
?-t )( .) ""-U f"'v-. .r ~L...vl ,L.5(.., p~rtioIHl'iereb~ Oregon law reo qUires Y?'~"'t. S 19.00
bllr.If' ,,,Ie" nrlnnted by the '''\,IV," - ./n Y
Permits are non-transferable and expire if work is .t:~c)i Manufacra:HoYlfrl5se rules are set lorth
not started within 180 days oflssuance or if work Is NMHaul\lr':-O\.Jellirtl!~~mice 'll' gh OAR 952-00;50 00
Suspeoded for 180 days. inFee(j&952-001~r)1U mr U b .
O~p\l ~~l'.. "ht~in r:Qpies 01 the rUles .y
2. b~O~~~!!i~*T~Tio.NoiYL.i"l B. ~"l!'Rr;fI!'~~i', -(ti.istllll\l1lo~lNRMallns o'r Relocation: I
~ .. (\ , limber lor the Oregon UUlliY Nujlncatic;r. /.<: ~
Electrical Contractor ~)'~,J) 1..'J)VOlICL-\-\ (') r)' RlOAmPt%\~e'i is 1-800-332-234</), $ 63.00 ...J.../:?.-...
~ l l 201 Amps to 400 Amps $ 75.00
Address ~ q ~ u ,\ )('1.\ I fJ.....vJ 401 Amps to 600 Amps $125.00
P l 601 Amps to 1000 Amps $163.00
City ~1 1'1 UI..I'U Phon~ --I n. <6Ca -l)<1 Q5 Over 1000 Amps/Volts $375:00
ReconneclOnly $ 50.00
NOTICE:
\ 1"6 u &S c. l(n"A1!>'(tffl~lVi&wAltoll@lRE 'If'-'fl:!E WORIC
\ ,,\. 1 \ ^ ^" '1 AUTHORIZED UNDER THIS PERMIT IS NOT
V rU--ll los0~P.~I\~tlPl'\S~If*NaJ fOR
c:: 200A\'\l\f>4~Y 'CRlOIl $ 50.00
Consll'. Conll'. Number , )L\ Ll ~ 1 201 Amps to 400 Amps $ 69.00
01 r l' 401 Amps to 600 Amps $100.00
Expiration Date -\ (~() ,~OO( () Over 600 Amps or 1000 Volts see "S" above.
Signaru~~in::lec~ D. L~~:ehr~:::U::EX:~:s;~o:per Paoel " .
V~."C/)t?l ~ OneCircuil $43.00
~ ,~ Each Additional Circuit or with .
t\ _ Service or Feeder Permit $ 3.00
Owne7Narp ~ Q~~ .
AddreU~ 0 C'\ \20 () 0 r, c.:s\~ E. ~Misc'eila~eou/~'(SerVi~e/fe"d~r'rioi iric!ndedf-Eachl~stalla!ion I.
Cit~-(L p-hon~3tP-04-~PumpOrirrigatiOn $50.00.
I I Sign/Outline Lighting $ 50.00
OWNER I~ALLATION Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Supervisor License Number
.1
Expiration Dale
1:
The installation is being made on property I own which
is not intended for sale, lease or rent.
(nspectlon Request: 726-3769
Miolmum Electric Permit (nspectioo Fee is $45.00 + Surcharges
4. /,s0jroi.AiPEABqvE:":> :'::'" .1(03. 00
(,.'50
4,4/
~,3 ,(I
7% State Surcharge
10% Administrative Fee
Owners Signature:
TOTAL
Shared Drive(T:)lBuilding FormslElectrical Permit Application 1-o3.doc:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
. CITY OF ~rKll~vl'1~LD
Building/Combination Permit
PERMIT NO: COM2005-01459
ISSUED: 10/18/2005
APPLIED: 10/18/2005
EXPIRES: 04/18/2006
VALUE:
SITE ADDRESS: 660 KELLY BLVD
ASSESSOR'S PARCEL NO.: 1703341400606
PROJECT DESCRIPTION:
Owner:
Address:
JAMES PETERSON
660 KELLY BLVD
SPRINGFIELD OR 97477
Contractor Type
Electrical
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
Phone Numher: 541-685-0438
I CONTRACTOR INFORMA~TioN I'"'' law reC]uires you to
. ",..ad by the Oregon Utility
Nul.I:Guti('i!i~en~er. T~ExpirJ[tlonfDaUortphone
'~ ^ ~::'~ ,9f-S44:W -001 0 tllrol'09'73'Qt~0'0652-00 1541-686-0905
Contractor
ROSE CORPORATION
_ # of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Sethack,
Solar Setbacks:
- Street Improvements:
Storm Sewer A vaUahle:
Special Instruction:
Notes:
Description
Type of Construction
.-- ...-. ~............ ............'.......~. ~...... ............-.;,
I BUILDING INFORMA nON lenter. (Note: the telephone
number for the Oregon Utilitv Notification
i # of Stories: Center is 1-800-~J,~~!\~\.
Height of Structure Sq Ft Ist Floor:
Type of Heat: Sq Ft 2nd Floor: ,
W~'fT~J'e: Sq Ft Basement:
~a~1n'e: Sq Ft Garage/Carport
~~II~~PIltlif SHAll EXP Sq Ft Other:
f ~\iliilleifINlI~ingCR TH 1RlilM= THE 9fflllDant Load:
('n....~,... _ "cr<; I~ Ocn,'I./_ . _ n"
I DEVBM)"~;';~~f~ii~CvlON~ED FO'R'YUI
. !1fUlJ. REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS 1
Sidewalk Type,
DownspoutslDrains:
I Valuation Descriotion ,
S Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
.
.
. CIT\ v.. SPRlNul'lJ<..LD
Building/Combination Permit
PERMIT NO: COM2005-01459
ISSUED: 10/18/2005
APPLIED: 10/18/2005
EXPIRES: 04/18/2006
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
Fpp~ P:aid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
S6.30
S4.41
S63.00
10/18/05
10/18/05
10/18/05
Receipt Number
2200500000000001451
2200500000000001457
2200500000000001457
Total Amount Paid
S73.11
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.
Electric Service: Approval required prior to utility company energizing service.
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 be made ofany structure without permission ofthe 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 ail 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 ofthe property, and the approved set of plans wIll remain on the site at ail
times during construction.
Owner or Contractors Signature
Date
Pal!e 2 of2
225 F,ifth Street
Springfield, Oregon 97477
541-726-3759 Phone
J,ob/Journal Number
COM2005-01459
COM2005-01459
COM2005-01459
,
Payments:
Type of Payment
CreditCard
..
"
"
10118/2005
.
RECEIPT #:
.~.~-...'.:.
~
~-.:
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
2200500000000001457
Date: 10/18/2005
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
PHIL ROSE / ROSE
CORPORATION
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 17155a Phone
Payment Total:
Page 1 of 1
9:1I:40AM
Amount Due
63.00
4.41
6.30
$73.71
Amount Paid
$73.71
$73.71