HomeMy WebLinkAboutPermit Electrical 2003-9-10
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"":0' .. CITY OF sf --INGFIELD OREGON ' --,
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPliCATION
City Job Number c.0I'1l..0o,3'-oc> 709 Date q -10-Q.S3
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LEGAL DESCRIPTION '. . A.
/703. 27 4 L/ 02700 Service Included
JOB DESCRIPTION
~o;..r leJ "
1000 sq, ft, or less
Each additional 500 sq. ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
Permit re non.transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50,00
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B. &es or. 1eea1f~~~aJto~~~Ei.~"t on 0 ~~~pn:'
Electrical contDa660~~
P.O. BOX 2237
Address Fllr,~~~, oa 974C?
City
Phone ~4~ ll.o<i<-I
$ 63,00 ~L~ ~
$ 75,00
$125.00
$163,00
_ ,,()'$375,OO
"I\"'~' $"5"0"0' 0
Ie"" - \,;. .
... \ la'" _ ()Iegv. _0.\ \of>
c. ':"rn'i'IfOJ!m.Se"".:e~~~..":ee(i~f:i
\"i\::;\~' c. a.Ou" \Do~v n u"'. l\l\e~'
/I.. . "11P,~ - ,p.I. , '1'109> '\De ~e
InstallatIOn, Alterahon or,-RelocatlOn 0' len'\\O"
W\','; \10\\ - ,,~,\.lU', co~\v- \e" ~"'Ofl
200bihp~or lessOu oXlla.1fI '0' I\,\e _ '0$\50,00
'" . ,0. ':l.r n\!' \.~( ~\'j..' .
20h{\fups to~Q.01AmpsflWI. f \ I\i 1 _ ~~,,69.00
401 Atiip~td600.'A1np.~eOte9~~ ",3'2-;(.... $100.00
v' ra.III\!''' 10(\'(\ \ .eu '
Over 600'~ps'or..H)00,V61ts see "B" above.
D. ,Bta,dr;~Jl 6it~'"
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
J
Supervisor Lic.,nse Number. .1 ~ q~ S
Expiration Date
jn - 01- o.;;f-----........
,_ ""'1',,
Constr, Contr, Number
..".:\ <;<-00 I
Expiration Date
0.. - I 04 - O~
7~-Q,~(!)Jtw
1/
Signa~'fe of Supervising Electrician .
(tyJe.d-M.... ...-r
ISH... s j-
Phone ~ -..::t'tQO
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
Owuers Name Q.P
Address j C(;/O
City 'Sfp-J'!.
$ kOO
.<<:J: . ~. ~~,I'L':'Iili:j:'iLllll.:t"...;~...'Ir'l:
"" . aell Ista. allon
~~ ~1m '~~IN'\ e;, ~\)'t.\l> \tI~\\~~'t.\) tG~ 50,00
Sigfu<il'l~\l\ 8qgi\ \e;, t>.'O $ 50,00
L~\5~t!SA~r ~ilI~\\}\.l. $ 25.00
Limit-"",,~g.r~ Commercial $ 45.00
,,'\'to'-
Minimum Electric Permit Inspection Fee is $45.00 + S,urcharges
. .' .
4.1_'
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for ~ale. lease or rent.
Owners Signature: . _ ... ,_ u ._' _ _
7% State Surcharge
10% Administrative Fee
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Inspection Request: 726-3769
TOTAL
Shared Drive(T:}lBuilding FormslElectrical Permit Application l-03.doc
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. CITY OF I)rKll'l\.d'l~LU
Building/Combination Permit
PERMIT NO: COM2003-00909
ISSUED: 09/17/2003
APPLIED: 09/16/2003
EXPIRES: 03/1712004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1222 1/2 Kelly Blvd
ASSESSOR'S PARCEL NO.: 1703274402700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
, Residential
PROJECT DESCRIPTION: Upgrade service
Owner: R P INVESTMENT REALTY
Address: 1810 15TH ST SPRINGFIELD OR 97477
Phone Number: 541-726-2400
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor License Expiration\D~te Phone
OREGON ELECTRIC SERVICE 38001 _oOl09/iV~004\:~{\ 541-343-1681
BUILDING INFORMA TIONI,~O~ \'~'~e 0' :;,e S~~.()()"
~." .eO u'l ,uW "?- 9 'es \.
\ ,v -'09' ose ~ 1"1..- ,U'
# of Slories::,,;\:;.~ S ~'-' , ,\'0 0.1.:01 Size:(\e o(\e
Height of structure\€> ce(\W Q'\ () \'\\' Sq~Ftq\si'Floo'?: ~\\o(\
Type ofHeiit':~'c',,\,o'(\ "0,\,0 .',\(\ COSq'Ft-2i1'd,F.J;;~I':
~\,,,, 0;;1)'''' 0'0'''' ~c', ....,'~
Water Typ!':' ?- 9 ~ ~-o.'l \e" \1 ~qY:t,B~~~.'Pe"t:
Range Typ~: 01>' 'lOu e Ce(\ O,e~c~~,~!,~ai'ageJCarport
Energy pathJ.Cl9Cl. \'i'~~ \'\\0' \,\\e, '\ .'?,fSq Ft Other:
c'O' ",,'Qe' \ ".e' ,s Impervious Surface Area:
....\\\" r.e\'"
R-3
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Constrnction Type:
# of Bedrooms:
VN
SETBACKS
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist: Total\:\J'1Cl?-'f.
# Street Trees Rqd: 'C. ~ab'ilical!P1l.qi\
Paved Drive Rqd: C,. , \.. 'i;.i-?\'?\ oli\lml;1.~t:' ~
.. ,,~\C~' .... S\\~\. ,\\\S r c.\) r\.ln
% of Lot Cover~ge: ?t.?-w.\' 'Ut(I..'0t.?- f',t(I..\)Cl~\.
'~~~\.\a?-\l~?n {\?- \S_~'O
I PUBLIC IMPROVEM{l'IT\$II:-'t.~':;~i ?t:."'v~
.. \'0\1 v
f',W\ Sidewalk Type:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee I of2
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. CITY OF ~nuNGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00909
ISSUED: 09/17/2003
APPLIED: 09/16/2003
EXPIRES: 03/17/2004
VALUE:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Fee DescriDtion
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
9/17/03
9/17/03
9/17/03
Receipt Number
1200200000000002145
1200200000000002145
1200200000000002145
Total Amount Paid
$73.71
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.
L.Reouired \iw1..dion.,
I Electric Service: Approval required prior to utility company energizing service.
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 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 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.
Owner or Contractors Signature
Date
Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00909
COM2003-00909
COM2003-00909
Payments:
Type of Payment
Check
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Receipt #: 1200200000000002145
Description
Penn Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
OREGON ELECTRIC
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt
,
Development Services Department.
Public Works Department.
Date: 09/17/2003 8:35:20AM
Amount Paid
63.00
4.41
6.30
$73.71
. Item Total:
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71
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