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Home My WebLink AboutPermit Electrical 2004-1-27 ;;,;,,~,\,/,~':':,.l:--^C"ITY"-''''O'F''''''S''P' 'RI' '. '~F"'IE' L' 'D"ORE"" GON-"~:'.~;-":"'.--", 1;.>",- ~_...:,:~- ".J.' 1,\..J, . ,........",; ",: ~:'i,".:."'.:'\r..'''.:'.':'','<\)' ..~ .,~ ~~''''''''''''-'''~ '.':,,,: _:';~~...~'l " _~!.'_':.',~ .w":-- .1....:... :..'=..".' .,~ :'_~ ,; 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 \D~~ ' ELECTRICAf..~~m-,;{fPIM~TION () rV1 . ~1' City Job Number UIDllil "t'l'U.\U l Date \ "/1, lJ\ \ ( I. flfrl(JWimI{ffNf(jjEiiNS7t~;'(ij'N '. 3. [;>,e@MffjjjjfJli'j(EE;S7ffHEDfiJiIEillEi1iil.'1~tf~~~'\ : ~A;,v:~-",..<L,... '- . - . ~, f~~~~'4&v::w.tll:H~"'''''~~'''''Ila'i!l'.;H..;1i~ll~?li1i~'~~~'''', \~q~ ~q LEGAL DESCRIPTI~ rvYlO ~ \11)~~ T L UJ'""'\ -...) JOB DESCRIPTION ,.,,"~13!?: ~;;w,,'" not started withm 180 days of issuance or if work is Suspcnded for 180 days. ~:-W:Nm~l'~@Rrmsj:~:rJ@~~@~~? 2. ~~!l9;i.r~,_~,...~~~"....,'bjlh1:.W."'!j~~1'!"'.~~i':ro.;.~J.<:tt.}i~~ Address {( (\ V< ~ E..J.N"> \-0 (. ':) I ~~ ()h+0 ~-\-- Phone ~ ~C/5Y9Y Electrical Contractor City f\~~ 1000 sq. ft. or less Each additional 500 sq. ft. or portion tllereo f A. ~r:J~~il~Wi~~~ili~g';~r:lli~FTliii~J7pr&~~rlii'W'g~~ "~ ~~;~........lM"~~""""" __. ~::.'h:""'~"'l".fI:~",';'.::''''.'''-_J_-'''" Service Included $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 i1f~~ic:w.\f.""~"iMt~'&-:"~"'.;\"~'Wl!i~~'\&.~~~t~?i:~'li.~"'li~l'f:)j;f.~. , B. i.~1W~\~~~~~ii~~~t~~~&?:1~o~~!or~!telorc=1tl~"~~ 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only $ 63.00 S 75.00 S125.00 S 163.00 S375.00 S 50.00 Supervisor License Number ~ L/7 '1vs c. ~.]S.~~,,$~J,~~1>:t!.if~if~~!!.~~~~jf Expiration Date (b - 0 I - 0 Y Installation, Alteration or Relocation : 200 Amps or less S 50.00 Constr, Contr. Number ~ 5 C~ 7Y: A.';;. 201 Amps to 400 Amps $ 69.00 f??:nf1ii~C€. ~ 401 Amps to 600 Amps SIOO.OO Expiration Datel~rfiO :c.;~1-C,) O~,e:600.A~~~~ 100~ ::~tspsee"~";b?~~""n C '. ." ',,_, Signature of Supervising Electrician COMME. 'R/IED UN,HALf/.. iBl;~l €1rI~~b_~l<~~M~~ (/ / ~~R 'DER ~?~rf)4t'!:tH.n or Extension Per Panel 411 00 ~. '1)' PER /S 4691"e f.fi9i~b7" 'E WORk . --1- S 43.00~. ~OD -'E~ ldmWQg.;U'i1 or WIth S 0 () fu,,~ ~. . Serviceo &/vrW.fuit I $ 3.00 . Owners Name -.m ~ Address 1 ~Q. , . '. . C- .' Phone JLn'\SC\5 City Pump or inigation S 50.00 Sign/Outline Lighting $ 50.00 OWNER INS Limited Energy/Residential $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 is not intended for sale, lease or rent Minimum Electric Permit Inspection Fee is 545.00 + Surcharges , A""'ENTION:oregOnlaWreqUlfesY.~".:.."~~,~""_,,,,.>,",_.,c ..~_' ..' ,,",. 4\' 00 Owners S'gnature: ,J' h Oregot1 lli@'!:.~'p~(!)jVR ,c. l~,.. (J I '\low rules adopted by t e .~ ...""......"iifi\i.X..~""""'!ii.'ffI.'.'.A . .' o. . . C t r Those rules are se . ~ " n lotlllcatlon en ~_'. _."', h OAR 952'~iState Surcharge .. . ~b \ OARYo~-uu"vv'v .,..oug '.. . . _ ~ ' . ma obtain copies 01 the rUI1l%'AdmmlStraltve Fee .. ' 0090. You Y . the telephone t:.. /I Inspection Request: &lIi6~!i'e center. (Note... N tT iliRlf{\L 'r ) l . ' ~ n mber lor the Oregon Utility 0 I IC U ,... _ _ t 'r"" .. : _ -l ~ q (\n. t') ~? ~ ?~AA.'. Shared Drivc(T:YBuilding FonnslEleclrical Permit Application 1-Q3.doc . ~ ~\o.~\ . . U 1 l' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00107 ISSUED: 01/27/2004 APPLIED: 01/27/2004 EXPIRES: 07/27/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1595 KELLOGG RD ASSESSOR'S PARCEL NO.: 1703342200905 Springfield TYPE OF WORK: Electrical Work Only '. TYPE OF USE: PROJECT DESCRIPTION: 2 Circuits for Gas Furnace and Air Conditioner Addition Residential Owner: FLEMING ROBIN E Address: 1595 KELLOGG RD SPRINGFIELD OR 97477 Phone Number: 541-726-1595 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor ROBS ELECTRIC INC License 156678 Expiration Date 0811412005 Phone 541-686-5444 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Impervious Surface Area: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: I DEVELOPMENT INFORMATION I Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: REQUIRED PARKING Total: Handicapped: Compact: ,. Rearyard Setback: Solar Setbacks: ~~~I~~~MIT SHALL EXP"~i!oo[i~i~Wli!}VEMENTS I UT,uORIZEO UNDER THIS n.r"''' , (... ,'~.. . to Street Improvemellls: ANDONED FOR Sidewalk Type: \ requires yoU ('nMM~NCEO OR IS AS nl\1'Oreaon aW on Utility Storm Sewer AViiiUibTe. 0 DAY PERIOD ATTE!\1j)Awnsl\out~mrVp!l.M Dreg t lor. Special InstructjD~;f 1 tl. lollOW rules aljop Those rules are se2_00 Notes: -lotilicatio;~~~~~1 0 thrO~gh ~~~e9;ules \ ,1 OAR 95 :, iiy' obtain copies telephone _/:.""" "nil m ,,,'_.0. the I '~- Irng the cell'"'' \'.. - Utility Notl1l(;<1"V" Valuation Descriotion I ca Iber lor the Oregon ",,?_?~44'. " Jm .... ~ .(1("1". .--,........ $ Per Sq Ft Square Footage or multiplier or Bid Amount % of Lot Coverage: Description Type of Construction Value Date Calculated Total Value of Project Pal!elof2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00107 ISSUED: 01127/2004 APPLIED: 0112712004 EXPIRES: 07/27/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ~s PlIidJ Fee Description + 10% Administrative Fee + 7% State Surcharge Add, AI!er, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $4.60 $3.22 $43.00 $3.00 1/27/04 1/27/04 1/27/04 1/27/04 2200400000000000063 2200400000000000063 2200400000000000063 2200400000000000063 Total Amount Paid $53.82 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 ~'mlired lns\ll'dion~ I 1 Rough Electric: Prior to Cover 2 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 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 JoblJournal Number COM2004-00107 COM2004-00107 COM2004-00107 COM2004-00 I 07 Payments: Type of Payment CreditCard ,l 1jiA~. ~' Wi"."""~''""''''''--"''''-''' i, I ...... 1 ....~ '., t >'.',_c_ _ 0'" ~ ......."J> --,..j Receipt #: 2200400000000000063 Description Add, Alter, Extend Cire Add, Alter, Extend Cire Ea Add + 7% Slate Surcharge + 10% Administrative Fee Received By IIh Check Number Batch Number Authorization Number Paid By ROBS ELECTRIC 000285 027670 --- City of Spritlgfield Official Receipt. Development Services Department . Public Works Department t. Date: 01/27/2004 9:17:21AM Amount Paid Item Total: 43.00 3.00 3.22 4.60 $53.82 How Received Phone Payment Total: Amount Paid $53.82 $53.82 . .