HomeMy WebLinkAboutPermit Electrical 2005-10-20
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(S41)726-3753 . FAX: (S4I)72t36s9 .'., . ~
ELECTRICAL PERMIT APPUCATlPN,.. ,. .
CityJobNumber CoN\Z0CS--CO~/lbate /O-tp-O) . '. ~
I. "'i.OCAfiON.OitiNsTA. ;i'iAifi6NT"~ 3. ?OOMPUi'ii'FEE. -:SCHEiiULERRf.Olv.i"'i19'.,". .', . '.'
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I bZO \CeII 0 7 ~ m::~.''''''''>n_'.,._.,.,.'''''"~..''''~"'-'''''''''~''''''''''.'''n.."'''''"'''y.' ''Ii'
LEGAL DESCRIPTION A. New R.!$,i~tia~~gl~~l!It,iif~~J.lyiP.tt;d"'ellll)g;!!.Il~~~f~.i1
J 70 3.3. '1 Z- Z 00 7/ b Service Included
JOB DESCRIPTION 1000 sq. ft. or less $106.00
-- -~5\"'''L dlO J.. Each additional 500sq, ft. or
~ <;\" 'f c...c rc.oA.7', ~ portion thereof $ 19.00
Permits are non-transferable and expire if work Is Each Manufact'd Home or
not started within 180 days of Issuance or (fwork Is Modular Dwelling Service or t $5000
Suspended for 180 days. Feeder I ... requireS yOU .0 .
., _.. .,. r =n.\lr.. .. )l1)\iW
2 ~~$R:lNST,ti"}:r?:.tnON'ONi"iI\iiENB\~~~'.i~~~1~~.1riik':.t.i.~;~'ti~I.;'ili.~iatf@n:<'
. lllI,<<t'" ,w'~"'lZ""":'.""--"'" <=......'""'-.."~\\QW ru\Er.l'~;;.w~t;~~Il'~5~.'tl6\:;'" '''w_..-'-.... .. ,
Electrical Contractor~ C.PF~ ~ c; lDcAfl~li~M6~f-6~W~O~gh ~ the rulpg bY I $ 63.00 b.:l
, in O/'.R 952bP9Jn8t!9.\jlIlOll'ili1~ \elephnne $ 75,00
Address PD. e,()'t.. L\ ~ c;. co n1)90. '(0'401'~.lR.6~fA'mp,~he No\lhc<>lion $125.00
cal\in~mei\'tWf&.IlQllO~~Y 344), $163.00
City f, .,... ^ M_ Phone /4la- \ <{ 1 \ l\urnb~~n\g9</g'\ln\l~6I'a.2.2 $375.00
~ t&c!lJnnect Only $ 50.00
Supervisor License Number ~(').;l. 3 S
ExpirationDate 10 I () \ I ;).007
, L
Constr. Contr. Number i 5' 0 S S'c:2
Expiration Date S I ~ ( :J. 0 0 s:-
~~~li~~....1'..*.:>...~.."".;~AC~.'..--r,a(~'Q..~' .'~(~~'.~ .,~ '~~-~~ ..'~'~
c. ~~,~!!!P.9..r!!YJ~em~eslord~~ersu~_
'-'"
IustaJlation, AJteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see ''B" above.
D. Ajit':ri'Ch-"Gi~i1i~. ".:\'Wf\';:O; ':'~I<fii'~I$~~~\".J!,n'ml~:ti'IQ";'~'
~,<~" ..~.. .._,...".~~'if,<;m~r~~~~.l!:'_t~"\'1.\'ij
New AJteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 50,00
$ 69,00
$100.00
Signature of Supervising Electrician
/
...d~~ ~
"
$ 43.00
Owners Name S ~.4A.-+ ,wtyCif. \
Address "3'"l'l61 '"8/0-" 4.t-rc, I&d
City f'1^6-EIIIC' Phone
It) $ 3.00
"}.o
E. ~iJlVl~li~~~1ii~~~~~~~.tti~i~hid1=d~.-~ii~iJar;ill'ti.~~~
l~~~~, .',-n<_""-'"..-......".,"'~.._.~,,~~I.t-...kwWS:r..........~......'"".'l~
OWNER INSTALLATlON
irrigation ~O.OO
'IT s~pPlRt IF H'It nv 0.00
lH ~1l6 PERMIT 1::1 l"t~ 5.00
AU R~N~ "UK $ 45.00
MI~I~':~~:::~Fee~~:,:;~nrCharges
4. ,p:Sll1uv~AL;OE:.4BOVE>'l-",~':, ~1]';,,"
~"."..,'>t''''':'''''''''''""{.'''''''''''J,\''''';,,,,:;(\:i.<~ ~"=~'"~~ 7 '3
6'51
'710
JO't !!-
7% State Surcharge
10% Administrative Fee
The installation is being made on property I own which
is not intended for sale, lease or renl
Owners Signature:
611
Inspection Request: 726-37~ew c.t.1!f 1"1.\
e~f. ~/q/01 '))!$
TOTAL
Shared Drive(T:YBuilding FonnsIElcctrical Permit Application l.mJloc:
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: cOM2005-00918
ISSUED: 07/19/2005
APPLIED: 07/15/2005
EXPIRES: 04/20/2006
VALUE:
SITE ADDRESS: 1620 KELLOGG RD
ASSESSOR'S PARCEL NO.: 1703342200916
Springfield TYPE OF
Site Work Only
TYPE OF USE: New
PROJECT DESCRIPTION: Sanitary, gas and paving for partition approval parcell
Residential
Owner: STEWART MEYERS
Address: 33461 BLOOMBERG RD
EUGENE OR 97405
,
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Contractor
WALTER DREWS III
CAMP CREEK ELECTRIC LLC
License
124842
164877
Expiration Date
08125/2009
06/0912007
Phone
541-606-1755
541-746-1471
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
I BUILDING INFORMATION.
no IC:I~I/ON' 0
tOVrOfS~E'''~d regon law requires 0 ~ot Size:
.Notjaeigl!Jr"ten~ted by the OregonY U~,~WFt 1st Floor:
m O;rypJ~R_q}J~!bo' Those rules are set t~rrft 2nd Floor:
009LWJlW I~~e,; 10 through OAR 952 S~tilt Basement:
caRaDl!e]lY.Jle: btam Copies of the I -rsq1Ft Garage/Carport
.", 'b""l, e.7 Prlt ru e~ '
nU~J1J'rn.l"lith:er. (Note: the tele -SqlFt Other:
Spriul<le\i1e Oregon Utility ",Dla PhonrOccupant Load:
I.",entp.r;e:.- 1 0...._ _ Onf,f::=Ifi,..,....
-__ ......'_~~~A)
I DEVEWPMENT INFORMATlON'I'
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Street
Storm Sewer Available:
Special Instruction:
!PUBLIC IMPROVEMENTS I
Partlallv lmprNDJICE: Sidewalk Type:
fili~ PERMIT SHALL EXPIRE ~slDralns
~g~HJ~~~~ ~~DER THIS PERMIT IS NO~
ANY 180 DAY PtR:g~BANDONED FOR
Drywell - Provide
Drywell Engineering
Notes:
I of 3
Status: Issued
225 Flfth Street, Springfield, OR
541-726-3753 Phone .
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Type of Construction
Fee Description
-Mechanical Issuance Fee--
+ 10% Administrative Fee
+ 7% State Surcharge
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Sanitary Sewer - 1st 50 Feet
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
Sanitary Sewer Each AddtllOO'
SDC SanltarylStorm Admin
Storm Drainage Impervious Area
+ 10% Administrative Fee
+ 7% State Surcharge
Sanitary or Storm Sewer Cap
+ 10% Administrative Fee
+ 7% State Surcharge
Fixture
Storm Sewer - 1st SO Feet
Storm Sewer Each AddtllOO'
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Total Amount
Public Works Review
08/05/2005
.
.
CITY OF SPRINGF1I!.L1J I
Building/Combination Permit
PERMIT NO: cOM2005-00918
ISSUED: 07/19/2005
APPLIED: 07/15/2005
EXPIRES: 04/20/2006
VALUE:
I Valuation Descrlotion I
$PerSq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Fees P3idJ
Amount Paid
Date Paid
7/19/05
7/19105
7/19/05
7/19/05
7/19/05
7/19/05
7/19/05
7/19/05
7/19105
7/19/05
7/19/05
7/21/05
7/21/05
7/21/05
8/5/05
8/5/05
8/5/05
8/5/05
8/5/05
10120/05
10120/05
10120/05
10120/05
Receipt Number
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001033
1200500000000001056
1200500000000001056
1200500000000001056
1200500000000001146
1200500000000001146
1200500000000001146
1200500000000001146
1200500000000001146
1200500000000001577
1200500000000001577
1200500000000001577
1200500000000001577
$10.00
$10.40
$7.28
$4.00
$41.00
$45.00
$247.91
$325.91
$14.00
$74.13
$908.79
$4.50
$3.15
$45.00
$7.30
$5.11
$14.00
$45.00
$14.00
$9.30
$6.51
$30.00
$63.00
$1,935.29
I Plan Reviews I
08/05/2005
APP CAS
Drywell approved per PW
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. '
2 of 3
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit'
PERMIT NO: cOM2005-00918
ISSUED: 07/19/2005
APPLIED: 07/15/2005
EXPIRES: 04/20/2006
VALUE:
Sanitary Sewer Line: Prior to filling trench and including required testing.
Rough Gas: After line Is Installed and required testing and capped if not attached to an appliance.
Septic Tank Pumped: After septic tank has been pumped and filled. Please provide the Inspector with receipt and
verification from company performing pump and fill. I.
Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as
required by the code.
Storm Sewer Line: Prior to mling trench.
Rough Electric: Prior to Cover
Electric Service: Approv,al required prior to utility company energizing service.
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 certity that any and all work perforl)led shall be done bt 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 wID be made ofany structure without permission of the Community Services Division,
Building Safety. I further certlty 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.. located at the front of the property, and the approved set of plans wID remain on the site (
at all times during constructiolL
Owner or Contractors Signature
Date
3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-72'6-3759 Phone
Job/Journal Number
COM2005-00918
COM2005-00918
COM2005-00918
COM2005-00918
Payments:
T)1le of Pa)1llenl
CreditCard
'"
10/2012005
.
RECEIPT #:
~
WiL.:
City of Springfield Official Receipt
.velopment Services Department
Public Works Department
1200500000000001577
Date: 10/20/2005
Description
Penn ServlFdr 200 amps or less
Add, Alter, Extend Circ Eo Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
CAMP CREEK ELECTRIC
Received By
djb
Item Total:
l:becK Number AuUlorlzatlon
Batch Number Number How Received
472273 In Person
Payment Total:
I of I
II :06:42AM
Amoont Due
63,00
30,00
6,51
9,30
$108.81
Amounl Paid
$108.81
$108.81