HomeMy WebLinkAboutPermit Electrical 2004-7-19
Supervisor License Number ,3 <;97S
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200 Amps or less $ 50.00
7o,?'P9 201 Amps to 400 Amps $ 69,00
/ 401 Amps to 600 Amps $100,00
/'::2.. l' e>/t1 ~/ Over 600 Amps or 1000 Volts see "B" above.
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Signature of Supervising Electrician. _ .-,~,..~",~~~W"a~~~4l$t.%S"~
T J j / ' New ~te~ation or Extension Per Panel ' ,
,-, _ ~M/ ' One Circuit " $43,00
, -" "E~cb. Additional Cin;uit, or with E \~''''t,WO~1\
Owners Nwne f~ hw, LDAU~ S:::~:!~=~)J~,~~~~~~. ~~~.~.~~
Address ..9'/ ~.o""'AU25f: et-t:.- ~ E. ~\:S~!!..~,: ~~~~~~al!.,tJoll'
City ~) /'.44' Phone 7</</. 6(, 7 3 Pum~or i~~~~r>.'( pER\OO. $ 50.00
o SignlOutlin4>tfdg ,$ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45,00
, Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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LEGAL DESCRIPTION
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07700
JOB DESCRIPTION ,
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Permits are non-trans';;;;~xPire irwork is
not slarted within 180 days or issuance or if work is
Suspended for 180 days,
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Electrical Contractor Ie. S" &17' ,1/1./';'
Address 0.0. 1.50>c ,}. {/Y33
City ,ku JC~ _ Phone brfC, ---600k
Expiration Dale
Consb', Conb'. Number
Expiration Dale
OWNER INSTALLATION
The installation is being made on property I own which
. is not intended for sale, lease or rent
Owners Signature:
Inspection Request: 726-3769
" "
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1000 sq, ft, or less
Each additional 500 sq, It, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or , $50,00
Feeder " ___-mesyou...
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U=O\tllOU9h ~~'r~~q?J;.00 b '3
OIJtmln eopIes ,~ 9100
B.I...tA: the Ullll\il ,ul'l.~~5 00
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60~<f~on Utility l'lUU ,- $163,00
Over 1000 ~t1-8Q0-332.2344). $375.00
Reconnect Only $ 50.00
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C. ~I1]RP!~~~~~!$~~~~i!~rJff~~\~1l4~~
Installati~n, Alteration or Relocation
7% State Surcharge
10% Administrative Fee
TOTAL
Sharm Drivo(T:)lBuilding FonnsIEIcctricaI Pennit Application 1-ll3,doc
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. CITY OF ~rJ:Ul~u1<mL1J
Building/Combination Permit
PERMIT NO: COM2004-00891
ISSUED: 07/19/2004
APPLIED: 07/19/2004
EXPIRES: 01119/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2375 LAURA ST
ASSESSOR'S PARCEL NO.: 1703224407700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Service upgrade
Owner: LARSON GEORGE M III & CHRIS
Address: 21 HAYDEN BRIDGE WAY SPRINGFIELD OR 97477
Phone Number: 541-744,6673
, CONTRACTOR INFORMATION I
Contractor License
KS ELECTRIC ,~,\ifeS '10\l,~~. 70889
O~ Otego" "'i;.iilimDiN'c:iNF0RMATlON I
p.~~ ~dO\ltedb\~t\li~$\J, 95'2.'OV"-
# of Units: ~\O'I' (U\eS ,,\et. "(nO O\lg\'#<Oi'-S\o~i~,~s ""
Primary occupancy.lio" ~~~'\O \nt ie~g~:allo!~f!lI'ture
Secondary Occupan ~aPZ 10\8.\" CO~e' ~flI\q\,~, e~UOO
Primary Constructio\? e'lo\l ~'1~t. t'"'O ~ri,t \~e:
Secondary ConstructillR ~\'ig \\'18 ~e OtegO(\ ~M)ype:
# of Bedrooms: It\'061\OI \1l '\..&OO.~ nergy Patb:
flU C8"tel Sprinkled Building:
Contractor Type
Electrical
Expiration Date
12130/2004
Phone
541-686-6236
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
N01\CE: EXPIRE If l~~ype:
1\-115 pE.RMII SHr>.llIHIS PERMIfj~~1.ts/Drains:
r>.U1HORIIHJ U~~~~ r>.Br>.NOONE.O fOR
~~~~i~~~~ PE.RIOO.
Notes:
I Valuation Descriotion I
Description
Type of Construction
$PerSqFt'
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee I on
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00891
ISSUED: 07/19/2004
APPLIED: 07/19/2004
EXPIRES: 01/19/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
~~ P3irll
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$4.41
$63.00
7/19/04
7/19/04
7/19/04
1200400000000001099
1200400000000001099
1200400000000001099
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..Reouirerl Tnsnections I
Electric Service: Approval required prior to utility company energizing service,
By signature, I state and agree, that 1 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 of any 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
Pa2e 2 of2
225 Fift~ Street
Springfield, Oregon 97477
541-726-3759 Phone
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Gr~~_QIJ1~ __n"_
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~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001099
Date: 07/19/2004
9:26:20AM
Job/Journal Number
COM2004-00891
COM2004-00891
COM2004.00891
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Perm ServlFdr 200 amps or less
Payments:
Type of Payment Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
4.41
6,30
63,00
$73.71
Amount Paid
Check
KS ELECTRIC
djb
4358
In Person
Payment Total:
$73,71
$73.71
7/19/2004
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