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Home My WebLink AboutPermit Electrical 2004-10-26 · 0 Dllll ~ I: a ,.:. t .,' ~ ~~~.. .i~~'i;'.t.~ 1f:- ,... ~ z" o~ "f1.5 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-~ 'lo",-;" 'l " ;l) ELECTRICAL PERMIT APPLICATION . . 0.." ~ 0' O'o"'~% . / 0 -2/ . II -</ " ~ "..~, City Job Number COlM-ZOol.{- 0/330Date O~Ol vl.1 o"t;" "0,.... o.,.~ ~ ....& .s'''o r~~.'Y;'...""I"ffi"::l~'('<""'i""";:'iif.:);;,'{:?~r:~T'.Y:1,.:J"--l{."'''';J!:r,'';.:<;<::-: '~-:::-'.'S~,'t!~:;'<;;\',~f: "~.',,,,,,;.,~t'!t'l\'c~_~'!'>>:O;::~7!:~,:":"<::~~"x~',,;t'>':":)J.;:"'_~' ''':::''r. ",;~,"'!", .,,,~~~r:~9~);~~:f.;;'~:'N'"1~t""~.:l:,.~~' 1. ifLOCATION;OFjINSTALEAnON~/fiJ.~~~~ 3.'cCOMRLETE-FEE'SCHEDI L W''(''~~''~''',~"",,#\'r;f~W ~ V{~~'?iJ5LJ;;;;;;,,^".'A~<:'~:71.:+" ':fJ~w,,,,c~81t~7" "'~ '"~"'~'~~~~~."~.,' S. ~,~~N ~~~~~!,~~~St~i~l~'~~ JOB DESCRIPTION . 1000 sq. ft. or less Ii - II J/lIIA 'OAI' . ,J / ..L.,./i. " Each additional 500 sq. ft. or N'?lir U- I'f/IJ ~ fVY/ LL CbII/Jt41.a.... iii /.Kiftt' It-portion thereof .~{ 'fIJr'~fft's/lrf!lft-transferable and expire if work is Each Manufact'd Home or not started within 180 days of issuance or if work is Modular Dwelling Service or $50 00 Suspended for 180 days; Feeder . _."'-,,";<'{;. ~~~~requ'f8SmM,~> .~ ~ rlicof.ti'RAiJilfiiflNsvrtU}lM.Tj'. .' -." e OreR"\A;~~~~4f~W':ffiSl;il~fuW'rA]terati~Kf7f?~~iCtft~~(~ 2. 1<"e"_~"'""'''''''-~~'ICJllo~;a r T;o~~ rules :;t'eff5~<~1=""".iAAit"/==~''''''~>?0''"~ Electrical Contractor ~'JCaB!?1l. b1lra~~.::W.r;.'J9h OAR2ll6~hr less $ 63.00 fJlJ, In OAH ::t::>,,-uu I in copies of th2<TIJWfuWto 400 Amps $ 75.00 Address 6lEO~e'lftllm~~~~~ V;1~~: the tel~lfj1~s to 600 Amps $125.00 ca~~~r 'f~~ ;he Oregon Utility N06'biF~Jlto 1000 Amps $163.00 City Spfld. 974 77n'Phonecci.4.=7Mi6ti-BIa::l-332-23440ver 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 Supervisor License Number 4944S C. ~.T.emD;;rarvis~~WF~~~~~~~ ~t,~~~~\W"u''''''~-L~'1'''Jitol(.1o''!~~l.:~D:''~~~~ Expiration Date !t} /1 /07 Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. Signature of Supervising Electrician D. [~~l[~~~' ~~"<' ~ "':--.:~ -', 1 dN01\Cf:. ~~'\ ~fra,\w~rl1i'fel,'s'i~li\~er Panel ~"J ~ _ /?, ~,"c oI'RM\1 SOne.brcuits PERMII IS NO $ 43.00 - /'. ~",. / ~\;~'\W,\ZED \.Elfc~1Xd~W~",\\,~\@il\'&Rvith r,) j) 1-1114 ~HICEO ~er;vil:eI'o\.1Fe'!\ier Permit $ 3.00 . tl I\N~ 180 D~ ~J}~w'-~~('S"~~f""''i{lil:''''~fW'1~'''d)''.'E'~!jf)'\'l11I~'7'''~i . . ~t~\I>~.~",~!:l~~..mJ.$rd:.~~~~~~~~k~c~"~~~~~~.~~'~ Phone 1J.(P, 3153 8699 $ 50.00 $ 69.00 $100.00 Expiration Date OWNER lNST Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~.~,~ . . --"~"""" )';;." ,...-.V'C:'..:..J1.' ::-:--t:i~I'-;!:l;"';:)~:"~.- -,":'~~~~>-l~1(?~."ri;<:l~~~ ."' 4. M';SUBTOTAL:OF1l.BOVE'e'-f1Jtt5.',,;t1i.i: . "~-""'~"""",''"'''''i~,",'''!\~'~1;f'''''''''''''-':'''' ':--..-;'l!f,""'%-,l;~_.~..j;il.i"~~_ :,jlM.j.t,?~~,"-.;... ~ 63. Lj.lf/ 1;,30 13,7/ Owners Signature: 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL ~ Shared D~ve(T:)IBuilding FonnslElectrical Permit Application l-Q3.doc ,J . . Ll1:r' OF SPRIr\jlJt<IELD Building/Combination Permit PERMIT NO: COM2004-01330 ISSUED: 10/26/2004 APPLIED: 10/26/2004 EXPIRES: 04/26/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 285 Main St ASSESSOR'S PARCEL NO.: 0000000000000 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Commercial PROJECT DESCRIPTION: SW corner of Main and Pioneer Parkway East - installlOOamp service cabinet on traffic signal pole Owner: CITY OF SPRINGFIELD Address: 225 FIFTH STREET SPRINGFIELD OR 97477 Phone Number: 541-726-3753 10) ,- I cONIFRl'hrdk.'lNFORMATlON I ..I . ,"'., e9J"!," e" v. \~'" 01 J e S - ,p, Contractor..o.l?<' ~e.. ~e~ 'O\~, ~":l?-: ";~'\ License LR B~~r.6 ~~c.e '~:i O:::~ I~~_~e ~ 8699 .A.((;,.~'\\eS ~'6 ~e" \ ~UiLlDr'NGjINFORMl\TION I '" ' ~,~ cp<' J:Jf;)'\ 'd./,. '''~ M"""- ~\O 'o<'~' 7;;<' '~', ';.,,, ,~" ';, # of Units: '0 .~\r::3~. f::>'2:1J 0'0-:' ~Q#fli!>t~~j,~:l: Primary Occupancy G~<t.-~ ~ ~ ~\lo'l e<,\el' e~gH~jJlJ!J~f Structure Secondary Occupancy GI1il~."O ~e c. :r-e 0' ,~ype of Heat: Primary Construction Type 7;;\\0-'VJ ~\OI"~,'''' \ Water Type: Secondary Construction Type? ~~'Oe 00(1 Range Type: # of Bedrooms: ~ Energy Path: Sprinkled Building: Contractor Type Electrical Expiration Date 12/18/2004 Phone 541-747-6638 Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENTtNFORMATlON I REQ~RED PARKING Overlay Dist: ~ T~~~ ;\ # Street Trees Rqd: ~ \~ \~ :\H.'n"dPcapped: Paved Drive Rqd: ~i-\,\\l\ \'~\\~\ R'!Jtpact: % of Lot Covera~ x'\>.\..\.. ,y..\S 10~~'i) ..\\),\\~(.~~\,\ ~ \~'i)~~ \>.'O\>.~'i) I PUBLIC IMPROVEM.E~Ts:i~'i) 'i)~~'i)'i), \'~'i)~~~~ 'i)~~dewalk Type: . \>.~" \ Downspoutsillrains: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descrintion , Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paeelof2 . . CITYOF~rKll'\j\.dimLU Building/Combination Permit PERMIT NO: COM2004-01330 ISSUED: 10/26/2004 APPLIED: 10/26/2004 EXPIRES: 04/26/2005 VALUE: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I F~~s Pail! I 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 10/26/04 10/26/04 10/26/04 1200400000000001522 1200400000000001522 1200400000000001522 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. ~ Reouir~l!l',Wl~etion\.l 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 furtber 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 Paee 2 of2 r 225 Fifth Street Springfi~ld, Oregon 97477 541-j26-3759 Phone . a."~'!I~,Q._~~ "..'c- '.', ~. ; ;"~, I ~. . ....--,."'.. u' lliii.ty of Springfield Official Receipt .velopment Services Department Public Works Department RECEIPT #: 1200400000000001522 Date: 10/26/2004 3:05:27PM Job/Journal Number COM2004-0 1330 COM2004-01330 COM2004-0 1330 Description + 7% State Surcharge + 10% Administrative Fee Penn ServlFdr 200 amps or less Payments: Type of Payment Paid By Check LR BRABHAM Item Total: Check Number Authorization Received By Batch Number Number How Received djb 31235 In Person Payment Total: Amount Due 4.41 6.30 63.00 $73.71 Amount Paid $73.71 $73.71 10/26/2004 Page I of 1