HomeMy WebLinkAboutPermit Electrical 2004-10-26
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"f1.5 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-~ 'lo",-;"
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ELECTRICAL PERMIT APPLICATION . . 0.." ~ 0' O'o"'~% .
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City Job Number COlM-ZOol.{- 0/330Date O~Ol vl.1 o"t;" "0,....
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1. ifLOCATION;OFjINSTALEAnON~/fiJ.~~~~ 3.'cCOMRLETE-FEE'SCHEDI L W''(''~~''~''',~"",,#\'r;f~W
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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
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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
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4. M';SUBTOTAL:OF1l.BOVE'e'-f1Jtt5.',,;t1i.i:
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63.
Lj.lf/
1;,30
13,7/
Owners Signature:
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
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Shared D~ve(T:)IBuilding FonnslElectrical Permit Application l-Q3.doc
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. 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
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,"'., 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
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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
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