HomeMy WebLinkAboutPermit Electrical 2008-4-28
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~ INITIALS N rvA .
~ DATE LJ - }~ 0 ~ Oy..,
'IIIJ" SOURCE (r.. r "'3 ~ ~
Date '1- 2-8 ,.. 0 g-
, CITY OF SPRINGFIELD. OREGON
225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(54I)726-J7SJ . FAX: (541)726-3689
ELE~l1UCAL PERMIT APPLICATION
City lob Number (O~~K'- C> 0 s""' b
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Expiration Date 5 -.z~ - 'D? Over 600 Amps or 1000 Volts see "B" above.
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I -1- _ " Service or Feeder Permit ,
Owners Name (.../tJ'\ A- c; ie,,,,, ,^A,^t:'IL-
. Address ~ , 0 I ,. - ~ ..,.... E. Miscellaneous (Service/feeder Dot included) -Each Installation
City s:f>F~ Phone 7lf 7 ~ I b , 5"' Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
OWNER INSTALLA nON NOT'CE~ L:r~~Il\:t'tf{1lmetltiil1HE W~ $ 25.00
The installation is being made on property I own whi'dIHIS PER ~f ~t51!f{~~T \s l'tv $ 45.00
IS not intended for sale, lease or rent. AUTHaP.t\ ~ ~ts~Jsblm~tf~'ee is $45.00 + Surcharges
Owners Signature. ~~~~~ p'~.OF ABOVE g b
o State Surcharge IOS".L
10% Administrative Fee B bU
5% Technology Fee '( :1 0
"lz,
/0' -
1. WCATION OF INSTALLATION:
hot lJ M ~+-
~ .
LEGAL DESCRIPTION:
17o"\~743
D470D
JOB DESCRIPTION:
f2c~A-\"- S~VL f L( c..(r~~,;
Permits are non-transferable and expire if work is
not started within ISO days of issuance or if work is
Suspended for ISO days.
2.
CONTRA",... \J:J..\, INSTALLATION ONLY
Electrical Contractor Ii /Cr f E. / ~c--I rl L-L" c-
Address
/970
N Z-~~ Jr.
City spr~"''j-r;dcl
Phone .)'C/1-7 Y7- z,z- J.1
Supervisor License Number
SOb;). S
Expiration Date
/0- J - 20/0
Constr. Contr. Number
/277;)..
Inspection Request: 726-3769
3. COMPIJ:H.6!. FEE SCHEDULE BEWW
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq ft. or
') portIon thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B. Services or Feeden - Installation, Alterations or Relocation:
7D
200 Amps or less I ,$.63:00-
201~~~ ~ Am~s $ 75.00
. : e on law requIres you to
tfJ" e a _by the Oreg~n .....t!~it1125.oo
NOt~ ~.~e rules are set for~63.00
In OM ~~rough OAR 952-00\'975.00
O~"'~~:Qbtain copies of the rUles ~50.00
calling the center. (Note: the telephone
cnu~lYll;~ra.4tWcYe~tification
Center Is 1-800-332-2344).
Installation, Alteration or Relocation
$ 50.00
$ 69.00
$100.00
$ 43.00
$ ).00 ~
TOTAL
Shared Dnve(T )lBuddmg FonnsIElectncal Pemut ApphcatIon 8-06 doc
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-00596
ISSUED: 04/28/2008
APPLIED: 04/28/2008
EXPIRES: 10/28/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 601 W M ST
ASSESSOR'S PARCEL NO.: 1703274304700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Repair service and addlalter 4 circuits
Owner: GREGORY ESTELLE
Address: 601 W M ST
SPRINGFIELD OR 97477
Contractor Type
Electrical
I CONTRACTOR INFORMATION I
Contractor fet\U'fel,~\\
ALERT ELECTRIC IN~I' Otegon 'e.~"'A Ote~t;tf'\ft"
'" l"~;U r.~, ~_-OOill
l\0'H .,Il\'Ji P Oft
to tillca\IOl' ~1~;"U. ! \he ,u\e~ 111
~o O~R 9S2Pf>>. 6{h\fC CO~\?~\1~ \e\e9.h@~~
R-j~. '{ou 1t'a~t!f.S\~~tiftW No\l~t)@ft
ca\\\ng t~ Otffe@Q~$32--~)'
VB nul1\tl8{ W~Gf~O
~nge Type:
Energy Path:
Sprinkled Building.
Expiration Date
OS/22/2009
Phone
541-747-2213
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
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 1 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 ~~
Sidewa<<xt\t~t ~~01
~01\C~:' \-1\\\ $\-\~~~~iti}~;ti\\
",\\\\S ?E?\ lEU ~~Ut.\\ r..B~~QO~r.;
~",\\,\Q\\\ 0\\ \$ f'\
~Q~~~~~~ \'t.\\\OQ.
p.~ . . to
I Valuation Description I
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2;e 1 of 2
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2008-00596
ISSUED: 04128/2008
APPLIED: 04/28/2008
EXPIRES: 10/28/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid-t
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$8.60
$10.32
$4.30
$16.00
$70.00
4/28/08
4/28/08
4/28/08
4/28108
4/28/08
Receipt Number
2200800000000000532
2200800000000000532
2200800000000000532
2200800000000000532
2200800000000000532
Total Amount Paid
$109.22
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
Reauired Insoections I
Rough Electric: Prior to Cover
Electric Service: Approval 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 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 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2008-00596
COM2008-00596
COM2008-00596
COM2008-00596
COM2008-00596
Payments:
Type of Payment
CredltCard
cRecemtl
RECEIPT #:
2200800000000000532
Date: 04/28/2008
DescrIptIOn
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Clrc Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdmInIstratIve Fee
Paid By
ALERT ELECTRIC
Item Total.
Check Number AuthorIzatIOn
Received By Batch Number Number How Received
dJb 028205 In Person
Payment Total:
Page 1 of 1
1:44:09PM
Amount Due
7000
1600
430
1032
860
$109.22
Amount Paid
$1 09 22
$109.22
4/28/2008