HomeMy WebLinkAboutPermit Electrical 2005-6-16
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2i5 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~~<~:., ,..,,,-, -"t,t:,~ --fl.',
ELECTRICAL PERMIT APPLICATION / b . ~~,,~;~"~iw'{0;'" ~ ~ "'<f~ ) .
City Job Number LOaM l..O 0 S" - 00 7YS- Date V -( -Q.JS ,$-\" ~ '
1. ki:JOCATi6EtoM1NsiAiJLAfi()M<)~'ii 1/"'--'~"---'-.--.....~"~if~~Ri~':'-i""/~'~" .",,'
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LEGAL DESCRIPTION ...m~ "_=-=~~,,.,._,.J'~1-..~~ih, - ~" - -. ""
J "7 0 ~ Z Z 'Z. 0 CY2 20 0 Service Included ,,/ I:> c,'<"<- '
1>~ ~,1-0
1000 sq. ft. or less <) ~o $ 106.00
Each additional 500 sq. !l~ or
portion thereof
ATTENTIg.~~P.mf;WnJIlW rn9!l1~IP..u t!J
follow rule~)l94et~a oyth'liUid'gdn C1!lt{v>n
Noti!icaliort'C'Efi'1W~ W5~ rules are set fl"rIh $ 50.00
1:-: OAR 95i-~19d\lMtIWOAR 952..(l1l1- $ 69.00
0090, Youtllaf8'~~f the rules bv $100.00
~alling tlJ>.v<OOiOlJJI\!!~~tloo ~~" above.
numb.....!O"""..'....-;"""nn,rttmm:NoUfil........... ,.p " ~",." "~'?i ,.'.,' "'1
~. tDmn"eh'eJn:utttl;,'U .':,li ',"<<r "~-'!i," ",~~t;;\:?....;<,:,~ ':'.;fa,"'l'" ,~~,g.~".r~,,'j\:_\;~Jr;..
Ce1'lt!Wl~"f-80~g2344);""N'> ,.",,~ "- . "'",", "c. ","
/7'-, //...1./ New Alteration or ExtenSIOn Per Panel
'IT I~ Tf.;L.. One Circuit $ 43.00
l/ Each Additional Circuit or with
Owners Name C-,.r1"c:-t..V \ldIA~e- i\i>T<: Service or Feeder Permit $ 3.00
Address I b 77 ( N; ~ oH.' '&+ ~ 4c ~ ~;~1~~J;;:;~.~~i(~~~itii~~~?~~f,~(bi5(gd~.;);~~~~h'lii{~ii~~~~
City ~....d ,fAA,hone Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited EnergylResidential $ 25.00
The installation is being made on property I own which Limited Energy/Commercial' $ 45.00
is not intended for sale, lease or rent. Minimum Electric permit~nspection Fee is $45.00 + Surcharges
MOIICE: ^'..'. "i8~\ftlt,~....".. . ,,,,,,.,, ".'.'.]' / (
PERM\1 S\-I"4, ;'SUBJ:OTA1i:OF/ABOVE""..j:":;'i"";,i.?/,:':.,,.. t:;> ..>
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"'lJ1~'~~;~~~D OR \S fJo/.tsik~.P~~Ptlarg~ l{1(!
uU\V""." ~R /
ANY 16~D"'Y ;'ER 0% Administrative Fee t:>JO
,,~ . OTAL 717(
\:...;~~ '7::, t;< Shared Drive(T:)/Building Fonns/Etectrical Pennit Application t-03.doc
JOB DESCRIPTION
Owe?! P61.1./t:rlZ.. PeP.
Permits are non-transferable and expire if work is
;, not started within 180 days of issuance or if work is
Suspended for 180 days.
2. W[Q~lf9~;W~f:1i.~P?.N(q~~~
Electrical Contraclor Li ~ ~~ L-
Address to. 8-IlX I ( I 3'7
Phone <'II t", ~mb
City t3-v't. ~e.
Supervisor License Number
Expiration Dale
~'l7tf~
C;/ob
I
Signature of Supervising Electrician
Constr. Contr. Number
Expiration Date
Owners Signature:
Inspection Request: 726-3769
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
~~:'~i"t~.,.~,.~.;.'t\::!~;-1:;? -">.','_ \f""'"'-~~)("::if:.'i~ _, , ,:Al' 't:_-.,l~'~"'J,~""''it.!.F:,',!,r' ,:t
B. .. ;~etilc~~..~t;.~~~~~fJ,:~;Jl!S!!I!~!~~/~\t~r~tJoh~ .,C?t~"teJ~_a.ti~~:~\~.1
200 Amps or less
20 I Amps to 400.Amps
40 I Amps to 600 AInps
60 I Amps to 1000 Amps
Over 1000 AmpsIVolts
Reconnect Oniy
I
c,~.~
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C f':r". ,'r;;>,^1;\Y~. 'i<':'::"S.,,'f>-:j~;~+;-'1":"".Fw d,.,:'\t;~-<?-%i":;{t4A' ~:j."f !l->:;;,':~;t:'tLl.."{i~,t .',0' ~,~, J ~:'1;~
. t~ _~.mp.<<:'r~~ -' ~E~c.~'o,r:)_ ee.. ~r.s,~>:,...:::f.r-.. . ,~<., '::,' ~ ~'f~7(-&>~ -' <it;.~"'..t. I.; . ~;:~
. CITY OF SPRINGFIELD .
Building/Combination Permit
PERMIT NO: cOM2005-00745 '
ISSUED: 06/16/2005
APPLIED: 06/16/2005
EXPIRES: 12/16/2005
VALUE:
.
Status: Issued
225 Flftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3255 GA TEW A Y ST APT 1
ASSESSOR'S PARCEL NO,: 1703222002200
Springfield TYPE OF
Electrical Work Only
PROJECT DESCRIPTION: Qwest power pedestal
TYPE OF USE: New
Residential
Owner: GATEWAY VILLAGE APTS LLC
Address: 16771 NE 80TH Sf STE 208
REDMOND W A 98052
Contractor Type
Electrical
I CUI' .KACTOR INFORMATION I
License
59748
I BUILDING INFORMATIONI
Contractor
TONY KOTH
. # of Units: # of Stories: you to
Primary Occupancy Groul\TrENTION: Oregon 11II~fgi!!:"re~ Utility
Secondary Occupancy \I w rules adopted bYJiYP'eQrn'la~: t forth
Primary Construction TW~ti~cation Center. ThoWate\eI~~:2_001_
Secondary Construction. R 952-001-0010 thRalij:'e . I by
# fB d. InOA . .., .........",.... ~.rues
o e rooms. y may obtain C"'!I~srrB .
0090.. au (N~P~hiklelJ3lephOne n/a
.....':llllnn the center. . rO"L ~I.....+jf;"'-:::Itlnn
number lor tnl-Dt\ffiWP.MEIll~INFORMA TION I
Cente
Front yard Setback:
Side 1 Setback:
SIde 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
. Street
Storm Sewer Available:
Special Instruction:
NonCE": IPUBLIC IMPROVEMENTS I
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Expiration Date
05/0412006
Phone
541-688-8996
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drabts
Notes:
I Valuation Descriotion I
Description
SPerSqFt
or multiplier
Square Footage
or Bid Amount
Type of Construction
1 of 2
Value
Date Calculated
.
. · CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00745
ISSUED: I 06/16/2005
APPLIED: 06/16/2005
EXPIRES: 12f16f2005
VALUE: '
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection LIne
Total Value of Project
Fl'l's Paid I
- Fee Description
. + 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
6/16/05
6/16/05
6/16/05
Receipt Number
1200500000000000848
1200500000000000848
1200500000000000848
Total Amount
$73.71
I Plan Reviews ,
,
To Request an inspection call the 24 hour recording at 726-3769. AIl 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. ' I
Electric Service, Approval required prior to utility company energizing service.
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 p~rtaining to the work described herein,
and that NO OCCUPANCY wID be made of any structure without permission ofthe 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 wiD remain on the site
at all times during construction. ' '
Owner or Contractors Signature
Date
2 of 2
225 Rifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
Job/Journal Number
COM2005-00745
COM2005-00745
COM2005-00745
Payments:
TlI'e of Payment
Check ,
\
,
.
"
,
I.
6/16/2005
.
RECEIPT #:
~l
Jiiity of Springfield Official Receipt
.veIopment Services Department
Public Works Department
1200500000000000848
Date: 06/16/2005
Descrlpllon
+ 7% State Surcharge
+ 10% Administrative Fee
Penn ServlFdr 200 amps or less
Paid By
LITE ELECTRIC SERVICE
Received By
djb
I of 1
lIem Total:
Lbeck Number AutnOrization
Batch Number Number How Received
6777 In Person
Payment Total:
f
1:25:41PM
Amount Due
4.41
6.30
63.00
$73,71
Amounl Paid
$73.71
$73.71