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Home My WebLink AboutPermit Electrical 2004-6-10 , ,. :hr:'it1,~... 'l~ . !1 . !....,.....'.'!'l. . I .. · . "UIl""'llOUllI6'f!1i\b~S8"l"'~" , ,. 225 FlF.TH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 ..FAX: (5',fN~20-~oo, ~~: c ELECTRJCAL PERMIT APPLICATION Oate " ' l'1~.;;It)1ito_ City Job Number CO>14 z.OOC{ -0 o{,gif Date b~1 0 ~ 0 fthorized Signature ~ 1. 1lil/fJi".rWii.pifiNSTAiJLAtiON"~1'F;fI:l 3. ~,@JMPEETE:FE.fsCHEDUffu"<BEt'oW'~~~~lr~')i?~<r{~ . '" ;:.:~.... 1oOt,,""....,ba~lf;U."'i'(l:i.~..._~.in-';b.~~ ~~lUI..W_~~~,~1.oI-~1.:~jf=~..Io4lt~,l<,,~~~.s.~}m..1t~;\UJ sb;rWq"5J~h-t."kC,i~'P1- - 56'7.,3; , , LEGAL DESCRIPTION fRo Z-Dl{ l ( 0 I.{,)OO ~;n~~:)v~?~'ot;;.~{t\t'~~~~:1':f'~~~J!\~Jf;:~~~%j'~.it.~J~:~ A. l':N ew.. ReSldent13lcg:Sm, 'gle. or,M ult.; Fa mtlYiper, dwelllng,u nit~~'\ liA6~~;c:;.'~~~-1:;.;,.'1J~~~~':n."U,;.J;~';~r;..,~..>>~1U;';,~o>"j.,,,,,,..r.z,." Service Included $106.00 JOB DESCRIPTION 1000 sq. ft. or less 111 P . p Each additional 500 sq. ft. or 10 () A- o/Wt;5/ D Wt:::it- t:t:h1 S77!4wrtion thereof Over 600 Amps or 1000 Volts see "B" above. , Signature of Supervising Electrician D. iB~i1!.c@!~if~~~~~~~t'i!M . /Zl-- u... / / New Alteration or Extension Per Panel Gf / . /Ifb TL1 ATTI=t\ITlnN: Orecon law ~\fOU to $ 43.00 {/ , follow rules adoptedrby thel01Q~b\1illlVircuit or with . Owner~Name G.i~bvdci9~c~aticfYf~o/\-1Jh05eRll~G!lIW~_~nnit $ 3.00 tr1 ut\rJ ;:l'J,-vv i -361 0 through",Q!.~:t.~~?:Jt9J~;5f-~'!ii'~ >'\~i"~ffi~'y!"~'~J.'-'~"":\":^l""-''!''J:'"\~I~''''' ~,t"r1 Address "37.7t( ( ft~I~<)r-rlmli mav obtain co/1al~fDIl9YtilJ'~ryi~!lf~j~.~~!,1.~_C)Ji~!~);;-.ffi~~I.!'!t~Ua.p'0~:1 eu.6-bY'c::~ calling the center. (Note: the tel~phon.e City Phone"u" ,~v, f.:., t~,c 3regon uKi\WlNI5t1~ . $ 50.00 Center i51.800-3~V.me Llghtmg $ 50.00 , Limited EnergylResidential $ 25.00 Limited Energy/Commercial. $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ,.. ~~""_"'""'O"'~""", ~"""'."'."'~~.'/l!'~'~"'j"""'~'il1 b 3 4. '-SUBTOTAEOFiABOVEn,,!'I> 'Y"~""<l')()/\-; . . }'!,~.~flqy\...~"!';ii}=-~~'(~->ii:.',.,.ti'~..l:\fJ'-t,y,:';li:~~' . lfi( I 6;;ro 7s~ Permits are non-transferable and expire if work is not started within 180 days of.issuance or if work is Suspended for 180 days, w., ..(loNfRAiIT:oR'INS,'TAL:Dr'iiON.iONLYi~ . 2. ~'l."""-;:""~\J?'fil:_'1"fidi/t'q;.j;J1~"1i/':t:"&id.t;.,.n""i'\:ll!.~",,~e'~..'~.,. Electrical Contractor L-i /E;. ~ C- Address (6 . ~O'K / IJ ?q City f:::06f:#~ Phone 6f~fqqb Expiration Date ~C:5'35 /0 ~ol./ c;Q1lfS 5/0b Supervisor License Number C.onstr. Contr. Number Expiration Date OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 $ 19.00 Each Manufac!' d Home or Modular Dwelling Service or Feeder $50.00 ~~i;"~<",/:jh.~.';~.=..t)-~"l'~~~~";;;~"'l:~~;P''i'~-'1'''':~~,l;."t'''","'-~~~'-.N B. ,Ser.vices"or"Feeoe"'r~~lnstllllatioh; Alterations or. Relocilt,ion:i"'<l '~~;i~e'JO'~':.:.wi.l\~ ~~~'~':Y"","'..,a;..>'''-':'''tL.I.'''~~~J 03~ 200 Amps or less 20 I Anips to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsIVolts Reconnect Only I $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 NOTI~~~p'1ftfi'iiTs~.\Yi~1~rLF~e>i!~~~~~~ THIS P.fsa.bUlio'b.~uit'i:ql\r<lf~IIff1'Ci'WORK AUTH20~I~slMJPern THIS PERMIT I~ Nnr cOMr~~NAJiAQfl\66~OONED EQQ , ANY ~~~ !M,~sR~6ll~limps. ' $ 50.00 $ 69.00 $100.00 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FonnslElectrical Pcnnit Application 1-o3.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINlJ.f<l~LD Building/Combination Permit PERMIT NO: COM2004-00684 ISSUED: 06/10/2004 APPLIED: 06/10/2004 EXPIRES: 12/10/2004 VALUE: SITE ADDRESS: 5691 Glacier Dr 5693 ASSESSOR'S PARCEL NO.: 1802041104500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: 100a Qwest power pedestal Owner: PRASAD GYANENDRA & SATYA W Address: 3274 LAKESIDE DR EUGENE OR 97401 Contractor Type Electrical I CONTRACTOR INFORMATION I Contractor TONY KOTH Phone 54 I -688-8996 # or Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description License 59748 Expiration Date 05/04/2006 DUIL"U"-, u~FORMA TION I NOTII~I!'~Stories: Lot Size: THIS ~Je~~o~W"N-rf~PIRE IF THE WOR~: :: ~:tdF:~:;~: AUTHCWatf,cT~~9ER THIS PERMIT IS NOsq Ft Basement: COMtvRaligHi'ypll: IS ABANDONED FOR Sq Ft GaragelCarport ANY 1 miemYffliillftlOD, Sq Ft Other: Sprinkled Building: nla Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMrROXl;~TI to AT1ENT\\J,.., d' -~d by the Oregon lity., Sidewalk Type: folloW rules a op se rules are set form . Notification Center. Tho hOAR 952-OO1Downspoutsmrams: in OAR 952-001 -O~~n~~~~s of the rules by 0090, You may 0 te' the telephone calling the center. {No Utility Notification . .._..M-.o.nrp.oon , "Ull...........- --- ....:.';. .~--'i Center 15 ,-0"" --- . ,-valuation Descrintion S Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Value Date Calculated Total Value of Project Paee I of2 . . Ll1 i' OF ~r,Kll"l"<I~LD' Status Issued Building/Combination Permit PERMIT NO: COM2004-00684 ISSUED: 06/10/2004 APPLIED: 06/10/2004 EXPIRES: 12/10/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ~Ff'f"~ Fee Description + 1 0% Administrative Fee + 7% State Surcharge Perm ServlFdr 200 amps or less Amount Paid Date Paid Receipt Number $6.30 $4.41 $63.00 6/10/04 6/10/04 6/10/04 1200400000000000882 1200400000000000882 1200400000000000882 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. I R..nuirf'd \lw'f'~tion'l.l 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 an work performed shall he 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 he used on this project. 1 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 225 Fifth Street S~ringfield, Oregon 97477 ~1-726-3759 Phone . ~ IfIi.ty of Springfield Official Receipt .velopment Services Department Public Works Department RECEIPT #: 1200400000000000882 Date: 06/10/2004 2:S6:23PM Job/Journal Number COM2004-00684 COM2004-00684 COM2004-00684 Description Perm ServlFdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By Item Total: Check Number Authorization Received By Batch Number Numher How Received Amount Due 63.00 4.41 6.30 $73.71 Amount Paid Check LITE ELECTRIC djb 6489 In Person Payment Total: $73.71 $73.71 6/10/2004 Pa~e I of I