HomeMy WebLinkAboutPermit Electrical 2004-11-3 (2)
.' < CITY OF SPRfNGFIELD, OREGON :'"
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: ~1~6-368'~; "": .: . ..'
ELECTRICAL PERMIT APPpGA,TION . . '\ ~~., '? 9, '.
City Job Number COWtl.Oo'-\-D (3b( Date 1I~?'D4 . "'0- ~ "'1,\. .
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I. );';f<YeA'!i;ta' dkJJ!NSiIfAlrW'~riff€)N~112JJI11A~ 3. ~(jMffi!.i!iuisjgJii5s;'" '". '. ~>1!lII'(;_
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J\.j) < H!trLIJ-tc:, 1 l-O'n f/ fl,InTlr.F'.. ". . ,,(;~\
LEGAL DESCRIPTION . . '. ! .': "\ A." ~~' '.',. itllli""'. . ,,' ";.'V ..", . uni. i'"
, "^/"70'.:s'Zi'i33-\'O'.'CYZ-(!)O s 'l.l,lTU!'I(!,17.FeilD UNOER1HI~ ~ .K. 'N. ;) I'u., "'.<
~ u., ..:"7 .. ' ,_ e"..CeIncuu NEll' '" o-~
JOB DESCRIPTION t" . loOO1~Nt~~G.fsP OR I,S ABANDU .1 106.0%.0~
n EaMla&diHbMl rsOOPs~.Prt.QJ;l, ~
C,I1L""':-.\'" I--vL S"""",11 portion thereof
Permits are non-tran~ferable and expire if worJ is Each Manufact'd Home or
not started within 180 days of issuance or If work is Modular Dwelling Service or
Suspended for 180 days. Feeder
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 Amps/Volts . $~7.~~o
Reconnect OnlY-ION' Oregon laW requlI "S Ji. 0.,,,
ATTENT ~~...'L~~~ uregon Ill.,..,
C.~~!~~~g~
Installlttl'on~,(ltl!ratlon 8!i~aU'!in's of the rules by
. (l!}Q() "OU may I" th tl'~p.nh&\ne
200 tunps O(.IeSSthe center. (Note: e "nu:oa\ior.
. 201 Amp~%\Ilb'Or1B1~1e Oregon Utility l'>l~~~'im .
401 Amp$1tlP6bntm~r is 1_800.332-,..,4i) 00.00
Over 600 Amps or 1000 Volts see "BOO above,
l!-:~E_:"1 f,k^1"'" D~
L I Each Additional Circuit or with F)
Owners N e lJllr4't1 WOOD CJ1IUSll en. ClvuJtYervice or Feeder Permit 0<--- $ 3.00 ..J, ,f) 0
Address ~lf;}-(, .J.liA1..uCl\,1 ~ E.l~~~~~~~~i,~~cifciJr~&if~~
City ~~ _ Phone '7 '{{". - ). 770 . Pump or irrigation $ 50.00
. Sign/Outline Lighting $ 50.00
Limited EnergylResideniial $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee Is 545.00 + Surcharges
4. ~w~If~~"fi1J!1:m.~.~;\',m
~~"''m.~~~~~m
tjf~
8,V~
10% Administrative Fee t./ ~ (j
_ ,,~ >At{}. ..l.OTOTAL, .,. . 51. 3 J
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Electrical Contractor (I h (.1' ">'\ M sun Vl, I a. ~ I 0
Address
ld-.'H
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City r LlC, 6\J ~
Phone 1o~S- -(,p I ~ I
Supervisor License Number' 37 5tj S
10101 101
Expiration Date
Consn-o Conn-. Number ;) r;., III <1 c...
Expiration Date
1\1 IO(p
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
o ~ oo,qo-..l 7
.;h.~;;,...
$50.00
, ."'!;jf_"""$.....'!\lIW'liI_~_~=''''m:~",.''''.-
B. . ... rNlces~or.,~eeuer:!1~lnstaU3ti~~AlteraDOD tfQl\r,Keloca o~:.
7% State Surcharge
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2004-01361
ISSUED: 11/03/2004
APPLIED: 11/03/2004
EXPIRES: 05103/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2425 HARVEST LN
ASSESSOR'S PARCEL NO,: 1703243300200
Springfield ,TYPE OF WORK: . Electrical Work Only
TYPE OF USE: New Residential
PROJECT DESCRIPTION: Circuit for sump M01ICE: XPIRt IF THt WORK
_,,~ ncoM\1 SHf:lLL t _ _~n>m Ie. NOT
Owner: NORTHWOOD CHRISTIAN CHURCH ~l;1KO-R\lto UNOt; ~;AN[r:~q!!~NU'Di'ber: 541-746-2790
Address: 2425 HARVEST LN SPRINGFIELD OR 97477'OMMtNCto OR \
l. __ n^V amIGO.
f\Nl IU'"'....
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
CHRISTENSON VELAGIO I!"C
License
64137
Expiration Date
07/14/2006
Phone
541-688-6121
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
R-3
n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I 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:
" . _ ,'_'" .........lItroe. \lnlJ to
.. . ~ ~"" . ,. ',,,. '-" .....::;:1--. '-'. . .
I PUBLIC IMPROVEMJ;:NJ:S,I. adopted by the Oregon Utility
.' , ThMI:\J\.Iles are set forth
Notification CenSiileWlIIK' I yp,e:OAR 952-001-
. OAR 952-001-0010 through
In DownsDOutsl!J'l!IlQ~:3 rules by
0090. You may (jUldl""'vp'~
calling the center. (Note: the tele~ho~e
number for the Oregon Utility Notification
Center is 1_800-332-2344).
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee I 012
.
. CITY OF ~rKll'lu1'l1!,LD
Building/Combination Permit
PERMIT NO: cOM2004-01361
ISSUED: 11103/2004
APPLIED: 11/03/2004
EXPIRES: 05103/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees P3id I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Receipt Number
$4.90
$3.43
$43.00
$6.00
11/3/04
11/3/04
11/3/04
11/3/04
1200400000000001558
1200400000000001558
1200400000000001558
1200400000000001558
Total Amount Paid
$57.33
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 Reouired Tns,rections I
Rough Electric: Prior to Cover
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 agr~e 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 2 012
225 Fifth Street
Springfiehl, Oregon 97477
541-n6~3759 Phone
.
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Jiij"ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
Job/Joornal Number
COM2004-0136 I
COM2004-01361
COM2004-0 1361
COM2004-01361
RECEIPT #:
1200400000000001558
Date: 11/03/2004
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
llem Total:
Check Number Authorization
Received By Batcb Number Number How Received
Check
11/3/2004
CHRISTENSON ELECTRICAL
djb
In Person
Payment Total:
.1097
Page I of 1
10:07:2IAM
Amount Due
43,00
6.00
3.43
4.90
SS7.33
Amount Paid
S57.33
S57.33