HomeMy WebLinkAboutPermit Electrical 2005-5-18
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SPRINGFIELD
1 .
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~ ~
. ELECUUCAL;ERMlT APPUCA110N ;J;- _ _...
City Job Number t-()(v12.D05 - OOS7Lf. Date~'f11lr~? '.. ....
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JOB DESCRIPTION . . ~ 100q&f!o~ f\!il~adopted b the eJ Ut$.ffii~~
. ,^Ar\ fA" ^ (~ Eaf~~l\1E!\.'?IBiH991~!lJtft.l;Mse" ~]~s,tfo~Ff-~
f.cfLvru- P,"~~ l1f . '~6i&9'5f2_001-001?throuat1~52., ~9.00
. Permits are non-transferable and expire ifwJrk is \ladll:iinlnufal;t1(!1Hi>mll1b1'n copies 01, e ~~
"not started within 180 days of issuance or if work is Modu@!r~llin8'SClVic& dr"lote. the telt,. hone .
Suspended for 180 days. Feed~umber lor the Oregon Ut;'.';' ~1"t,fLr~..s5Q.00
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2. ~!lt!f.fAC!!OR7I1'fST.A'!.~~Nk'X~ B. ser;Vi~es.or,~e~e;;~~.!!i'=~~t~~~!~1f~~!~~eloca!!6n~
Electrical Contractor Jhi:h:Jf< 'fU= :r {)ok 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 AmpsIVolts $375.00
Reconnect Only $ 50.00
Address 2li D
~}.:w-.~,:/"
City
lS./(4~ Ooff- Phone q2./-<;"..<;rO
Supervisor License Number .q /7;)" S
Expiration Date i 0 - c 1- D I
Constr: Contr. Number f Y (,71.J,,-
ExpirationDate OJ - W- 0 I
Signature of Supervising EleClrician .
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oLName f--Au'. / ().;h~^J
Address .6L IJ i>lAOi"v-- &"05 f' ()/Aer-
City <:.,/)f.vv2 97';77 Phone ~- ,7
''IIZ- &6&5"
OWNER INSTALLATION
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: .726-3769
C.l~!~!~~rY1.~m!i~~F;~~~~~~~1b~
Installation, Alteration or Relocation
200 Amps or less $ 50.00
~20ifA'mPs to 400 Amps $ 69.00
T~o~ AmPs,l<?~6QJl~!:sEXP'RE IF $100.00
~'c\W~o6~~P's'~rPOOi"))!\Ss,~e..~.\1[b~~!~~ ",.
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ANAFf~~cA~rcu~RI!Jn '\; ..; rL~:<""~~~~':'f'~~~:~~
New Alteration or .Extension Per Panel
One Circuit J
Each Additional Circuit or with ? .---
Service or Feeder Permit ~ .., $ 3.00
$ 43.00 .
43.00
(05,00
1.$\~',-w~cs.".::K~""-~'" ,~':V':"?>il~',I..'..V~VI"'~"'~ ._<~.,,-ri_._ ..-..~ '''''':; -\.....',.'.1"li>."""""........='l!'....~oI.Jl'~.,
E. "MiSceiIaiteoust(SerY;'ceJfeā¬der;iiot'liicj'1id~i1)''''EaclDfnStallilllon~
~"",",~r.'l'~~~"'_~'~'r~=~~4:.".....""""" ...;!l.":.:'_...."UI..".:::....~..,~
Pump or inigation
Sign/Outline Lighting
Limited EnergyfResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. ~UBfOTA1~OF:~o~j:,;~~~,-"."'J.p. :"s~.i~~~.
"'~..t"".;t,-"""1t<i,,,.~,~~~cr~1t-i~ /4-~. 00
10.3("
~n
113. ilo
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:YBu;lding FonnslElectrical Penn;t Application 1-Q3.doc
.
. UI l' OF SPRIrljul'lJ<..LD
Building/Combination Permit
PERMIT NO: COM2005-00574
ISSUED: 05/16/2005
APPLIED: 05/16/2005
EXPIRES: 11/16/2005
VALUE: \ requires you to
ATTENTION: Oregon a~, _ "_nnnn IJtili1V
,f,...lInv.I ruleS aaut'l-=-..... .., 1 .' ~ . _ _ ;.".,... C'ot fnrth
SpringfieldomEr6{.'wORK:~Eh;~t;.i;~I- iv.orJ{Oolf]01-
in OAR 952-0?1-~Ut~~n'~~V;~~ of the rules by
OUtI,uJj,IOF, USE:b Rep*. the telephrRilSldential
calling the center. \I'i~ ~ti\ity Notification
number for the Ore~~~ "",,_')'\44\,
l"enLt;1 1.oJ , _f.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRES.S: . 660 HAYDEN BRIDGE PL
ASSESSOR'S PARCEL NO.: 1703262100600
PROJECT DESCRIPTION: Replace Panel.
- Owner:
Address:
CARLSON GARY J
660 HAYDEN BRIDGE PL
SPRINGFIELD OR 97477
I CONTRACTOR INFORMA nON I
Contractor Type
Electrical
Contractor
MITCHS ELECTRIC INC
License
146745
Expiration Date
01118/2007
Phone
541-747-4483
I BUILDING INFORMA nON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
Height of Structnre Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Tyji~';lTICE: Sq Ft Garage/Carport
Energy PatliiS PERMIT SHALL EXPlrsq Ft O'tiier:'UKK
Sprinkled:J,l.!l!I~!!g:IZED UNlw8\ THISOcc'ilp~'Jt 'Co~diT
__, ___ .....-......... an...U"""I,t\ rnn
. ,....."". .",.. ., ,.,. ." ,......" ......... .-- . -
I DEVELOPMENT INFORMAHON)llD.
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:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDralns:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pae.e 1 of2
.
. Ul l' OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00574
ISSUED: 05/16/2005
APPLIED: 05/16/2005
EXPIRES: 11/16/2005
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
Fee~ Plli!U
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$14.80
$10.36
$43.00
$105.00
5/16/05
5/16/05
5/16/05
5/16/05
Receipt Number
1200500000000000628
1200500000000000628
1200500000000000628
1200500000000000628
Total Amount Paid
$173.16
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.
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 agree to ensure that aU 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 aU
times during construction.
Owner or Contractors Signature
Date
Pal!e 2 of2
225 Fi~fh Street
8,p?ngfield, Oregon 97477
541-726-3759 Phone
.
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.City of Springfield Official Receipt
evelopment Services Department
Public Works Department
Job/Journal Number
COM2005-00574
COM2005-00574
COM2005-00574
COM2005-00574
Payments:
Type or Payment
CreditCard
5/16/2005
RECEIPT #:
1200500000000000628
Date: 05/16/2005
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
MITCH'S ELECTRIC
Item Total:
l:heck Number Authorization
Received By Batcb Number Number How Received
ddk 133560 In Person
Payment Total:
Page lofl
IO:49:58AM
Amount Due
43.00
l05.00
10.36
14.80
$173.16
Amount Paid
$l73.l6
$173.16