HomeMy WebLinkAboutPermit Electrical 2004-6-23
cl as submitted has the following
not reqUire specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PII:(541)726-J75J . FAX~r!iJW'26-J68Q L D v<--
ELECTRICAL PERMITAPPUCA 110N Zonin~
City Job Number CPMzooy.-007L( I.{ Date b~L5 -O~( Date (riJ.S-ofJ.
Authorized Signature 9'S
3. .. COMl'LElE FEE SCHEDULE BELOlV .
200 Amp< or legg
20 I Amp< In 400 Amp<
401 Amp< In 600 Amp< \NOQI{
,mn.:t\C~'. 60 I Amps ~~qo.V\'Ol\f; "I"i \S \'In1
4 ~S- 07~~?t.I'\Cim~lw\fO\. o'V~~R~"'~\ ~QR
,,\\\1'5 QI'\fi.~m\~ - 1~~I'.~\)Q~t.Q
, 11-\\"\\'\ ~t.Q QR \S
CQ~~~\) ~P!l'~9~hvices or Feeders
II-~'i \0
Installation, Alteration or Relocntion
'.' ",,""~.' .
1. ; LOCA110N OFiNS1'ALLA110N
..:'...<......,... . , .. "' I. I . 'r
Nend€-1~() V\
/'/Olo
LEGAL DESCRIPTION
1703"3 ~(3L{
DIQoo
JOB DESCRIPTION
YV\lI(P r,ron5~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
-rlt......!.,.:.;"';....... :.' . . .
. .CONTRACTORINS1'ALLA110N ONLY
2. ~ _.....?;j.I;'.t;,"";~..J,.< '_,.".. .j" '.' . ..~'.. ,.... '.; ,1_,"
Electrical Contractor R! lI'ldp(S . Uec+rr '<:. ,,)C
Address
IClC) MClC/,,~()r\
City
!S'1)3 {' n ('
Phone
Supervisor License Number 3:190'. S
Expiration Date I D' 1- 04.
C~nstr. Contr. Number 4 ';:lq ( 0
Expiration Dale \'J - 10- 01
Supervising Electrician
tJ'b
A-N((::L is /.l (L,Q;\f
Owners Name 0 "'n 'S. t I' \ IeVI')
Addre.. 170 G ~clc-5-,,^--
City i::;:vL C:r-rrtv g Phone
OWNER INSTALLATION
The installation is being made on property 1 own which
is nol intended for saie, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A. .Ne,\ Resideutial- Single or Multi-Famil)' per dwelling ullit.
Service Inclllded
1000 sq. ft. or les<
Each additional 500 <q. ft. or
portion thereof
Eaeh ManufacCd Home or
Modular Dwclling Service or
Feeder
$106.00
$ 19.00
$50.00
B. ,Srn"icrs or Feeders - Install fit ion. AIt("r~tion~ or Relocntion:
I
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
&~-
200 Amps or legs
201 Amps to 400 Amp<
40 I Amps to 600 Amp<
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volt< sce "D': abo,'e.
D. Branch Circuits '
New Alleration or Extension Per PMU'e& yClll.Ul
One Circujt ,tol:,Ote90n \a'tol .,~ ~llQ
Each ~l\~~91~~>cipwdJ+t\\ \tI6 tu\8S ate se\ ~
servi\iS\\O'IIf<l~ceRllit, 'thOSe o;.&\g!tl-tlM-
~ot\\\catIOn 1.(lO10 \hfO\1on \)\9, cu\8S \rf
E. IVW,ee/llilAlilHl?er80tfLffCI!JilIAA ~~~~Ch IlIslallalloll
0090, 'lou ma'i ~et O'lote~ \tI6 No\i~
Pump or~\l.'Ik;I~ :Ot~~3M).$ 50.00
Signlout\~nilfl~~\lI' $ 50.00
Limited Euergy/~'dential $ 25.00
Limiled Energy/Commercial $ 45.00
Minimllm Electric Permit Inspectinn Fee is $45.00 + SlIrcharges
. 4. SUBTOTAL OF ABOVE'
(0 -=<, -
Lf Ij(
bJO
7"3 ?l-
7~~ State Surcharge
10% Admini<lralh'e ree
TOTAL
Sh:ued Dlive(T:VBuilding. Fonn~/E'eclrit:nl Pcnnil Arplicntion I.OJ,doc
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00744
ISSUED: 06/23/2004
APPLIED: 06/23/2004
EXPIRES: 12/23/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 1706 HENDERSON AVE
ASSESSOR'S PARCEL NO.: 1703343401400
Eugene
TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Service change
Owner: BARTON DANIEL A
Address: 1706 HENDERSON AVE EUGENE OR 97403
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor
BUILDERS ELECTRIC INC
License
4296
Expiration Date
1211012007
Phone
541-485-0922
I BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: R-3 Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VN Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: Ene~l~
"O't\C~:. , ."'PIRl:. IfS~\:IIik'i B,ilding:
'" " ,_ "u~\ \. ~" __.n,. tc, D
1\\IS ~troI~O U~OEP.1i\~~~~Lij~NT INFORMATION'
" "'\l1\\~Et~CEO 01\ IS p.\/..,
Froutyard SetbackCOWl < a\) O"'~ ~~P.IOO. Overlay Dist:
Side 1 Setback: M~~'''' # Street Trees Rqd:
Side 2 Setback: Paved Drive Rqd:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nla
REQUIRED PARKING
Street Improvements:
Storm Sewer Available:
Special'Instruction:
Total:
Handicapped:
iompact:
. _".a6~ ~
:-~t<<\\~~~o1\~~
I PUBLI'- ll>IP~Ml~i~~,u\99;;9Si.oo;
~\\~=ce~\~~~~9~~
~o\i~~.o\)\ ~~~&,p
'" O"'~ ~~.-t. ~~;;tio\"'-
fi:J9\)' tl6CU"":......-t\u.. ~.
~\flQ \o'~~
~ CI)~\S
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee 1 of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00744
ISSUED: 06/23/2004
APPLIED: 06/23/2004
EXPIRES: 12/23/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I F....s Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
6/23/04
6/23/04
6/23/04
Receipt Numher
2200400000000000833
2200400000000000833
2200400000000000833
Total Amount Paid
$73.71
I Plan Reviews ,
.
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..ouir..d InsoedionsJ
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 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
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
~~.IlEY?,.'."._..._"".
~
~fj\
~ of Springfield Official Receipt
_elopment Services Department
Public Works Department
RECEIPT #:
2200400000000000833
Date: 06/23/2004
9:06:13AM
Job/Journal Number
COM2004-00744
COM2004-00744
COM2004-00744
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard BUILDERS ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 000418 025120 In Person
Payment Total:
Amount Due
63.00
4.41
6.30
$73.71
Amount Paid
$73.71
$73.71
6/23/2004
Page 1 of I