The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2004-10-5 I ~I. I, ill ~ ~ ~i' i'~ 111111 I It i'~jlil II " Il: SPRINOFIELD ~~1 0/,<" . M 0" h. A'""""J . ~ --A,"~ot)~~Cr~~ 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (S4I~6-368ct../ ...,~~~ at'~,~ -1. ~@ o;,~~;'~l~~ ~J' '~ ELECTRICAL PERMIT APPLICATION v~ ~~., ~o;,:"~;~" . A"L 10 ;c+.~ ~ "o~1f' City Job Number Cout 'ZJ!X)& ~ ~ l'2. '" ~ Date , O~".. ~, ~~.. "'v6 ."..--., .'.".'.' -. ....... ..-.-".,' I?'COiVilfETE'PEEiSCii'E15ffi '-E'lv.~i:".;.,., "~";;&~' 1. 'i:k~TI,Q1Yl!F:,!!~$r#YTJJJ,!f:ift-hliil~(:j 3. l:.:=;,~"... ,. ,...,'." ,.. ,..~".=; 7~ 11;;."<,,.:OtS>Jt..~", ~",..J.\ 3L'fEOSA7L DEJ+SC6.:.RI\.lpd.ennON'B; :U'\~;~14-1'7 A. ~1Rv7ft~id~\';'".ti.iI':Y~ie~ti(Mt'~j-.~\;~*~~~~~""'.:~::-:j \, ~imz~JN_.o;:tJ.;,c","-"'~'~' --L.-~J ."..,,,,"",~~,,l "i.: :tO~ ..... '~~6:"'%~ /7 D ? ; q 0 0 0 '3 -3 00 Service Included JOB DESCRIPnON'::rpB~ ~12C 1000 sq. ft. or less .;l3iO'j IN '1-~'a-3~ Each additional 500 sq. ft. or ~sfCI f( l~ 70VJ<2..y l/QmQ L- portion thereof Permits are nen-transferable aud expire if work is Each Manufact'd Home or ~ net started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder 2. l~~iWMrrqi~iw~f~f:t\fl?iYj~qRly~ B. ?~!t~.~~~~~~~<:~~!~1~~~s~il~!ll:;,1\it~!:[t~~~{9,~J1~R4;tJE]f~:~ I . Electrieal Contraetor lSwe. 8 SOO AT.\!. Address t;.""l A (/F, City 8u..<7evuL rDf2... Phone 4i 4- .d4j,fJ~~"\ ,\'0'<-'S ~ ~~ ~'\'\J~ Supervisor License Number 4-0 ~~~~,Y'V <.; . ~'v'v ~ "\~" ~'V~" Expiration Date A.(Y .-< m,<f!jJ.~ ....'O~ \"~ ~". '0" \':l' ,(\"\ Q~~ ~'V <;J<(-. !\J'V' Constr. Contr~NiJliiber('~'\) _<-'V ^y~ '\'<'~,\'0' ~~v ~ ' Expiration Date ~_("\~~~":J 'V . 0" . 1C fS ''''~EI .. ature 0 upervlsmg ectncmn , ~.S,~ . -.J 0 Owners Name Ew B 8 Address SCt:;> (5 -1-T f{ City e(;..G~. Oe.. Phone ~+,~41r x Ci l~ I ?rld(;. 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 $50.00 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volls Reeonneet Only '-. $ 63.00 $ 75.00 $125.00 $i63.00 $375.00 $ 50.00 c. l~Jr~ffi"t"~;l~s~fVit~~gF~Wd~is~~~i';~~~;~~:~'~~"~;ff#1[f~::fi.~)(~;;~~;!ll~fj [j.~_, """,'''' P...... !':Y" ......, ......_~_.,...<'".."..., ~".^".,.. 'it)';., ./.oJ;;:,,", 'c__. ,,) ?\~_.A'":;<'.. ...,y,,!,,. '..^~'_" ~ Installation, Alteration or Relocation '" 200 Amps or less J $ 50.00 50. on 201 Amps to 400 Amps ,0 $ 69.00 40 I Amps to 600 Amps f.> -\O~,~~"'\ .V"o. $100.00 .~0 ,,~o\. D o!~B.e~~O?h..~C~~~c~~ ,~,m~~~~~e..0~ ;~l,,:~ .lj(','''.'':;;;"..'5.''':-'': ,".;1 . . ranc .~ lr,CUlU~:-:'~"'~~e..'v~h~-:J.,,(A""'Jl\~:" ..'-.'.'..,;...:.-......--...;.,. ..1:'~''''-'""" -', ., -, '.o;~~"""~'O"'~~'4.\)''QS~''; ..' - .., ".>--. New A1tee!ibh t'T-1O~Jells~D'''~a~ ~o~ One CiriiUi~0\>'0 ,\,<p '!0~0'\0'" 0 ~ ,0-0 ,~,&- $ 43.00 EacJi:-Xddi"iio 'V~ cuit nl'>'With'\<' ~v' . " ' ",,-,,111' ~." >:r ~' .~.~. /., :\S~rvice or<j;ee~? !;(!lilt ~o \:)~_<M' $ 3.00 "" . 00 ~,c.~~: ~\\~4;~~~\.~1'~'1:1j,?:~:".""", .... -' ",.1-"4''''''1 E~~~~~~4$..~i_\-~.r,z:n9t, in~'"tf~.ed).7.];;~~Il;t~t'!..I}.~\!!'I!\ .!:' R). ,,~ ~~ ."" p~I1W~r.eng~dR 0~0~ $ 50.00 Sign/oJ"ilwf''Ligftrlng $ 50.00 (' Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~:;;t:,.,,-<'l' - ~'f~\'I<'2r;;i;!":~~;;.~'i' --<;:r:.~<:'f~i:i.~1.-;p'-t.'::;\$'"J';,h1. 4. r'SUBTOTAL OF'ABOVE;,' lh,."".',.,o;' ,.),.C: 11> r k,.i sv"'~,.,.c..~:;,_:...."':i!/\:~ ''8'.'~.,i.''4'-:'~.~~' r?;:;";~~::::-fi~:' .;..j : <:: . ,!Cd. 0 D 4,34 fo . do 1f"1~. 54 7% State Sureharge 10% Administrative Fee TOTAL Shared Drive(T:}lBuilding Forms/Electrical Pennit Application !..o3.doc . . Lll t' OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01243 ISSUED: 10/0612004 APPLIED: 10/06/2004 EXPIRES: 04/06/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3957 HAYDEN BRIDGE RD ASSESSOR'S PARCEL NO.: 1702190003300 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Industrial PROJECT DESCRIPTION: Install temp. power panel. Owner: EWEB Address: 500 E 4TH EUGENE OR 97401 Phone Number: 541-484-2411 Contractor Type Contractor I CONTRACTOR INFORMATION I License Expiration Date Phone BUILDING INFORMATION I # of Stories: Height of Structure TY.l!.e of Heat: ,-. ,~~ater Type: ~ ... RalI~e Type: & '\~ ~E'new Path: <>..<V "''1A:~. -.~ ~inkIed Building: ^'-,.... ("\v ...v'Jr ,>\~rDB~ELOPMENT INFORMATION I ~,o~ ~~ f:<.,Q;.. ,&,. r:, ~O 'J~ ,l~' ~ REQUIRED PARKING 0~~ .~~~~~ Front yard Setback: ~"~ ~ ~ '\; ~<::>. Overlay Dist: r:f" <o.:f? 0 ~ fD<!; r:,'<)Total: Side 1 Setback: ~<;J<:/.<v~ ~<::> ~ '\<v~ # Street Trees Rqd: ~ ,<0 0<; r:, ~ ~ OJ ~0 ~~{!.dicapped: Side 2 Setback: ~ ~C:J ~<i!- ~"'<<:; ~ Paved Drive Rqd: ~,'I> '$'<0 ,~<o O~ '$'<0<; lifO $-ornpact: Rearyard Setback: ~ :;:;,"'~.iff ':;::, <::j % of Lot Coverage: ~ o'<)~ r:,<O if 0- ,~<o ~v Solar Setbacks: ~ \:)~ ,'tJ 0,0 ~0 ",,<:-0 ~O .~., ~<o ~o l:\" C, ,...\.. _~. .,,~ _~',,~.'>:.~...~ ~' I PUBLIC IMPRO.xEM~1:St~<:;'~<i,>" ~~o~ 'J-:~<j,J AV ,~ ~ 1! (3) w"" .('..0 N.~ ~. o~ ~O aP #0 ~o~WlI1*..)'lype: :>$ .(,'1> O)"=> <$'. (,0 0.: ,0 iJ! ~ .10-<> ~<o ~NJSpouts/Drains: ~o O~ -:' ~'>: ,& ~t- .-s- ~O)<:; ~<::' rtJ- r!lJ<::' ~ c1~ '" ~v # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction I Valuation Descriotion I $ Per Sq Ft Square Footage or multiplier or Bid Amount Value Date Calculated Total Value of Preject Paee 1 of2 , , . . CITY OF ~rK11~hl<mLU Building/Combination Permit PERMIT NO: COM2004-01243 ISSUED: 10/06/2004 APPLIED: 10/06/2004 EXPIRES: 04/06/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I F,.,.~ P.\lid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $6.20 $4.34 $12.00 $50.00 10/6/04 10/6/04 10/6/04 10/6/04 2200400000000001246 2200400000000001246 2200400000000001246 2200400000000001246 Total Amount Paid $72.54 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. ~r"d Tnso,.ctions, Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, T 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 ;g::"~"':. ~ /0 CXb.04- Owner or c~s Signature Date Paee 2 of2 225 Fifth Street Springfield, Oregon 97477 " 541-726-3759 Phone . Jeb/Jeurnal Number COM2004-0 1243 COM2004-0 1243 COM2004-0l243 COM2004-0l243 Payments: Type of Payment CreditCard 10/6/2004 RECEIPT #: iil~ ar of Springfield Official Receipt "elopment Services Department Public Works Department 2200400000000001246 Date: 10/06/2004 Descriptlen Temp Power 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By GREG BLACK Item Tetai: Check Number Authorization Received By Batcb Number Number How Received jmp 087464 In Person Payment Total: Page I ofl 1l:29:I7AM Amount Due 50.00 12.00 4.34 6.20 $72.54 Ameunt Paid $72.54 $72.54