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Home My WebLink AboutPermit Electrical 2004-9-7 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH~.(541) 26-3753 . FAX: (541)72~a'9tlo.., . ' ~ ~ ~ ~ ELECTRICAL PERMIT APPliCATION 'lJro.~/"C/~:rOfeCI a --> Ql( , 9s 9S City Job Number COW\'ZOoi{- 0/10 15 Date /, /, o. ~ "01, SlJb",. qf~ 0";1) .. 9qiJir. l!tea ~.." ~~ ''''~-'-''-i'''''''''~'\.1'''<~~"~.<:,,.':'-~~.'I.-''~F..t1r''"'.p:l. '. .!. I "'.;"":>'...,..'~. .. "-~"'~~-.;':'h~~"'iI..~~' -'"Q,~~l'.,:q .,~. ,."..".<>.~...-~{i/Jil1l:1$. 'tP;'~..J'1:f 1. i""LOCAnON~OF;INSTA1:I3AT10N.",: i~';," 3, L,COMPLETE'FEh"SetlJ!}nl TL 'L;,o)'", f@.9it;' "9)i""; . l..".;,..a....'.' ,~, '-..:..:.."'H....&iJ.~.il~<..t.~..,;;....:.Lh.::~..iE~:,;,;^":;?..;;:.4!J; ll.:.i(;at'....}w;.~.,~,..:-.;C'i.;.lc,..L,;,:;:~J'.i,;,~~G"d..s"'i:l:.-.,~ ",:,:,::,"", '- -'l\.::, ". ~~;P;.I'i;i~ g!lo/t:. 3Lib yr;iJ-/;V 51 ' ' ig"9flJr. '5=- C/IJS9 '''0 :;."....~7''':.~yTt,.tt '~.i'Off~"'.:~fff::.;;.-:,~":.;..,>r.~,ry.".e,., r..._.: 'J:.-;.'<, ~ A. ~~<~~~c'V~~!!~~~,!it!i!~.'~:SJ~gt~.iir.\i\~~)~i:fa)l~1 ~-.. er~~ -------"'--'.-. ',-' --...--- ~.. ''', - LEGAL DESCRIPTION 17033S'5 ( b7 L.ao Service Included .' 1000 sq. ft. or less Each additional 500 sq, ft, or portion thereof JOB DESCRIPTION A)\~ I D c.,~-;-h $ 19.00 Permits are non-transferable and expire if work is Each Manufact'd Home or U \0 not started within 180 days of issuance or if work is Modular Dwelling Serv~gf> 'l~~\i\'f $5000 Suspended for 180 days. Feeder 01' \a.~ 1~le901\ ~ \0$,' ' 2 ~~pNTAACT.ORfINST-iLLir'ridi./roi~i;~71 _"'Il\'i\\SW~~:~f,iFt8~~tl;i~~$1rm;~~~;~iT;el~~:ltiOll: ~:,.J, . ...oJ.l"'-.'_. ~ ~""""'U"'-""''';:~''i,l . _'I. ,:""",:.;.;~ .-Y... '.'7'! p;.-\ ,c,T... 1. s.3U~\"'~1''' ~Ot'~"~~.~es,\)'I~''';\.~-'''' ~~~..t '" II J- ,rl ~-I, --r \o~ 1\.I\e r.&~~el. n1o\.lg ~ \\,\e IU B Electrical Contractor J1lflOne nfI;m (" ...we. 101. iCa.~QO\0\(l'i',gt)!~~ Co~ieS 0 \e\e~\'\~~.G. $ 63.00 I . yO\I\ j>-.rf{)1,?4~ ~~6l"' \~e ~o'i>-W;;"-" $ 75.00 Address 4)C)t ga.r~fr r:.V, ~ IJ5 il\090401~Pt~mro RJP.,u\I\\"!,~~). $125.00 J 00 . , \\,\6 OI~~V:" 'l2'J:';~ . a J! C/O ca.601~WS\ilJ3nJO &9lP"'-. $163,00 Phone (p g( '1 ":) (() l\Ji)VtP\~Q..Q-.W~s . olts $375"00 Reconnect Only $ 50.00 ...- City ~P. 4(()() '7 c:.,' J(J/oLf /LI t:;' 'I S (, 10/ f) tj , ( Signature of Supervising Electrician J?I- ' ~ciJ- Supervisor License Number L:T~~"~'.'\i;,i;';;.~''1-~L''''";'.~,..';. _~..:......" '\,,'~".\.,..."\ ". ~'..V~.4".' . c. u!zI:llRO.I;tl!r~tr:2S~~:..or-.,Fe~d~~s:;';-, '2~~:', ;,~:<:~,;-'_::;' "JJ.' . "~':<-':-- " .....\~ . Expiration Date Installation, Alteration or Relocation 200 Amps or less $ 50,00 20 I Amps to 400 Amps $ 69.00 40 I Amps to 600 Amps $100.00 0;,.e:,600 Amps or 1000 Volts see "B" above, __ D. ~. 'r~'ridr(S'i;.1:liiiS1A~~,':I.\;;:. '-,-:-;]:';;'~.~~, :':'~:f~'UjJj';:'>.~~~."'~\'::;.i.W~~. ":j. [I!:~-.~~__.."...-...,..,_< .",_.-",,,,,,,,,,_.,,,,-.., ."'__Or -.<-,"" ,,-,-.; .,~~,,~~~~ Constr. Contr. Number Expiration Date The installation is being made on prope is not intended for sale, lease or rent. New Alteration or Extension Per panel; One Circuit $ 43.00 Each Additional Circuit or with C. z.. 7 Service or Feeder Pe~~ . I $ ,,00 . ~~~., c. ...- E, l'Mi,~~~lMs,(S~i-~\~'f;ed';r lIot iiichfdedY::::Eacl;: Insi~ll:lti~1I ! .-., f;.;~ ~,,~W:l)o' -"'.~' ~" - -,-,Of; "., ", ....., , ~. "t'~'t: "c:.. ~~ -1'\ ~~ . t,~\("~' ~\\ <2>" ~\or1rr~QIl' $ 50.00 't\ ~"S ~'t.\'\ 't.\l \j~~ \~u~~e Lighting $ 50.00 \~\j\\\(J\\\\'t.\l (J\t~~ EnergylResidential $ 25.00 I o~~*''t.~ \l"''{ ~Bmited Energy/Commercial $ 45.00 ~'{ \'0 Minimum Electric Permit Inspection Fee is $45,00 + Surcharges 4.ls@tQf4[!QF~QVf'_.': ";~,;;,;, ....L,Z.',.'l' 70 ~.>(,~.... ,-f'_~',"__;-,__ 'J J ""~... -.......;.;.~;: l{ ?O 7% State Surcharge 10% Administrative Fee ~ 8/ <;0 TOTAL ____ 4'S. Address 3l(Z- 'S"?~ Loe:., Crt!" -7Z7D YJ? #1' /II' Owners Name SPF'.Q City Phone OWNER INSTALLATION Owners Signature: Inspection Request: 726-3769 ~< ~'\:ft.. ":J. Shared Drive(T:)lBuilding FonnslElectrical Permit, Application 1-03.doc e . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01108 ISSUED: 09/07/2004 APPLIED: 09/07/2004 EXPIRES: 03/07/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 346 MAIN ST ASSESSOR'S PARCEL NO,: 1703353107200 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Commercial PROJECT DESCRIPTlON: Add/extend 10 circuits for Ruthie B's Owner: SPFD LODGE #70 100F Address: 342 MAIN ST SPRINGFIELD OR 97477 I CONTRACTORINFORMATlON , Contractor License ANTONE ELECTRIC INC 'l>' i,.,e ~'i:Rf:\ 145436 I BUHlIDNG.li\mORMATlON I . ,;i L'-'.,\ ,l1i ~. ~t>-\..\.. ~ ~S r '" \l t\J" # of Units: ~,,\t; ~\SI\\ C;; '0't-~ ~&:\~I~~ Primary Occupancy Grou .~\~ 'i'~\\\1t.\l \}~ ~ \~ liIl!ight of Structure Secondary Occupancy Gro is\~C'l l;;l.fUt.\l C'l t.\\\C\1ll'pe of Heat: Primary Construction Type C\w.w.~ \)~ 'i' Water Type: Secondary Construction Typ.j;; ,,-\'( \'Q~ Range Type: # of Bedrooms: 1'-\' Energy Path: Sprinkled Building: Contractor Type Electrical Expiration Date 04/23/2005 Phone 541-689-4560 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a Fronlyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Sola.' Setbacks: I DEVELOPMENT INFORMATlON I ~'I!I . ~tf/& ~~QUlRED PARKING Overlay Dist: l~ot\~"''0\90~&e\ ~al: # Streetl~~P.09\e~~~\e90p!'~:1; dica~ped: pav~~~~. '\~c.t' ..1'0\9 mpact. % o~d<:.;~~Y!i'\l\l(8. :.oa'OV'~V' ~~ ~o~'iC~ :f)'2..()O~ ~~f\ aMlIto. ~ wP''''''' be l, ~. "f I ill>" or..: u"_.. I PUBLIC IWlKOO :IS' ~~.;,..,. ... ~.,.! ..~. ~ \0' ~ \$ \ ewalk Type: fIiJ'i DownspoutslDrains: Street Improvements: Storm Sewer Available: Special Instruction: 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 1 of2 - . CITY 01' ~rKll'luNt<.,LD Building/Combination Permit PERMIT NO: COM2004-01108 ISSUED: 09/0712004 APPLIED: 09/07/2004 EXPIRES: 03/0712005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L.Fp.p.s Pf<lid J Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $7.00 $4.90 $43.00 $27.00 9/7/04 9/7/04 9/7/04 9/7/04 1200400000000001315 1200400000000001315 1200400000000001315 1200400000000001315, Total Amount Paid $81.90 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 Rp.?'1irp.1 up.ctions I Rough Electric: Prior to Cover Final Electric: When aU 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 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 . Springfield, Oregon 97477 541-726-3759 Phone - Job/Journal Number COM2004-01108 COM2004-01108 COM2004-01108 COM2004,Oll08 Payments: Type of Payment Check 91712004 RECEIPT #: 8~ ~I ~".I Jiii1y of Springfield Official Receipt Wvelopment Services Department Public Works Department 1200400000000001315 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By ANTONE ELECTRIC Received By djb Page I of I Date: 09/07/2004 Item Total: Check Number Authorization Batch Number Number How Received 1430 In Person Payment Total: 2:59:5IPM Amount Due 43.00 27.00 4.90 7,00 $81.90 Amount Paid $81.90 $81.90