HomeMy WebLinkAboutPermit Electrical 2005-10-7
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.225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~~i~~~ ~ t!..~L!'
ELECTRICAL PERMIT APPLICATION ~ ~~~\2l.,\~,," - .
City Job Number r i ..;, n lL(-IJS Date,;t/ 7. ~:> <" .
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1. 1fLOCATIONOF:'INSTAIiEATION<:>f~iJ'" 3. -COMPEETEEEE'SCHFnru;' - DW.'~,jJ., r.'!P" ".,
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L1G'AL DESCRlP~N' .. '0 ~ A. ~"~1i'~i;;['~~tf::~f:l%~p.'it~#i11~g~fu~ij
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. JOS 0, ESCIUmON . . ""~ooo~' h l~. "06,00
c- _ r\.. .' 'P..... L,..' ~ Each additional 500 sq. ft. or
~ 1.1~\,--J II It, . onion thereof $ 19.00
Permits are non-transferable and expire if work is Each Manufact'd Home or
. j. not started within 180 days of issuance or if work is " ' Modular Dwelling Seryice or
Suspended for 180 days, .' . Feeder'
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, . Address ~ l(~ e;\Q.\( L{Y{YP _~~: ::::::: ::: ~17~~0~0
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f\~f\'", 601 Amps to 1000 Amps $163.00
City \J6" v~ Phone ~ ~:~:~c~ :~slVOlls ~3;;~~
$50.00
Supervisor License Number \}1.1.2 ~ S
'EXPiration Date ~tlJ '
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Constr. Contr. Number' ~ --.
Expiration Date l/...JJJo s-
Signature of Supervising Electrician
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Installation, Alteration or Relocation
200 Amps or less
201'Amps to 400 Amps
'401 Amps to 600 Amps
$ 50.00
$ 69.00. .
, ,$100.00
Over 600 Amps or 1000 VOlls see US" above. . .
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Owners Name C;u(5 T/./t/ #. !J/;cMt'?1f
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Address PD /(/N( )2.'
, - r
City _I!it'~ r7~ Phone
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
~
$ 43.00
$ 3.00
2d
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OWNER INST ALLA nON
Pump or irrigation $ 50.00
ATSigil/0liUiilellJig~ing law requires VOL! to $ 50.00
. folIUimitea1EIfergy/R:.sideiliiilB Oregon Utility $ 25.00
Noti~i;iliiitea f&?gyicdrlliilgfCiai1es are set fortr$ 45.00
in OAR 952,OOl-U010 through OAh $)<<-uu 1-
Minimum.Electric(jPermiUnsp.ection.IFee,is $45,00 + Surcharges
VU;;JV. IUU lllC.~V Ulalll L,Ul--'C~ VI ~ It; IUIl;;:;~ vy
oJAOO'!C~~\,. SHALL EXPIRE IF THE WORK 4. ~;;;UBTOJAL\~&~~~9t.~~,'t,~f.d
1H\S PtRMII ' ni>t"""",,,.,"'#.~'.;~ft~~~l1..~,J
AU1HORIZED UNDER 1H.IS, PER~'Tc\So NO~1 7% sGteCSiifcliaig~00-332'2344).
COMMEN,.tU Ut\ l~ ~"IMlIl_S ,f) , .. .'
v ' 10% Admnnstratlve Fee
ANY 180 DAY PERIOD. h
Inspection Request: 726-3769 . ~ ~\ ~~. TOTAL -/-a,/ . 1 'i'
....!..':i Shared Drive(T.YBullding Forms/Electrical Permit Application J.()3.doc
41 '7, ()~
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070
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The installation is being made on property I own which
is not intended for sale, lease or rent.
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.- \...11 ~' OF ~nul'1uFIELD
Building/Combination Permit
Status Pending
225 Fifth Street, Springfield, OR
541-726-3753 Phone'
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2005-01405
ISSUED:
APPLIED:
EXPIRES:
VALUE:
10/07/2005
04/07/2006
SITE ADDRESS: 919 INTERNATIONAL WAY
ASSESSOR'S PARCEL NO.: 1703153000700
Springfield TYPE OF WORK: Shop
TYPE OF USE: Alteration
PROJECT DESCRIPTION: FEEDER & BRANCH CIRC FOR FREFAB STRUCTURE INSIDE BLDG
Commercial
Owner: GIUSTINA E NICHOLAS 25%
Address: PO BOX 529
EUGENE OR 97440
I CONTRACTOR INFORMATION I
Contractor Type
. .
Contractor
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
, Secondary Construction Type:
# of Bedrooms:
# 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:
nla
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:
I PUBLIC IMPROVEI\<,,,,, ,I> I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e I of2
.
. CITY OF SrlUl'l\.d'II!.LU
Building/Combination Permit
Status Pending
225 Fifth Street, Springfield, OR
. 541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspectlon Line
PERMIT NO: COM2005-01405
ISSUED:
APPLIED:
EXPIRES:
VALUE:
10/07/2005
04/07/2006
Total Value of Project
F....~P.'lW
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Clrc Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$8.70
$6.09
$24.00
$63.00
10/7/05
10/7/05
10/7/05
10/7/05
2200500000000001397
2200500000000001397
2200500000000001397
2200500000000001397
Total Amount Paid
$101.79
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
wiII be made the same working day, inspections requested after 7:00 a.m. wiII be made the following work
day.
I R..ouir..d Insn....tinns 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 wlIl 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 wlIl remain on the site at all
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Owner or Contractors Signature Date
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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Job/Journal Number
COM2005-0 1405
COM2005-0 1405
COM2005-0 1405
COM2005-0 1405
Payments:
Type of Payment
CreditCard
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IOn 12005
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RECEIPT #:
iii.~
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
2200500000000001397
Date: 10/07/2005
Description
Penn ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
EDWARD N GUIDRY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
DLM 004565 In Person
Payment Total:
Page I of I
2:19:32PM
Amount Due
63.00
24.00
6.09
8.70
$101.79
Amount Paid
$101.79
$101.79