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HomeMy WebLinkAboutPermit Electrical 2005-10-7 " ~~~ r~~~~~ .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. ~:> <" . ~....'''-"=.''''''''',,..,...~., "_A",,","''''''''''''':\\W;;~,' """'," ~7,,,,,,,,,.,,,,,,,,.J,,,",,',;"'~'~~' ''\'''!'-- "','~'~' ", "".' .~, . 1. 1fLOCATIONOF:'INSTAIiEATION<:>f~iJ'" 3. -COMPEETEEEE'SCHFnru;' - DW.'~,jJ., r.'!P" "., q jq~~"~;"''''~:n~"'ffi'o/'' ~ ~ .~~~., 6<" ~',;:''J>i ,~ L1G'AL DESCRlP~N' .. '0 ~ A. ~"~1i'~i;;['~~tf::~f:l%~p.'it~#i11~g~fu~ij E \ '1 D3 \S .:xJm"'"\ 0 . ~, :':::;:::d'~ --..... ""~:~'::J~~" '--'''"'''' " ' . 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' . .~ltt~::Qi:;=~. ",::::~r,r~~~~~ , . Address ~ l(~ e;\Q.\( L{Y{YP _~~: ::::::: ::: ~17~~0~0 , I - 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 ' " ", Q7S-~b Constr. Contr. Number' ~ --. Expiration Date l/...JJJo s- Signature of Supervising Electrician YP~~~OVU~ ~'~~~~':~-1""~."J'~:~~'i&J~':'':_'-"~ :", v. ,.".-;, - -'" '1,~.t.:<r.~1~iE'''1 . ~. .-'~~mp.~~!Y~~!;r~~'~~I,<!r.~!f~~-t!~r~~i<r;,i-~i:~~ '~.{( '~~..~. .~:ft.~t!:.c:( ~,. ' 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. . . " ~=-."'''''"'''''' .......~~,"" " '.;;'~'" ''''-'-"..""", 'hfl. D. .~a~",c}i19!s.~J~~~'~l~..'i~:;-'~~:;~'L~'''J. ;~,fl;,,;'~:VE~;; i>t.'~~.,~'~ Owners Name C;u(5 T/./t/ #. !J/;cMt'?1f I 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 J E. ~~~~~Tr~~1jlif(s~rii{e1fi~t~jf~'riil~i~ea)V;;E~~'it;IIt;t~li~tici1i~~ , ~ ...~~.~,.,.,...._~"/>.;..,;,.-=.,..,~~.-.o:!t..~,,.-,~._'~T._.r_:~~~.:~~.:;.;r.t..l 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, ()~ - hP'i 070 ~, The installation is being made on property I own which is not intended for sale, lease or rent. .. .- \...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 "'".e;:::&G~ ID/ ? /6<) Owner or Contractors Signature Date Pa2e 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone " Job/Journal Number COM2005-0 1405 COM2005-0 1405 COM2005-0 1405 COM2005-0 1405 Payments: Type of Payment CreditCard ;" " .' I; ;:- " :) '.~' 1 : IOn 12005 . 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