HomeMy WebLinkAboutPermit Electrical 2003-10-1
225 FIFTH STREET -SPRINGFIELD, OR 97477 - PH:(541)726:3753 - FAX: (541)7 6'~~w;ngprOjeclassubmittedha Ih I' .
zonmg and do . S e 0 lowing
ELECTRICAL PERMIT APPLICATION' approv~1. es nol require specific land use
CityJobNumber (DutZOC3 ,oC>990Date ID '01 -03 Zoning ~~.
I. ~Wiij;I@NfeR;iNS7j~tm'i!.mTi!iNi"""~~Ej. 3. ""e('iMP.IJEitJHtE:E'8,~-J'fj~.Llli1;;lillt;;:;,~~~~
. ~_'K._..",~.~,...~~..,.~/~" f;~.""=_...."""",...",,,-<~iJlIiijPlt<iil'Slfj\i'ath1.;~mr&~~eu-
I Z 7 ~ 7:sJAA...L ~+- . ,
LEGAL DESCRIPTION
17033Y z..z.
JOB DESCRIPTION
A. ~NlWii-gia~trtiU~in~g'~~1t;~Mtlfti~F1fiillyrp.' '~r~d1t!iiiirgr~ifit.~.;".'
.', '''J~~''''''''_ ..__............___.....,..,...,........... ~'r''''';~,:ir.. ,.
D0215
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion Ihereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
A~i) '2
c, (Z..cV'-:1~
$ 19.00
Permits are non.transfcrable and expire if work is
not slarted within 180 days of issuance or if work is
Suspended for 180 days.
$50.00
- -....'".,_,'-"'~+.I~.w~:.:,........_'f>';>;""tm~I'f.~~~;,.;.-..'.;.;\'\':Mll~.il.11
(gJ;)NJ.i ' emORrlNST-A'll.' 'I!fAmI{!!&.'",O"~.,,y~,,,->J"
2. .,.. - ~ "',~~t<yt~e-,}ji;'t1Sttx..,....hlO'tV!!l")<'~,,:~
Rn~s rlprk\( 200 Amps orless $ 63.00
201 Amps to 400 Amps S 75.00
')J ff) 0h\() 7':5t- 401 Amps to 600 Amps S125.00
601 Amps 10 1000 Amps $163.00
Phone hC}{,-SY YV Over 1000 AmpsNolts ?'f.. $375.00
Reconnect Onl\r \t\'C. 'l'l0 0\ $ 50.00
~ U7 tit U:, 1!'~~~t., :i~=-"=?""'ffii~"1-=1i~o(i;~foI'~ilI
Supervisor License Number ::::flJJ::llI!~_J ..I\'\l.~' \\ ~'" r1>l1_ '. '~"b""","l!r!'l!.~'!;,~'~~:AAiljt"''Wf>~!.'PAirI..:\1ll1
'.'''; 1't.\\WI \l~\) [l.~1.)
/() - (S) I ~() ~I-I()\\\lt.~\) ~a'U~n, Alteration or Relocation
IS (0 ~-/(5 " C)W-W-t.~c, l>-i2VQ.9..\Q~'or less $ 50.00
Conslr. Contr. Number ~(J_If.J ,c, n-.l, i'OIJ I.) 201 Amps to 400 Amps $ 69.00
_~ 0 "v. 401 Amps 10 600 Amps $100.00
Expiration Date ~ ::::_<~ 0 ~/ /J.-(j'::;- ,
- . Over 600 Amps or 1000 Volts see "B" above.
Signature of Supervising Electrician D.If!.i..l1:J~"W=~1~~
U# / < ~ ____ New Alteration or Extension Per Panel I
/c.A--- ~ One Circuit S 43.00 Lf.J
~ Each Additional Circuit or with .".
Service or Feeder Pef8\Y\O' I $ 3.00 C;;
Owners Name \Cbv, 'fI.f::(l...~o# . ._~\ IlleS 'I.,;,\!
Address J Z 7 ~ as L-A-N{) 'S.~..OI5g~~~_~4.iifuJlli[~r;!E1jjh~fi"Thm;\1.\>n
......... / p.\I\:::.I'" adop\e e l\lles ;{tl 52..00
City 5" P f1.LY Phone . ,"~'" lilIeS _'e!l);rffi~~r im~i'(ilhIf\ 9 \9& \ $ 50.00
,.I" --'--1' ee." " tl:\lO\l1i . hthe III
"o\iliCa\\O O~ _O~gl1lU'ghr/0~lIl mg "one $ 50.00
OWNER INST ALLA nON op.f'. 952.0 a'1 oti!in\~.Sdf~I1iYIR~\~~le'll.\iOI' $ 25.00
\ )'oll tn '''l..IN illll1J,NO\'iI\.
The installation is being made on property I ~q.hich.o \"e cel'..mllfeB~~'9y.....bXWl~rclal $ 45.00
. . d d r I I callI!'\! ~......o Oleg "''''''--23
IS not mIen e ,or sa e, ease or rent b l lu,"nfT\1um.~ctrle 'Permit Inspection Fee is $45.00 + Surcharges
I'Ull'\ e '"'~S T
CP.O ~:.iIIt'r...tf~"id~;;:~''>ti~~~\>.~~~~~-4t /
Owners Signature: 4. . ll$[\PJ;~.fn~~~~ LI f7
'5z.z..
460
5'38"7..
Electrical Contractor
Address
City rl }{}..(J no
<.J -
Expiration Date
7% Stale Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drivc:(T:)lBuilding FonnsIElectrical Permit Application l-Q3.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspeetion Line
.
. Lll l' OF SPRIj"\jlj1<lJ!,LD
Building/Combination Permit
PERMIT NO: COM2003-00990
ISSUED: 10/01/2003
APPLIED: 10/01/2003
EXPIRES: 04/01/2004
VALUE:
SITE ADDRESS: 1275 ISLAND ST
ASSESSOR'S PARCEL NO.: 1703342200219
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Add 2 branch circuits
TYPE OF USE:
Owner: KEN ANDERSON.
Address: 1275 ISLAND ST SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
i:o
Contractor u\1es'l . . se
ROBS ELECTRIC INC . ,,,-.tl te~.A~O(l . ~~m\
d,'BU~~fNGJiNfoRMiP~NP \
~~~~ 60'" '(10"- ~vr' tU~'6
!>-~ <u\e'6 ~ _-.rf -:S~,.;.,r,u~ 0\ \'(Ie ....o(\e
,,~'\II' ce,'w~n~~' ,,\es ~e9" '0(1
\O~ 9.\'0(1 .001I"etg~ W IStmie.tl\~~ \e ,,-,\,Ceo\\
~0\"\~~9f:J'l; ;rn\l\l}!~<!;ll'}e. ~\\\'j~0 ~
,~ ~ou (('~&M1'1;YJ!e;.' \)\! Z.?-~ .
0090' ~<;) \'(I~!I\\~~~i()'~
ce\~ ~et \O~n:;~gy.1>ath:
(luf;\ Cet:'<\
Contractor Type
Electrical
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
I DEVELOPMENT INFORMATION I
Overlay Dist: ~'&
# Street Trees Rqd: \'l\'t. 'NC) C)\
Paved Drive Rqd: j,.'?\~'t. \T ~\\ \S ~
- . . .Ij..J ,e. '?'t.~ r.C)?
(.)\\~:OfLO{ ~Qve;~,,\'l\\" C)~'t.'i)'
~\1\S '?'t.~~~\) ~~~~c.. t-'Qt-~C)
~ -~ .. ., ..- -........ ~. .....
I P~I(;i~v'~M\\IS'rS I
1.:,\)"" ~ \.I'"
~~'1 ,\'0
New
Residential
Expiration Date
0811412005
Phone
541-686-5444
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Impervious Surface Area:
REQUIRED PARKING
Total:
Handicapped:
Compact: .
Sidewalk Type:
DownspoutslDrains:
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Total Value of Project
Palle 1 of2
Value
Date Calculated
/
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00990
ISSUED: 10/01/2003
APPLIED: 10/01/2003
EXPIRES: 04/01/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fp.p.~~
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Cire
Add, Alter, Extend Cire Ea Add
Amount Paid
Date Paid
Receipt Numher
$4.60
$3.22
$43.00
$3.00
10/1/03
10/1/03
10/1/03
10/1/03
.1200200000000002243
1200200000000002243
1200200000000002243
1200200000000002243
Total Amount Paid
$53.82
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 R~\"W.ired Insnedions I
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do herehy 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
COM2003-00990
COM2003-00990
COM2003-00990
COM2003-00990
Payments:
Type of Payment
Credit<::ard
.
.
"
.'
....~'~~.'."''''_..........'.'.. '..'
lJiii!" ;
,
..""""-'-..., i
" ~.!
..~. . .'
,..,.,..,,__ .,._.,. T.,." ,
Receipt #: 1200200000000002243
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% Slate Surcharge
+ 10% Administrative Fee
Received By
djb
Check Number
Batch Number Authorization Number
Paid By
ROBS ELECTRIC
000184 001608
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 10/0112003
10:02:22AM
Amount Paid
Item Total:
43.00
3.00
3.22
4.60
$53.112
How Received
Amount Paid
In Person
Payment Total:
$53.82
$53.112