HomeMy WebLinkAboutPermit Electrical 2008-12-9
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(S41)726-3753 ~ FAX: (541)726-3689
ELECTRICALlERMIT APPLICATION
City Job Nnmber (/Om 2-L(() 7"- 0/73 (/
Installation, Alteration or Relocation
200 Amps or less $ 57.00,
201 Amps to 400 Amps $ 7~.00 M"i,oo ",," to
401 Amps to 600 Amps ATTENTIUN: YI "nI,I~:oJ: nrPOOn Utility
\Ipw rllh:~ "u~~.eu OJ J '" selforth
~er 600 Amps or 100 olt .see "~'~b6Ve. Those ru\e~ ~~e 0" /)ill-
~1Ji"i-~,,=. "" 0J'~"ll""" . , ''''1'l;/,?!t~'lIlii!l_i~
Signature of Supervising Electrician D. Jl!!!!!n.~Iik.(j!ir<;,qi,tS+~'l;!i!!lP ..... I ~..'"&,,~ E'" ' am;r,ll by
~ " New Alteration or Exte~2rJk,p~~~~ma hnter. (Note: the tel~f,hone
/) , , ca"m\j l'Ii L1nt'Et!9t't~tlon
. , :H ~ One Circuit number for he Or!ll~ei.b(j' II 3''')
, Each Additional Circuit or with Oe~r IS 1-800-332-t;, ~', C'O
V" ' NOnCServ;ceorFeederPermit J ~ $5.00 ii>='
Owners Nameleu/1 a'.c...- 'Jr1 C-/( / ('j:m'rNJs PE ,/lIT <;~AII ,FXPIRE IF THEVvut\"
Addres>o-'")q/q / 7~ /:)i . .\UTi!8 .
,\~ ? COMMFNCED QR.IS.
C,ty;Jv.:?LI'?e-.- Phone . ANY 1 &pmfl'h"1:I'1fttSI! $ 57.00
, {I , ~~OutIine Lighting $ 57,00
OWNER INSTALLATION .' Limited Energy/Residential $ 29,00
The instaIIatinn is being made on property I own which Limited Energy/Commercial $ 52.00
is not intended for sale, lease or rent. Minimnm Electric Permit Inspection Fee is $52.00 + Surcharges ~
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LEGAL DESCRIPTION:
170.3-;:)~2,-/-'O()3<(1
JOB DESCRIPTION:
\(11-c/1(/v
((flr!ODr;,C
Permits are non"transferable and expire if work is
not started within 180 days of issuance or if work is
Snspended for 180 days.
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Electrical Contractor f AS r :5 ) D (, (; a C r/?/ C
Address 3')j) 'i3 50S Cf.(r( Uv I
City SP'><:LO
Phone 7V /, / V99
Expiration Date
LJ7 ) 7 s
)(Jp/- IC9
1/7770
lo-V-ocr
Supervisor License Nnmber
Constr, Contr. Nnmber
Expiration Date
Owners Signature:
Inspection Request: 726-3769
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3. eo~",' :J3,EEEfS6HEDlJIjJ!)qJEEOT#~..f.,W'$:t;' ""'1lb1"'i!l ..
" " . "'_'u~"'"A~'"%0",_W'~"'N"',-"""",,,^'!C-"C"_'''''_____ ,to e., k -! _ _ ,i!' ,__ "', ,,,. R'~ ,_
I' ,
lif.:P.:r"'%!i;Jl@W'~'Ii1W,,",~mW;m1"""4!@;",i~"fW~~mzr'~t*'"0/*""/ij:W.,,,"""ttlhi%","""";["'_-_- 'r~1:>Yell
A. ''fNew,Resiilential@!l'Siii'' ie'O"MliltllFamil~e"i(jweDin uli'itJ~.~'
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Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
, portion thereof
Each Manufact'd Home or
ModnIar Dwelling Service or
Feeder
$121.00
$ 22.00
$57.00
li"W1W1(;."ilti0!1!t!"'!%S!'%i!K""Miliiiirif'''\'-O<''N'''''ifili' :g,!tTw!'C"r;W,j:$!iWili!\P}:;;@w,JM\1n~\";I;;W'.YL'f!"';~~"il!Wl, _ ,-
B 'S,,'_m'"''&~'E'''''ad/''JlRf,l''' l'I"V.ti~~","",j/jt""-"fi'C. ''''''-V.-''''R''''I'''~-tC.'"' "
. " ~Pi!~~cl!9,!i~,,*j,~~ m"~g~~~,~~/Jl,g~l~,\$~ Pfls-qrtu:y;~?~,",IO!!_~ > 1
200 Amps or.Iess
20 I Amps to 400 Amps
40 t Amps to 600 Amps
60 I Amps to 1000 Amps
, Over 1000 AmpsNolts
Reconnect Only
$ 73.00
$ 86.00
$143.00
$186.00
$426.00
$ 57.00
C.
,12% State Surcharge
10% Administrative Fee
5% Technology Fee
a ,-----
TOTAL 15 ,~)
Shared Drive(T:)lBuilding Fonns/Electrical Pennit Application 7-08.doc
Status
Issued
CITY OF SPRIl'iuc1'1.l',LD
Building/Combination Permit
PERMIT NO: COM2008-01736
ISSUED: 12/04/2008
APPLIED: 12/04/2008
EXPIRES: 06/04/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 241917TH PL
ASSESSOR'S PARCEL NO.:' 1703243400347
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Remo:del
Residential
PROJECT DESCRIPTION: Circnits for kitcb remodel
Owner: MCKICHAN RONDA F
Address: 2419 17TH PL
SPRINGFIELD OR 97477
/
I CONTRACTOR INFORMATION.
Contractor Type
Electrical
Contractor
EASTSIDE ELECTRIC INC
License
11 7770
Expiration Date
10/04/2009
Phone
541-915-9828
, BUILDING INFORMATION.
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height ol.Structn're
Type of Heat:
Water Type:
Range Type:
Energy Path: ' I
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:,
Paved Drive Rqd:
% of Lot 'Coverage:
Total:
Handicapped:
Compact:
I PUBL~C fMPROVEMENTS I
ATTE' Sidewalk Type: ,
f NT/ON: Orr. '0- '" .
, ollow'rUles ad Downspouts/Drams:
, opt" ...'"' ',,, "0" to
Notificalion Cent eQ by the O'2.~,-,; I ::.."
. er Th ' '~.....l; 0W' Y
,~~~t~952'001-00; 0 th~~~gl~leOs are set fo';th
Notes: NOT " ou may obtain ,I fiR 952-001_
ICE~ callmq thp /"on'__ ..copies ofthe nd,," h,:
I HIS PERMIT SHALL L ....m:-::, ;v'lhe Ore ,"v,e" !fIe telephone'
AUTHORIZED UNDE EXPIRE IF THl:~ion Descripti6nnFr is 1-f0~~3~tlllty Notification
COMM _ R THIS PERMIT~~NnI ' , 2-2344),
.'.. ENGED OR 1<:: AlH~IJ:\o"JED er'Sq Ft Square Footage
DesCrIptlOnl80 0 /f,ype.of,Constrncnon , F, It' I' B'd A Value
" til r'th UD. 0 u.p .er or I mount
Street Improvem~llts:
Storm Sewer Available:
Special Instrnction:
Date Calculated
Page I of 2
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
- + 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Cil'c Ea Add
Amount Paid
$7.50
$9.00
$3.75
$50.00
$25.00
Total Amount Paid
$95.25
Total Value of Project
I{ees Paid 1
Date Paid
. 12/4/08
12/4/08
12/4/08
1214/08
12/4/08
Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01736
ISSUED: 12/04/2008
APPLIED: 12/04/2008
EXPIRES: 06/04/2009
VALUE:
Receipt Nnmbel'
1200800000000001201
120080000000000i201
1200800000000001201
1200800000000001201
1200800000000001201
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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, ' ,
RpOl: "-ed To .nc'dions .
III" 1111 I. 1111.'.. II
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefnlly 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 with'out permission of the Commnnity Services Division, Building Safety.
I fnrther certify that only contractors and employees who'are in compliance with ORS 701.005 will be used on this project.
I further agree to ensnre that all reqnired inspections are reqnested 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 Signatnre
Page 2 of2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2008-0 1736
COM2008-0 1736
COM2008-0 1736
COM2008-0 1736
COM2008-0 1736
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Date: 12/04/2008
1200800000000001201
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
ROGER D KING
Item Total:
Che-ck Number Authorization
Received By Batch Number Number How Received
njm 04595c In Person
Payment Total:
<,
Page I of I
1:51:06PM
Amount Due
50,00
25.00
3,75
9,00
7,50
$95.25
Amount Paid
$95,25
$95.25
12/4/2008