HomeMy WebLinkAboutPermit Electrical 2004-6-30
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SPRINQFIELD .' . t
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-36~O~1>~~"~
ELECTRICAL PERMIT APPliCATION, ' :o,.o~: ~J'>.;; " ,~J11
CityJobNumber Cf::lwlZ60l{-- 007 '7 )' Date cb'Jc.k&.,'-I} 0'00:"%" ' ,,'
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LEGVALPL D2E'S~CRIPTI0IYlN -t,N7\OO e ?-.L-'3~ f A. tf~ffi~;~e : 1-'~liigl'lef~~M~~[~"'11Y'.~~~g;~~~
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<.,.,., ~ II J'U- IJv) Cj (l. yt.-(k (:) 2:.-( 0 0 Service Included /-~ 0' "ol':""';;
JOB DESCRIPTION \ J 1000 sq. ft. or less 6.0~ ~
Each additional 500 sq. ft. or :\.. "-
5C-fLV l CC;:- LA {/C::r f4.J-De- portion thereof r" Y
,-
. Permits are non-transferable and expire if work is Each Manufact'd Home or
"not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder .
2 1.\c,6NjitAfr,'ORJiNsTXiJJ:inON:'Om,','y:J B. r~.S"r~r~e~ -;;r,Fe;~:'~I~St~'ll"ti~n; Alierafioiis;';"';R.e'iocati~n:':>d
. . ,'~...,"'i'~"""""'" "'r"'~,':r.~/'~"'OI."'l"..;;cr.;;,.', ......""'. \~.::.0"<M!-. ~"'.,.h '. ..~~~'~,l.-""~..""1!'>-:JI'. "<';;C'O"~ '. .",'-~{..'~ ~",;J EJ
Electrical Contractor C (,(JW,.{l-z.Jf (i)J2d-ro.f2. 200 ~iJ ~s\c;, ~'Y' J $ 63.00 h ~
\ ~ ~~~ W~s $ 75.00
Address P, 0 \ ~o-t, 2- (p l{ ~'t..~.,:\ c;,~ ~\\d\~ d6 Amps $125.00
~~.R.~~~'U~'V \~"'~psto 1000 Amps $163.00
City (J Ml.h,,'; (Lt Phone [(1' 'V/Il~~~\)'Y~~~1000AmPs/VOlts $375.00
~~~~~~"\)~ ~"R'econnect Only $ 50.00
Supervisor License Number ~GG. - s ~'l ~ C. ~t;'mp:OrllryS~8~~:~r.if.~~~~fs' '~U<. '!' ";'Z," '" ".~\ 1
$50.00
Expiration Date {O II tJ / u (" Installation, Alteration or Relocation
I { - 200 Amps or less
Constr. Contr. Number / i q q <;- 20 I Amps to 400 Amps
40 I Amps to 600 Amps
Expiration Date I D (,1 0 f /J (p
I I Over 600 Amps or 1000 Volts see "B" above.
"~ors-;;~'~ ~~.. '~~~:;e-:;an:~'. '$:3.0:,:e;;:... 'r~1
. ~~~~~ditlO~,i!!-,cGitJ$'lI il!I .', '2...:.'" . 1-
'"'"" 0? . 1A~~l'.lYJ~t~. .. ..' $ 3.00. =
Owners Name (l,v4V\vlt:" \~/"c op(fiJo.OW'" ~~~
Address IbZ'3 f/l/!C/l/C-O ~~~~~~~~~n:i,t;in~l~dedr~~,asJi{~'S\~I!~Uoii~
City S?I~ Phone ,\,J,O'/>t1Jll ~~~Di1ib~ . $ 50.00
~~~Utline Lighting $ 50.00
~ Limited Energy/Residential $ 25.00 '
Limited Energy/Commercial $ 45.00
'iil
~
$ 50.00
$ 69.00
$100.00
OWNER INST ALLA nON
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
rl~"".-'?~"..4:Q"- i.....;..,......;,. :...s. ~'G4.'" .,-.,".to. ;~, ,t.- '''~J,
4. SUBTOTAEOF'ABO,l(E';'1'<,;;..: ~\',' ,.,....' ,
~' - --:::....;?V-l-''''''~..;-,: ":P, '::',"\': '~,~,~:'?"t" ~ ~'f~":. <;. ........
7% State Surcharge
10% Administrative Fee
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'30 72-
Inspection Request: 726-3769
TOTAL
Shared Drive(T:YBuilding Forms/Electrical Permit Application I-oJ.doc
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. CITY OF SPRINGNJ1..LlJ
Building/Combination Permit
Status
Issued
PERMIT NO: cOM2004-00795
ISSUED: 06/30/2004
APPLIED: ll6/30/2004
EXPIRES: 12/30/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 F:IX
541-726-3769 Inspectinn Line
SITE ADDRESS: 1623 MENLO LP
ASSESSOR'S PAI{CEL NO.: 17032733021()f)
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Nl'\\'
Residential
PROJECT DESCllIPTlON: Service upgrade and 2 circuits
Owner: BIWNDEL DIANNE K
Address: 1623 MENLO LOOP SPRINGFIEI.I) OR 97477
I CONT~A~TO~INFORMATI~ I
Contractor ~'4. Lieellse
GLEN A CAMPB..I'J~~ ~~ \t'\\ 73995
~'{ . ."\-\\.
~\~ 't.'(o.lN~tfU1)~N9 ~NFORMATlON'
t'~. ~f>.\.\. \~\~ ~ ~'t.~\'
# of Units: ~O,\\.~~~ ':) ~\J'i:.~ 'I>..~\Jr;j # of Stories:
Primary Oel\'~i'\ ~~:'J ~ \~ ~3 Height of Structure
Secondary 0~6:\Y\~: ~~ c.~\O'i:J. Type of Heat:
Primary con<<l~ .~ ~~ VN Water Type:
Secondary Con. . ~t~l,}r'Ype: Range T)'pc:
# of Bedrooms: \'I Energy Path:
Sprinkled Bnilding:
Contractor Type
Electrical
Expir:llion D:lte
OS/24/2()()(,
Phone
541- 7 44-0705
Lot Size:
Sq FI 1 sf Floo..:
Sq Ft 2nd Flnor:
Sq Ft Basement:
Sq Ft Caragl'/Carport
Sq Ft Other:
Occupallt Load:
n/a
I IlEVELOPME~:I~'1FORMATI_?N ,
IlEQUIRED PARKING
Front yard Set hack:
Side I Setback:
Side 2 Setbnek:
Rearyard Sethack:
Solar Sethaeks:
Overlay I)isl:
# Street Tn'es Rqd:
Pn\'ed Dri\'e Rqd:
0;', of Lot cn\'e~ ~
~..... .........
. ~ to. C ..,
P j , l-~ ~r 0-
. ~~., r~u.:~~,\S),o't>.
~~~ ~"~oO~fI1\fI1 ~"'ll\lk rype:
~6~'P~\'P~O~'~~~''!l.w.~outS/Drains:
f1J ~e 0"'" ~ O~
,,0, se~;6 ~ ~\~e~ ~ \pfIa'O'~
'\~\\eS~ote'~~~
~ ,.rl' r:"(\:
M'''~J. -.
r\C?t~lIati~n ,!)escriotion I
Total:
II andieapped:
Compact:
Street Improvements:
Storm Sewer Availahle:
Spcciallnstrllctiul1 :
Notes:
Description
T~'I}e of Construction
S 1'''1' Sq Ft
or multiplier
Square Footage
or Bid Amount
Val Ill'
Date Calculated
Tohll Vallie of Project
Pa2e 1 of2
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.
. CITY OF SPRINGFIELD
Building/Combination Permit
..~
Status
Issned
PERMIT NO: C0i\12004-00795
ISSUED: 06/30/2004
APPLIED: 06/30/2004
EXPIRES: I WO/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspeelinn Line
I Fees Paid I
Fcc Description
+ 100/0 Administl'ali\'c Fcc
+ 70/0 State Surcharge
Add, Alter, Extend Cire Ea Add
Perm Ser\'/Fdr 200 amps or less
Amollnt Paid
Date Paid
Hcceipl Number
So.'JO
S4.S3
So.110
S6J.110
6/30/04
6/30/04
6/30/04
6/30/04
12llll411lllHlllOOOOll I Oll8
12ll04llllllll00000lll0ll8
12llll4llllllllll0000010U8
12tJtJ4tJllllllllOOOOOI008
Total Amount Paid
SSll.73
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection rcquesled before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will he made the following work
day.
I RC(lUi~d Insl~etions'
By signature, I stale and agree, that I have carefnlly examined the completed application and do herell)' eerlify that all
information hen'oll is trill' and correct, and I furlher certify that any and all work performed sl1:111 he done in accordance with
the Ordinances of I he City of Springfield and lhe Laws of the Slate of Oregon Ilcrtaining to the work dt'scrihcd herein, and
that NO-OCCUPANCY will be made of any struetnee withont permission of the Community SelTie!', Di,'ision, Building Safety.
I further certify Ihlll only contractors and empl{)~.ccs who arc in compliance with ORS 701.005 willlJc IIsed 011 this project.
I further agree to l'I1SIII'C that all required inSJll'ctions arc rC(llIcstcd at the proper time, that cm'h address is rcadable from the
street, that the permit card is located at the front ofthc property. and the approvcd set of plans will remain on the site at all
times during COllstrllCliol1.
Owner or COlltracturs Signature
Date
1':t2e 2 01'2
225 Fiftl1 Street
Springfield, Oregon 97477
54i-726-3759 Phone
.
r~fl
-:...:., .'
JjiiL)' ofSpringlield Official Receipt
.'elopment Services Department
Public Works Department
RECEIPT #:
1200400000000001008
Date: 06/30/2004
10:28:07AM
Job/Journal Number
COM2004-00795
COM2004-00795
COM2004-00795
COM2004-00795
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Eo Add
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
Item Tot:ll:
Check Number Authorization
Received By Batch Number Number How Hl'crind
Amount Due
63.00
6.00
4.83
6.90
$80.73
Amount Paid
Check
GLEN CAMPBELL
djli
3495
In Person
Payment Total:
$80.73
$80.73
6/30/2004
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