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Home My WebLink AboutPermit Electrical 2004-3-4 ,~ approva . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541\72!i-3689/......17 ' 20m"n '--I .JJ'- ELECTRICAL PERMIT APPLICATION - ~_. ,_ 0 d I / Date CJ... T City Job Number COlM 'Z.OOLt - 0 0 i ZIO Date '2 113/ (/'1 \ . . ....::.orized Signature 1:S~ 3. ~COMPI1ffEEEE"SCHEjjUiE'BEf6w\':(:~;~?-'ftli,i, ~~:~~"l:.:'=:i:;:?'~>:~\;;....i.~'h.~...:..::~)~..c~.!.;>~~'..::-.~ ,.'j~'t~';'3: .J.- Over 600 Amps or 1000 Volts see "B" above. D. ~Br;rn~ifC}r:cuiU!4'" tkr -~ ,r,;;:.-::.(.~,. ~', ''', r~aul'r't!S yOtJ- u"---'''-''' .~ ~ d~ EN""\ON:oregCNe~'l\1te[atWI)@i ~\\ili1ion Per Panel . ~ , ATT 'k"''' ilia ur \:I t r\ " ." ~e ",dopterune eircwt s are set 0 1 101lU" '.~" center. iEac1\'9,.rii:hfiona~ircuit~Cwith ~otilicatlOn 1 001lSeMoelSrFte'd'er ie~ts \ '7 $ 3.00 :21. C Co Owners Name K~1 SQ,d",,.,<,,,nAR952-00 - i, qpieSonn. IU'~ ~~. '_', , .__ , / Y u may obta I.lJi;.., ,,,,,,tAljmhOn&. . C\\!-. .~. ---.- _"'30"""'N._. '" Address .,..- C ",,_ 5~'- '_I 0090, 0 ntE. :,'/' w.ma.Uanedus ServjCetIeeder not includeil)'-1-Each Installatiori~ -< <> 0 r".,H ne=" Ci:1";";; ~"., ce o;~~on'Ol1\ity'NO IlW<1\1<:!E.!=_==' - 'v.. ,.-., ".',,-'n City SP'''yAdd Phone n~lT1ber,f.~~~~~;~ 1P,~!"p.6(1mg:iltb~)' $ 50.00 , Sign/Outline Lighting $ 50.00 .' OWNER INSTALLATION Limited EnergylResidential $ 25.00 The installation is being made on property I own which Limited EnergylCommercial $ 45.00 is not intended fO'NeJerV~ or rent. tw/W{!{" Electric Permit Inspection Fee is $45.00 + Surcharges . JHIS PERMIT SHALL EXPIRE IF TH ,~y""Lj',,,o ~":'''''''''' ",;,'<i'~":ir .;' Owners S,gnatureAU1HORIZEO UNDER lHI~6~~~6TF~Ji~~~~g::~9Y,E~.:~ ;Y~1;.L~t;"':',td C '-/. co COMMEN~Eo. ~~}~~BA 7% State Surcharge "-/. 411 ANY ltlU Ul\l f ....) . 10% Administrative Fee 6'-10 Inspection Request: 726-3769 TOTAL 71.( f'l( --.... ~... . .._..._~~---~,,....,."-'" ..~.,"- 1. \1LOCAfr(jN'(j"ji;jjJSTAfi:A'rioNi,:;"rilj~,}<m. ;3 ~ ~.~~~~::r:'-~/;;7~--.~,~~~~~~~,~~~-j LEGAL DESCRIPTION 17 0';' 2")":) L../ sil1flla- - .f'eu<'/y cjiv~!1"'1 ObI 0 D ~ JOB DESCRIPTION (<g-) iJ,~.dl CII~G~"S ,Ag~ A ,,;JL//II-U::k;J' I dIr.:./nf7l/'<C, ';::71:::. - ,K,rc.1f"N KL:7"c{J.:,< PermitS are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. . ~. ~'... _.' ,:~;";>~ , .._" ~_ ~ ~ :.~:.. ..-~.--,"",rc7 '['''',;'''~-._.~ "_''''.~.;.'~ ',_ ,- "'",,,..- ',. ; 2. r.52~~SlJ?J1~N.~J:~{fA'f{f?lt:9!;lLY:1 Electrical Contractor !Y!YtO SP-4t" k'!eCTIYc, U-C Address fJ. c; J! C)I 2 :;-g Z. City 5vr~"'e., y7"ic2 Phone(S-"'/)4~S'88S:S- Supervisor License Number 4'13 2 S Expiration Date ItJ /1 /0,/ Constr. Contr. Number /S'l3' / T1 Expiration Date I / I / oC Signature of Supervising Electrician s submitted has the following reQ~ire specific land use --~.Ji} ~i ',~'''1 ,-". r;Jii"~-~~'_.""r.\~-t;jt-';-;.:~t;::-~W'~;,?]iti';'~~~j;"~'X:;"".~~:~ii~i!/t --"l~~; A. g' N ~!:\B:~s.i~~~.t.~~t~_~_~gle,'~,t ,~!_!.I~tt~f!l;rpjIY;PFr' gwell.i.ng,.~!,.I.~:J;~\",">"'~i iti_~,...._" .,~....,~'-'-'_" _"""'-._........._.~."'-1... ~.,~;~ Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. }t,s~~vi~~s;~o:r\FeVd~r~;;t~ll~io~",AIt1;aiicih~,o"~~ R~idC~'ii~ri:'~~,; ~,ll !~,q.1..."'~;~~'-:'~:''.id'';:-' r"t -.'t' 'll..tit~~t""'...'<i".,,';'f'~;~~h'~ 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1 000 Amps Over 1000 AmpsN olts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. f'.7rem'pofiry,Ser~ic~s:'(;r;F~ed~r~~~I~<: ~:~~~~':~~~lG,I>'1..i~;.::,~ :\~L~'~ ~~4)f,;:".-',:;. '."_" __."T . . '." ---~ J..I"'-.;.....~.;...~~t:'"~_t......~,~~~,.......-;C..K] Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 ,., '. 0- ,-". .,v., (1:-':1;' "~J.~_,",~' ".~... '.... ~ '1". ~ "~M,;_~ $ 43.00 "'/3. Co Shared Drive(T:)IBuilding FonnslElectrical Pennit Application I-03.doc . . Lit i' OF SPRINGFIELD 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: COM2004-00126 ISSUED: APPLIED: EXPIRES: VALUE: 0112912004 08/13/2004 $ 10,000.00 SITE ADDRESS: 388 MANSFIELD ST ASSESSOR'S PARCEL NO.: 1703233406100 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Remodel Residential PROJECT DESCRIPTION: Interior remodel Owner: KEN SANDUSKY Address: 388 MANSFIELD SPRINGFIELD OR 97477 Phone Number: 541-485-3315 I CONTRACTOR INFORMATION I Contractor Type General Electrical Contractor COHO CONSTRUCTION LTD DAVID STUCK ELECTRIC LLC License 121126 158177 Expiration Date 03/1112004 01101/2006 Phone 541-710-8691 541-485-8855 BUILDING INFORMATION I VN # of Stories: Heightof Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Impervious Surface Area: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 SETBACKS Fronlyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION' Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: Paee I 00 . Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Bid Amount Use Bid Amount Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 10,000.00 . CITY 0.. ~rRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00126 ISSUED: APPLIED: EXPIRES: VALUE: I Plan Reviews I Initial Review 01130/2004 01130/2004 APP LLH Plan nine Review 01130/2004 Public Works Review 01130/2004 0210412004 APP VRJ Structural Review 01130/2004 Total Value of Project F"". PIilLI Amount Paid Date Paid 01129/2004 08/13/2004 $ 10,000.00 Value Date Calculated $69.81 $6.40 $4.48 $43.00 $21.00 1129/04 2113/04 2113/04 2/13/04 2/13/04 $10,000.00 $10,000.00 01129/2004 $144.69 Receipt Number 1200400000000000134 1200400000000000203 1200400000000000203 1200400000000000203 1200400000000000203 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. IR,,~ 1 Rough Electric: Prior to Cover 2 Final Electric: When all electrical work is complete. Paee 2 00 . . CITY OF SPKll'lu1<IJ!,LU 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: COM2004-00126 ISSUED: APPLIED: EXPIRES: VALUE: 01129/2004 0811312004 $ 10,000.00 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 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 3 of3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00l26 COM2004-00l26 COM2004-00l26 COM2004-00l26 Payments: Type of Payment Check 17 ar-,[j.'~':!'m,"-".'," .'., Wi;' .,.. .-.' "-'i ,. I ......., : "'- '! " ,,' .,", ,,,,',-,,,,,,',,,",,"C'-..' __ ~ .'."; Receipt #: 1200400000000000203 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Cite Ea Add Received By djb Check Number Batch Number Authorization Number Paid By DAVID STUCK ELECTRIC LLC 1043 City of Springfield Official Receipt Development Services Department Public Works Department Date: 02/13/2004 9:19:41AM Amount Paid Item Total: 4.48 6.40 43.00 21.00 $74.88 How Received In Person Payment Total: Amount Paid $74.88 $74.88 . .