HomeMy WebLinkAboutPermit Electrical 2000-12-22
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TRANS#:01-0004105
00
,.60
225 FIFTH STfMlllNGE:
SPRINGFIELoc~m59
(541) 726,3753
FAX (541) 726,3689
ELECTRICAL PERKIT APPLICATION
Ci ty Job Number 00.0/8 d... '-/ - 0 I
~
SPRINGFIELD
.uC~lt~J;~i~ic/Jr'.J'::':iVJi';E':;-U:Z0Di~gifa8.c1.does not require specific land use
approval.
Zoning
Q..,<L,
1:1... - ;;<~
97471'ulhorizad Signalure
726-3769
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular D~elling
Service or Feeder
fA ~7r'Y.
B. Servt~~soP.f 'F,~~ders
Ins,taN!iltiOn'. (klterations
orORHoca't.i;o~: flci'-;ea('
V&q ;: .yO'.., , (./Yh 0.0/$ ~ 'I) /",
200"- r" <:"0,,, 'II'", 0" "/oz, $ 50
,', '<a!l)B.s{,~~ 1J:.e.!ft,S~ l'",o.l/<. ."0'1 .00
20Y').e}1lps:'.E<:>'!J4Q.0?~"J~ss._"/€' r. 'Zf.~$~ 60.00
401 a~p~i ~0"',9PO~'JJ~p~/. '(;/", 'C>o(S)oq: pO
601 amps fto d.00,9" all,!gsVIj,,' il/"$ $1'~~:'00
Over 1000 amp~j~o}Js~<n;~~9~$~09~00
Reconnec t Only 'I'; u/;. 1".0, ''I", vS,(),"O'~OO
, , - .14/ .C'{, rOt '0
'- ry lit. $.0" $S I
C. Temporary Services<?1,' cF,~ede.to~ 0
IVO~ Installation, AlteraH:on~oJ'oRelocation
~ ~ 'I) .
Expiration Date 10/01/01 A, 7.s',o€; ~OO amps or less S 40.00
Cl v If.;, '94f,~01 amps to 400 amps $ 55.00
Sign7=tur of Supervising Electrician 041~ 0-9{>€;/OV),bj 401 to 600 amps S 80.00
, / ~ ~_ ___ "IlJ;rl. ~IJ;Cl Z'Q.y~r~~6g0 amps or 1000 volts see "B" above
H#- ~ ~ 80D ~DQ Z)~~ :.r,o/.Q
/? ~D..) Btanch'fCir~ui,ts '"
O~ners Name ./J- / r,-otr'< '~~O V~~;/.);o~~ t,y~
~ Ne~. A~teratl~n~t~Extension Per Panel
Address;Lc:;-/~ tr/tJI.",u ,1.",,,/ PI/. ~/~D "1\911.1- 'T'
One Circuit IC'O,9 0,. $ 35.00
q1~c)Phone) 'I )- - 7769 Each Addi t ional
. 'Circuit or with Service
OVNER INSTALLATION or, Feeder Permit
Date
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. LOCATION-A~ INSTJ4.LATION /
2. r;, q(') 7',,(Lt'u (,f-- /lP'
LEGAL DESCRIPTION
JOB DES?IPTION J . _
(' '" U/ Il, f 7 S Y ') ~
Permits are non-transferable and expire
if ~ork is not started ~ithin 180 days
of issuance or if ~ork is suspended for
180 days.
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor ADT Security Services
Address 4660 Main Street. Bld2 A. #100
City Sorin2field
Phone 736-4973
Supervisor License Number
853 JLE
Expiration Date 10/01/02
Constr Contr. Number 26209CLE
City fi:-u<,eJ
The installation is being made on
property I o~n ~hich is not intended
for sale, lease or rent.
Owners Signature:
DATE: I 9-';>'.;1.-00
RECEIPT #: 4/0-';
REeE TVED B'y: (...il
COMPLETE FEE SCHEDULE BELOV
A.
Ne~ Residential-Single or
Multi-Family per d~elling unit.
Service Included:
Items
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
"
$
2.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
!
not included)
:D
3: -I
S 40.00 ~;g
$ 40.0 '-:-;:0--1 :z
$ 20..ge; ,..., ..
S 36 f'- 0
::I:.. I
3 b s:..1-i... NO
n1 .......0
~'.':..'r.,.I_~
..~~
_. __01-'
U'1 N ~....., .-,
~'l ~''':'' --~ ......-Q'-"l--'
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
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...... 1.
INSPECTION LINE
726-.3769
.
CITY OF SPRINGfiElD
COMBINATION APPLICATION/PERMIT
.
INFORMA liON LINE
726-.3753
())
Job "'ddr~n
~9{)~~a ih!
l'9aI0..,"p,;ao I 7 - (;J:2, - 2-5 -~';;.DD
ENERGY SOURCES:
Heat
Water H~aler
Ranqe
I Value of Worlr.:~
. Sq. fig. Main
Sq. FI~. Access.
Sq. ftg. Other
_New _Add._Aher _Rep.
_ __fence_Demo_Chongel U 511
_Otner
-,
Owo" -r~./c::o...-t~-'
Add.... ~ In 9 () 'rYl /) JI .rr,!J/A b Pha"
/ ~r
Building Permit Info: Describe Work (i.e., Build Single
Fornil.. Residence With',A,ftt'lched GoroC1e)
..A2N)H ';.1 j; J,:,.. ,
/j
o
J:-
-
cP
Conltruclion lend"r
YlIJ/YYU? ~
/ i
,
Addr."
Phon_
DESIGN TEAM
(nomei
. (addren)
(lies. no.)'
(expire,)
(phone no.)
Primory
'~, -'
~
J'Y!.
Structural
Electrical
Mechanical
Olln.rol
CONTAACTORS
a.....n-y
(nome)
(address)
(lies. no.l
Ce:lCpire51
(ohone no.)
PlumbinCll
electrical
~/adYi~~dP/'fAJL
It? 6y 7()8 h.lj;,M #
,g"b-,tnc:- 0-f5~
~'!~
".!
Mechanical
PLUMBING
eLECTRICAL
MECHANICAL
NO.
fe~
I CHARGE' NO.
FEE CHARGE
NO,
FEE
!CHARGE
1
I
/ I
Duo I..: (1 bolhl ..ach
SERVICES 266awr
Temporary Construction
:J.F5.dJ ::tq,cfj
furnau/ burner !o
IlTU's
Appliance vent
separate
Slatianary evap.
cooler
Vent fan with
sinqle duct
Vent system apar' from
heatinq or A.C.
M.chanical e.haust
hood and d~ct
Residenc:.e of
Each single fillture
R.locaT.d building
(new fia. additional)
S.F. Residen~.
(l both)
Sq: ft.
New circuits. alterations
or eJl:tensions
Additional bOlh
Amps.
Water service
Sew.r
Wood slo..../heot.r
Slor,m Sewer
FEEDERS
Heat Pump
Air handler to
lO.OOr') CFM
Air handler over
10.000 CFM
Amo.,
<,
ISSUANCEOF..PeRMIT
TOTAL CHARGES
TOTAL CHARGES
..!)&:),o5! TOTAL CHARGES
WHERE STATE LAW REQUIRES that the EI.ctrical work b. don. by the Eler-tricol Contractor, the electrical portion of this permit shall not b. walid until 0
label has b_n signed by on Electrical Canltaetor ond attached to the .Metrical panel.
I HAVE CAREFULLY EXAMINED the campl.ted application for permit, and do hereby certify that 011 information hereon is true and correct, and I further
certify that any and 011 work performod sholl be done in accordonce wirh the Ordinances of the City of Springfield and th.e lows of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permission of the Building Division. I further
certify that my registration wirh the Builder's Scard is in full force and effect os required by ORS 701.0S5, that jf ea_~mpt the basis for eJl:emptian is noted - -
h.ron, and that only subcontractors and employees who are in complian~ with ORS 701.0SS will be used on this project.
Ba.is far Builder's Scard eaemption-
NAME (ploa.. p';") A:E- NAIL;'" T// t!i...W / N&-SIGNATURE ~~ 1.251 ~
OATE~-2s:..rP) .
FOR OFFICE USE ONLY
Zone~!
Fire Zone
Flood Plain
Type/ Canst. ...l.--.
Bedrooms
<:'torie~
Units
"'ccy Load
"'ccy Group
Sq. Ftg. Main
Sq; Ftg. Access
Sq, Ftg. Other
"alue
"olue
Value
. TOTAL VALUATION
.
BUILCING P!:RMIT
Charge. and
Surcharge.
Plan CIt. Comm/lnd
65%/ Bldq Per F.n
Plan Ck. Res
30%1 BIde- Per Fee
Sydems D.....lopm.nt
Chorr:lel f 1 .5%'
PLUMBING PERMIT
Chorg.. and
Surcharge.
Fence
Cemo
Talol Comb. Pl!rmit
~t.. 0:'
ELECTRICAL PERMIT
Charg.. and
Surcharge.
:;):"'5.02
1.03
Sidewalk
AIr:: P,:,vin<:,
MECHANICAL PERMIT
Charges and
Surcho'ge.
TOTAL
b< b .02
Curb CuI
.
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COMBINA nON APPlICA nON/PERMIT (CAP)
I. Applica~ to furnish
A. Job Address
B. legal Description
1. exomole.tox lot 100. Lone County Map Reference 17 03 43
2. examoie-Lot 1. Block 3. 2nd Addition to Springfield Estates
C. Nome. elc. of owner and construction lender
D. Energy Sources
1. exomole-heot/electrical ceilinq/or forced air gas
2. cxomole.worer heater: electrical/or solor
E. Square footage or valuation, etc.
1. examole.1250 sq, foot house. 500 sq. foot garage
2. exam ole-if new project. check new-if addition, check
add. etc.
F. Building permit information:
1. exam ole-construct single family house with an ottoched
garage
2. exam ole-remodel existing garagE: into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value of work os defined in Section 303 (a) of the
Structural Specialty Code
,H, DESIGN TEAM -AND CONTRACTORS
To avoid design 0; construction delays, Building Division
Stoff mllst be able to contact appropriate persons regarding
design information or job site correCtions. etc.
II. ,Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description portion
or the Mechanicol and Electrical Schedules. the applicant
need fill.in only the No. Boxes adjacent to the appropriate
item(s} to be installed
R. Full Plumbing, Mechanical. and Electrical Schedules '
ore available at the Building Division .
1. To conserve space on the permit form the schedules
have been abbreviated .
2. If the item(s} to be installed ore not covered on the abbrevi.
ored schedules you should consult the full sche~ules
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND
CHARGES ON THE SCHEDULES
111. Applicant ,to sign and dote
Whenever possible. the initial application will be used as a
worksheet only. Where possible. Building Division Staff will
prepare a typewritten copy and return it to the applicant at
the time the acrual permit is issued for his signaturE..
IV. Fees and Charges
Plan check fees are due and payable at the time of the application,
and no plans will be processed until these fees are paid. All
other fees and charges ore due and payable when the permit
is issued.
v. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED' BEFORE OCCUPANCY:
,
Additional Project Information:
PLANS REVIEWED BY,
nam-
"';gnatur-
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. PERMIT VALIDATION
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Permit CierI-
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