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HomeMy WebLinkAboutPermit Electrical 2005-9-16 . . < c.\.~- ~ . 0 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-Wlh'0~" "',"~~ ELECTRICAL PERMIT APPUCATION. 0'0,'0 ,'1>,,0 ~,; City Job Number C.QI!d?COo;;-CIZ6/ Date 9!rs1r;cs. '\~u"'~~,~ 1,.o<.'''Cb' ./ 'f>.l~ ./ ...\.>,),\ 3. I COMPLETEFEESCHEDULEBJlf;l!W C\.,;r 'J.b v 0" ,~\" A. I New Residential- Single or Multi-Family per dwelling unit 1. i LOCATION OF INSTALlATION bF'S"3 14? A-I/V S I /7oZ JS'J] lYJ4-tAl ST. oE,z..O t( LEGAL DESCRIPTION b &'53 JOB DESCRIPTION ~ p. <:',:ietltc; f;-.t2... :5o!3 T1<AK.be<;, Permits are non-transferable and expire if work Is not started within 180 days of issuance or If work Is Suspended for 180 days. 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 2. I CONTRACTOR INSTALlATION ONLY 1 B, I Services or Feeders -Installation, Alterations or Relocation: Electrical Contractor f'nYAlL>?'ft! ~~)/J.c.. L~f206..{~~s,or;ess.11 e '\ $ 63,00 .--\,. ...., I"~ :,\ '''201 Anipst~400'Amps $75.00 Address ~J-S<' t:::SCkONrb ~7.S:' - :\\_(.0 U40\ "o\mRs to 600 Amps $125.00 \' ,Vi ,..() ",}. \0. ". \,,,~ J601;Anips to 1000 Amps $163.00 ^...... ' ",\\..-, ~ ",.. Phone ..Ji:t:.:.' 7- ~<:/q~0 0-\ Over 1000 AmpsIVolts $375.00 ,\,-.\'\ ' Reconnect Only $ 50.00 Minimum Electric Permit Inspection Fee Is $45.00 + Snrcharges ~ 4.[ SUBTOTAL OF ABOVE . <;0- ()f:> \ I\OCJ:' ~ )) 7% State Surcharge 3. SO ~ ~ ~ ~:~:~ministratiVe Fee <'_ cD '-J~ ~ \95><. ~ ~ ~ Sh"",d Drive(T'YBuilding FonnsIElectrical Permit Application t-03.doc City tub ,e,. <.I c==: t//?1'75 /O//J/07 Constr, Contr, Number .::;;8 - C; 22 L 1/0t!O(Q. Supervisor License Number Expiration Date Expiration Date Sz;oerviZ2 , ,. Owners Name (; ry: ~ .<:p;"",f), Address ;:::);:J.C::- fi F7J+ '.1 City s ? (.;') Phone 7U..-J7)J OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 c. I Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less / $ 50.00 ~ ao, 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" above, .,\0 D. I Branch Circnits "1~ 'l':'\"\'~ 'Y- 9;0.."" 0'\ \O\~ New Alteration or Extension P.elflll:inel(eQi ~ ",'0\ .....rv" ~\O- eV 'l>\V _".v 1'1 One Circuit 'O~O 1'1 \t' _\..$. ~~~ Co '0 Each Additional CjJ;~iPlr ),Xijli. '0 0"''0 \~ ~ O~ ~ \\)' ~0 Service or Feed<!i:'l>e!1'lii>OY- "\'\'Ir' \Qi J~'(fOR>'(\O -",,<\ ,-A'.;;.\~ ,,\'0"'. (\\'O\~..s'>\\'d.:,\'o". \e\'O.,\,;o.'" E. I Misce~~Ji'll~i-(S~~_<J~s.:'D'o~~';'i:f~?,~,~a'~ Installation i ~O\\":", CfJ':)1;' ~'3-'l- '1..'0\. "0<;\ v~9:1-;J.' Pump or in;tg.'lJjon -{O~ e c,'o<;\ ('{eQi _".'?)~ 50.00 SignlOutlin~ Ligbling,~ ~'O~ 'S''o '.~ \''O~ $ 50.00 v '?J.\'\" t " e' .- - Limited EnergytResi~~iab'O<;\\! $ 25.00 Limited Energy/CSgmercial $ 45,00 r '\(\~ . . CITY 01< ~rKll'1ljl'l~Llj 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: COM2005-01261 ISSUED: APPLIED: EXPIRES: VALUE: 09/15/2005 03/15/2006 SITE ADDRESS: 6853 MAIN ST ASSESSOR'S PARCEL NO.: 1702353306204 Springfield TYPE OF WORK: Modular Unit TYPE OF USE: New PROJECT DESCRIPTION: Modular units for crew quarters during station rennovation Public ::. Owner: SPRINGFIELD CITY OF Address: 4TH & NORTH A SPRINGFIELD OR 97477 Contractor Type Electrical I CONTRACTOR INFORMATION I "\"":' ,,'n,'" Contractor ,.':' "\"1'1.1' \1' lI;iCense.. CONRlCH ECECrmGQ,t3\li\I..\:. t;~ \~ PI'<'i49S09, \1...... P. . "'.' ,.. . ."" AU \ 'rl[Ir<BUILDlNGclNFORMATlON, , .'-t\'vCu ...... C01~\\" \ _ ~I ....L-_~\~l). . \tl\ll#,ofStories: I\~'/ Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Expiration Date 11/02/2005 Phone 541-607-3447 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a , DEVELOPMENT INFORMATION' REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: C~8IPlalt: teo.u\tes uti\i~ On \a,~ Qle90n \ \ottn --.. nleg ..i ~.,\ne ~," se -~.. I PUBLIC IMPROV~~itis a,dO\"l~" 1nose t\l~op..? 9':l;~:'o'/ \OIlV' ~on cent~ . ~ik'~~~5 0\ tne I none ~otW\ca, ~5'2.'()()~-~\a,in c~ tne te\e~, ca.'Uon . Op..? ~nOwnspol~.'rf\rl!iJw.~otl\1 In 'IoU <<''''' tel. \~\\II\~' ()()9()' . tne cen Qlegon :3'2..'2..y.4). ca,lIlng \01 tne, _'O()()-'3 nu<<,'oel Ce(\tel IS '\ Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descrintion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pal!e10f2 . . CITY OF SPRI1'\j'-'I'1~LJJ Building/Combination Permit Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax , 541-726-3769 Inspection Line PERMIT NO: COM2005-01261 ISSUED: APPLIED: EXPIRES: VALUE: 09/15/2005 03/15/2006 Total Value of Project ~~ Pail! , Fee Description + 10% Administrative Fee + 7% State Surcharge Temp Power 200 amps or less Amount Paid $5.00 $3.50 $50.00 Date Paid 9/15/05 9115/05 9/15/05 Receipt Number 2200500000000001272 2200500000000001272 2200500000000001272 Total Amount Paid $58.50 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. IRI'~ Temporary Electric: Approval required prior to Utility Company energizing pole. 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 shaU 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 wltb 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 ofthe 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 COM2005-01261 COM2005-01261 COM2005-0 1261 Payments: Type of Payment Check ,~ - '. ., . '; ~ 9/15/2005 RECEIPT #: 2200500000000001272 Description + 7% State Surcharge + 10% Administrative Fee Temp Power 200 amps or less Paid By Received By CONRICH ELECTRIC djb Cbeck Number Batch Number Page lofl .J;j,!,ty of Springfield Official Receipt .velopment Services Department Public Works Department Date: 09/15/2005 Item Total: Authorization Number How Received 2185 In Person Payment Total: 3:44:46PM Amount Due 3.50 5.00 50.00 $58.50 Amount Paid $58.50 $58.50