HomeMy WebLinkAboutPermit Electrical 2005-9-16
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-Wlh'0~"
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ELECTRICAL PERMIT APPUCATION. 0'0,'0 ,'1>,,0 ~,;
City Job Number C.QI!d?COo;;-CIZ6/ Date 9!rs1r;cs. '\~u"'~~,~ 1,.o<.'''Cb' ./
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3. I COMPLETEFEESCHEDULEBJlf;l!W
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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
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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
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. 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
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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