HomeMy WebLinkAboutPermit Electrical 2005-6-27
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541~1\03li89 Signt;Uf.G~;,~. - .
ELECTRICAL PERMIT APPLICATION ! / L--l.{~...-,--LI?q
City Job Number CD~ zooS; - ~ e \ 0 Date h 'Z. 7/6 r .-0
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approvel.
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, . CITY OF ~ ."...UNGFlELD, OREGON (.->' .
1. ~iOCATIO!iOFINSTAPAriON-'
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'70 1.5 IU A- / ~ c,T,
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A. [;N$W ReSiden~a.!.~i'!lPe,~.IVI~ti:~a~i.2' P:r:.~~v.!.mn!.u~i~, .
Service Included
1000 sq, ft. or less
Each additional 500 sq, ft, or
portion thereof
$106,00 ~
$19,00 ~
LEGAL DESCRIPTION
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JOB DESCRIPTION
IbO A. OWI-<;r!1Jwcx- rep,
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. 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
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2. ; CONTRACTOR INSTALLAtiON ONLY i &- ,~:-;h~<<;rvices or Feeders-Installation, Alterations or Relocation:
- -- ',~\'0, \S\~. . / 73---"~
Electrical Contractor L.i -re ~'!!t'6, ,,,;." \ \t.00 Amps or less $ 63,OQ." t7
(,-' ~ -< v ,:.:0 201 Amps to 400 Amps $75,00 ....,.,
Address p'[) .&x: 1/1 :S'1",,~~"-.,'\\\\",,~\J'" 401 Amps to 600 Amps $125,OO'~'4.
,:;":~,)~\,,,\),,~;>:.,),. 601 Amps to 1000 Amps $163,00 ''>4'0/,
City (?I/(-,. q''1t.fi:iPh~~~' \'>\Y:l",;{;;~I;::r.f71'6 OverlOOOAmpsIVolts $375,00 ''''i".9
,
,\\,\~ \\\J\' IJ'-v, '('V" Reconnect Only ..0 $ 50.00
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Supervisor License Number ,~ . "6'<) S '35 c. r Temporary S~~;Q~~~'\!...._ __ ___ .__, ___
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Expiration Date /1) 6 I: Installati~~\1,tio'il'~,'Rewc'ihi9n
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200 1@ps~re~l;) \ ~ ~'S' 0~~ :~,o $ 50.00
C; q 7 'ff?' ~(tl~to:'40~~~0 0'~ o~'v- $ 69.00
J ~'<4QI~\~~ ~t~l\.'\~ ,y.' $100.00
Expiration Date t:; 'D b ~<<) ~0' ~~ r:J_iR<:- ,t: ,~ ~~
'" ~o~ \~o~~,If~~~~&Q,1gJ~ ee::'~" ab?v.".:___ --- p -- -
Signature of Supervising Electrician ,0 ".0. ,~~al\'<.lVCII""n~ "',..
tf f dv ;j;~~<f,'~~:~0~~~:~iO~ Per Panel '- --,
7/ '/ A ~. ~~"~ \0' 0'
I . '-(/ , ~Un~&'lfllPitcl~ $ 43,00
v () 1O~~lIditionaI Circuit or with
,~/ /l. /1, ,"V'9-1~~l'eOrFeederpermit $ 3.00
Owners Name __! J/-I-":? I LlJf/o'I Jtt(jA {(.All I UJ~ _ ____ ____ _____
Address ~G'>D fJ. b~ . E. 'l\1iscellaneous(Sei-vke/feeder,notinclud,~dJ-Ea,~~I.",~allation,
City J!i t/;" t--:::J/r;;., Phone J1J!...lC-l/b /I) J Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50,00
Limited EnergyfResidential $ 25,00
, Limiled Energy/Commercial $ 45,00
$50,00
Constr, Contr, Number
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Inspection Request: 726-3769
.~: $~~OTAL OF~O~~ __
7% State Surcharge
..~~ 10% Administrative Fee
~~. TOTAL
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Owners Signature:
Shared Drive(T:)IBuilding Forms/Electrical Permit Application 1.o3.doc
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Status: Issued
225 F1ftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 7095 MAIN ST
ASSESSOR'S PARCEL NO.: 1702353406311
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00810
ISSUED: 06/27/2005
APPLIED: 06/27/2005
EXPIRES: 12/27/2005
VALUE:
Springfield TYPE OF
Electrical Work Only
TYPE OF USE: Alteration
Commercial
PROJECT DESCRIPTION: Install 100 amp. Qwest power pedestal.
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, \CONTRACTOR INFORMATION I
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Contractor'~", '<'" ~'V License
TONY KOTH,\~v0' 59748
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.... ,<\ . ,,,v S r BUILDING INFORMA TIONI
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#ofUnits: ~','s "... x-,\..vx.\) "",'I:'
Prl 0 "\G"'~\,):-l.'
mary ccupancy" ,roup:, C'\'<'
S d 0 .\\ ,~..,v"v
econ ary ccupancy(\\" ,'t,"
P'rimary Constructlo'n'Type
Secondary Constructio~'
# of Bedrooms:
Owner:
Address:
HAMMER JOHN
PO BOX 2266
EUGENE OR 97402
Contractor Type
Electrical
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
Description
Tvpe of Construction
':-..."....
Expiration Date
05/0412006
Phone
541-688-8996
# of Stories: Lot Size:
Height of ~ ,0 Sq Ft 1st Floor:
Type of Heat: "0 ~O \)~1IiA ~,<,Sq Ft 2nd Floor:
Water Type: r:".:il; 0'" e"O ~Sq Ft Basement:
Range Type: ;olI \'li O\eC$~e '" r.,'l:\l .. ~ Ft Garage/Carport
Energy Patb: O""~ ;-soe ~e"o ~~ OJ \Joe'~S Ft Other:
Sprinkled ~e<:$ 0. 'O~ e \V ~ 0;lja,\e ~COC41llpant Load:
C1 ,,9. . -''Ie;; . ,0;: .....\ ,"' ,0'9 n."\::-v
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I DEVELOPMEN'f-INFORMATJON~" ~O~
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<'-V \~'- Ci" ,,<;)v 1;:-" _,0'- ~'" ~""
~ "..fo '0(0 ~\) ~" ~ co\:) ~'f,;
,.9v~~ray",~iS~'(}~ 0 (o,ro\' e(:!? fY~~
#:Sfreet Trees c,'li 0\ !(,\l
~ Cl.'" .Ju. ,~0 e -V
p~Ye\l,g~~~Rqg:~ ~\"o
% of.~::t'Coverage:o.e
~/" Q~
REQUIRED PARKING
Total:
Handicapped:
Compact:
IPUBLIC IMPROVEMENTS'
Sidewalk Type:
DownspoutsIDrains
I Valuation Descriotion I
$PerSqFt
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
1 of 2
.
. CITYOFSPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-00810
ISSUED: 06/27/2005
APPLIED: 06/27/2005
EXPIRES: 12/27/2005
VALUE:
Status: Issued
225 F1fth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769)nspection Line
Total Value of Project
FP.es Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
6/27/05
6/27/05
6/27/05
Receipt Number
1200500000000000907
1200500000000000907
1200500000000000907
Total Amount
$73.71
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.
Electric Service: Approval required prior to utility company energizing service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work Is complete.
By signature,) state and agree, that) have carefully examined the completed application and do hereby certify that all
Information hereon Is true and correct, and) further certii)' 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 wID be made of any structure without permission of the Community Services Division,
BuIlding Safety. ) further certii)' that only contractors and employees who are in compliance with ORS 701.005 will be nsed
on this project.
) 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 wiD remain on the site
at all times dr,t: 7;;+2-- h /7- 1!rJ ~
Owner or C"tracto~s Signature Date ( (
2 of 2
. 225 Fifth Street
Springfield, Oregon 97477
. 541-726-3759 Phone
Job/Journal Number
COM2005-00810
COM2005-00810
COM2005-0081O
P.yments:
Twe of Payment
Check
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6/27/2005
.
RECEIPT #:
~~
City of Springfield Official Receipt
evelopment Services Department
Public Works Department
1200500000000000907
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
LITE ELECTRIC SERVICE
Reeel ved By
jmp
1 of I
Date: 06/27/2005
Item Tolal:
LneCK Numoer Autnonzation
Batch Number Number How Received
6788 In Person
Payment Total:
2:44:16PM
Amou nl Due
63,00
4.41
6.30
$73.71
Amount Paid
$73.71
$73.71