HomeMy WebLinkAboutPermit Electrical 2004-4-5
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SPRINOFlELD
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~~' ~~'
ELECTRICAL PERMIT APPliCATION" '~ffi~~'tiii.lttief!jfi6Wlng
,l-nO (J '-II, j..., ^" ,/ The following project ~~:qU~i~~ :pecific land use
City Job Number (' ,orY1:)OO 1 u ?;/o C Date . t- vv '1 c....ng, and does no D(2.
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L ~LqC;A!IQ!i:Qf !1YJ..r#P!1J9ff,';'!!fi;.~~'.~~ 3, ~:gQM~I~I!}.;[!2!L~~':;:1!J;!d::rrz#2:5T:E~:0 ~fiii
l-f ~ ( t-1)f-U.. IHZ-O Date - - ~ -
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. I .. L c.. J;:)'J(JLJ Service Included
JOB DESCRIPTION FO;i DS L (a:?, 1000 sq. ft. or less
I 00 ~ P tJWbSI /JOUJt::'Jt-- Pb-P11511H- ;~~~o:d~~~~~~ 500 sq. ft. or
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. r~~.ffj&:&,~~A~~f~~i1g~p~r~!.
Electrical Contractor Li rG ~//2.! c.....
Address p (). eo)( II (31
Phone 5'f{ ~ 6f('-mb
City el/h
Expiration Date
3<) S;3.5
frO /0 jL
517 Lf f
~ 5/01
Supervisor License Number
Constr. Contr. Number
Expiration Date
Signarure offsi~ez
{/ ..
Owners Name ~ ,\t'.L Qo~ 11,'
Address W~l1 %eet~~q
City ~IlV Phone
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signarure:
Inspection Request: 726-3769
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or $50.00
Feeder
B 0s'~%:.~fiEE~t:4~~gjl..."'!Bno.'6'll;rti!.:i\"lr.~"\:;'k"'ti"! ~". Rr ''''I.;.1"'t'''>:i--'';,''~~
. . e"v"".nr. ee ers -';',lnsllllm noil " ell. Ani"'" oca JOn:'~:
L";ihll.8t"J' .L\;( --aaopte(l't;y.tltil'" '.<i-"'T""''' ""' ,--.,~",'
'Jotification Centar Th I gon Utility I '2 oil
20QrN!l~rg5~-001_ . Osa rules artQMl<for+ (();7 -
20 06#tPs 1fld\9~6~O,19 !hrough OAAI;!:75:9Q)(I
401 AlDPiil\~~QMewht taln cO/Jlas of th$ltlb!~!ll
ar. (Notfl- me lal ..
601 Nl//PttlaaO!lIltNl!~ragon uiT ~'fi~JOe
Over 1000 ArilpsNolts.. < _"",,_~n~ 'i '..otr$~!Om
Reconnect Only . - -. ,~44J.$ 50.00
c. !P/t~lli'p~ ortl~!Ser~fc'1fsf()iJF~ed~~:: 'tt;~: j-~~6~~t\PA~'?~a:.'~~~~1
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Installation, Alteration or Reloc.ation
$ 50.00
$ 69.00
$100.00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps .
Over 600 Amps or 1000 Volts see "B" above.
ruil- ';"i-"_"""'~"''''''"''''Ti'^'~'~'''m<r.,."... ,~. ".,,~"'. '~. .., '~,"
D . '-""'''~_.,_. "g;.' p ".. ';'~"",,,;,' "'wt.",. .' ,., '-.' "~.'"
. , nan~~. IrcUlu: _1;';'1t,.; :w~?,"i,o' ":<:~~{;.1 B.t':~,i'lr.' -:"""".' 'f-!t:<.;!~.~'~~;<;:4:',""
"'l;;_.~~, .f':';.:?"- -'--';'~..;,.--"'- '_'.'_'~ ,r', __ ","c_ ""~''r'--".._",
NeTJilliBlir..MIJr~M.li.rri(fen NiiefHE WOR K
o~'tTJaQBIZED UNDER THIS PERMIT IS' MJlO
EaQl)MmlliaHaEOiIOOtl<S' )1cIJ\1\NDONEO FOR
SeM/:\! <1IW<@MP~IOD. $' 3.00
~';;'~\""W'i#:~:~~/~'?'E'J - ,.J'~,l.'~~"";":<:_'.)t'-"'''''If;'''~\~.I''~.,>v~ s,~~:''.~''t'.' ''''''''tt~
E "Mj 'II .. -."(S. . .,. /''''d' ...~,. r'." 'I''''d)' E""I'I"'U>" '"
',' sce aneous, eTVlce lee er..Ilot,IDC Uue ~7 .ac t' nsts aUOD'
...-"._. ,.""..... ""'''';''-'''J':''~'!i,~.r-'" "~;"""'F-',--'_ ,,-_,,,,,_,".\:'o.r,,,,~,._....~.'r..",, '.-~
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
r.v';_.ho....--...... ~4;;;::::~~~.'. r~~~' ~.,:;"^1'-:.. :~ ~- 'T' .:cn~~
, SUBTO~AL"OEABOVEt~ "'''''''-:''''''''1
4. L~;~,.': ~-i. ~-:_~(.~.~-~;~~"f~;.t~,;j.-:7-,,!i~,!::~~,., ,f'l~,,::f~ :,1
7% State Surch,,\,ge
10% Administrative Fee
I.( 't I
h'?':;:
737J
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 1-03.doc
.
. CITY OF :srK1J'lld<u'LD
Building/Combination Permit
PERMIT NO: COM2004-00368
ISSUED: 04/02/2004
APPLIED: 04/0112004
EXPIRES: 10/02/2004
VALUE:
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection'Line
SITE ADDRESS: 481 MALLARD AVE
ASSESSOR'S PARCEL NO.: 1703221303000
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Electrical for DSL equipment
Owner: POSEY LANCE B & TANA L
Address: 305 EST #9 SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
TONY KOTH
License
59748
BUILDING INFORMATION I
Expiration Date
05/04/2004
Phone
541-688-8996
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of 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 Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay nist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS'
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descrintion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amonnt
Value
Date Calculated
Total Value of Project
Pal!e I of2
.
. CITY OF SPRIN\Jt<mLD
Building/Com bination Permit
PERMIT NO: COM2004-00368
ISSUED: 04/0212004
APPLIED: 04/0112004
EXPIRES: 10/0212004
VALUE:
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
4/2/04
4/2/04
4/2/04
Receipt Number
2200400000000000312
2200400000000000312
2200400000000000312
Total Amount Paid
$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.
I Reouired InsneetionsJ
Electric Service: Approval required prior to utility company energizing service.
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 ofthe 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
Page 2 of2
225 Fifth Street
-Springfield, Oregon 97477
541-726-3759 Phone
.
~8Pj~AIN_"~~.... ... I
, ."
~.: ;
""" -...---.,--.
.City of Springfield Official Receipt
Development Services Department
Public Works Department
2200400000000000312
Date: 04/02/2004
8:21 :30AM
Job/Journal Number
COM2004-00368
COM2004-00368
COM2004-00368
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment
Check
Paid By
LITE ELECTRIC SERVICE
Item Total:
l:heck Number Authorization
Received By Batch Number Number How Received
ddk 6427 In Person
Payment Total:
Amount Due
63.00
4.41
6.30
$73.71
Amount Paid
$73.71
$73,71
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