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Home My WebLink AboutPermit Electrical 2004-12-12 .' CITY OF ~~ ~UNGFIELD, OREGON' ( " '; j ~ . -~. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (54t,..;q/i>;""""9 o 7tJt ~'W..o ELECTRICAL PERMIT APPLICATION i' <>'& ~' %/9-" . - U 1/ "'~:\o ,"'~' City Job Number COwU:.oOl{- O/~/7 Date ~-IO .....O'5~, "<,- "o,<>~ . '@ ;p -.....($l l5'",..( (l' (" u. 3. ffeo'MPLEt,tP.EE" ."",,, mEe-n~~~~~'''t'il(~ i ~~"~,_",<~"_j.......".:,~.,........,,,,-J,.~,_..<.,,,..,.,.,,," "i';;:.' ... .." ".~' .~Q'~,j~:,.. : ....t:> " 0~.,jI~ _'c..",..,..."n. ,'. ~"<:t.-'i1.'~.,''''~ ~.',_.,... ,..: ...n,';." ',' ~:, - ~~+~~:fo~ '.~ '.v"'" A. b'.rf'~;R~identi3Jb;siJigie:o' Ii 'J """i,~' er ~I 1,":uIiiE'ik~l l';(.,.-!'!" ,,,,,-,, .".".~", ,.. ''''-'' ,~,~.p. ';". \g.,.-, . Service Included () & ;s> 1000 sq. ft. or less ~ $ 6.00 Each additional 500 sq. ft. or portion thereof 200 Amps or less ) $ 63.00 ~:~. 00 201 Amps to 400 Amps $ 75.00 Address J~Jf(~ J..Iwj"'1 So 401 Amps to 600 Amps $125.00 . N01'jV~ps to 1000 Amps $163.00 Phone 5!L/- 7c1l0YrYfHIS<PBiI~~i'!?sr,.'oJ~ . $375.00 ReCO~ t !yLL tXPIRE IF Tlit WORK $ 50.00 AUTliUHILt NOER THIS PERMIT 'I'. N.0 . t.t. ' CO~~~""""""~'''''''''~'~G;_"~,.~...~.~.'"l!."",,,.. ,_,~;,,,<,,,'\o"'''''~W.q~l' ~I 0 (' . .em ora . '''''........'''1' III 'I1in., -"/1 ",'("'II@;:."';"'eJ\:.1~5 . . / ~ :a."'..... AN '1' "~IUO.'" "'''' " .<'In.,,,.,.,, '" ",..."",,,p Expiretion Date / D - / - 0 f,., Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" above. . D. ~Priii~h~€lrttim'R"'~""&"',;rlfu'i~~'lf''''1~.1,f}j!!''~'~1(ffi~''''J;;t~1'1 , .... ~ ".,. ./~~?'j!l\f,!""...';Ill,b~",,'_.~...I!''''J.,.jl,iJ.;1.~,;rdl New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with SennceorFeederPenrUt Owners Name /Ja I-()!d J-j, '/ ~L l"tt tal r 3'/ fV) 11..) ^u E.li[crlfiiij~t~!i<.:~~l~lJitj:m:1iiid~~Ejffh1TII~.i.'~'llltr.&i Address [e, - I' --'t.- t1/:tl. .t:!' <> AI ;~NTIBN:{,rig1l'",r~~,r&;~i~C'"''"'''',""j;;''' City ~ f.,t~ ~I 'i [J Phone 't'7Y - ~ 8'/~ Plll!llll6WFi!1mctopted by the Oreaon USlilV.oo C a."'t1i1h.. -k.~~yW!",i'l) S~e,h~r. Thoserufesares~l'l~ OWNER INSTALLA TION Liwt!l'A~~Q1t'i8through OAR 952s0Ah> LillllOO.~6\lnm~1\!MXlpies at me ~1S\~6 11' ~ntpJ:J!'~9ta: 1I1tl~ ' Minimumcm~ e it2f~'miftlYR . urcharges f~ .., <>"d,a;Z.J}~~. .';. ,~.o('!'.;~!o;I" " 00 4. . Sl:lB!FOT~1ltD . '. . ,'~ ..'."l;' ""'..,__ ..^", w.. . --'.'; ~:w1;r:::;.i_;-~t}':ft' ~~1:'~~~,~4'~~!~ '. ' / 0< c;o;t..- '1. - r;L.3--- I. ~'LO&TjON:OEINllit~T;t"ii(jN::!l~.~~~ t.V".....~.."d~.." ,,,.,.,,..e,~J" "...",.~"..,. (" :-< ~ M d II a.r A-Ul'. ~ . LEGAL DESCRIPTION /703, 2:2-( ~ I L{ 2..-0-0 JOB DESCRIPTION ,~f--U(LP c4- ),-L., A-- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. [,....' .~~"... ~.-,.,_..~":". .c.-'..",.-"...."";,, ''''''''''', "'. .....,... ....'r~.."'.,.,.,."""-,~.~Jo.. "'}t>-1~ 2. i~F~~9!Q~.~~~~$~~~R~li1 Electrical Contractor ,/klrl' ~ City _F..U.Uj)(}.p Supervisor License Number Expiration Date //")'//3 '7-,;Lt- 0 G, Constr. Contr. Number ... . The installation is being made on !''VIM'; I own which is not intended for sale, lease or rent Owners Signature: Inspection Request: 726-3769 Each Manufact'd Home or Modular Dwelling Sennce or Feeder $50.00 B. '~?S~~1tfi:'~'~d#~~~4~hi't':ili'tili~~Ai:t~rWiliiiis?itf.':RiI6;ifti~h~1;] ~~"'''~'l:l~i.IH,+.'J1.''h''. """~~....:a-~!;&~!i.if~'~"'" ..'~ -,/2f..~' .~.,'::,\'$_H;.,~~1tt.,f.ti., Jl.?"';.::i~ilWl'l~f.1 $ 43.00 ;~ 1 --; $ 3.00 7% State Surcharge 10% Administrative Fee TOTAL glf .;).If Sban:d Drive(T:VBuiIdin. FormslElcctricaJ Pc:nnit Aoolication 1-03.doc . . CITY OF ~nul~ul'IELD Building/Combination Permit PERMIT NO: COM2004-01514 ISSUED: 12/10/2004 APPLIED: 12/10/2004 EXPIRES: 06/10/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 636 MALLARD AVE ASSESSOR'S PARCEL NO.: 1703221314200 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Service and heat Owner: HAROLD HILDEBRAND Address: 636 MALLARD A V SPRINGFIELD OR 97477 Phone Number: 541-974-9872 Contractor Type Electrical Contractor ARC ELECTRIC I CONTRACluJ<.mruKMATION I License 115113 Expiration Date 07/29/2006 Phone 541-741-0494 VN BUILDING INFORMATION I 'n;r.'r~' ~ 'THE WlIHI( W.iifStorres: c:.HJl.LL EXPIRE Ir Lot,Size: W\!ghPM;~S~j:\Jcture0ER 'THIS PERM\1~~Ft\Ht Floor: 'frJ'f\<ifJHeatiJ UN IS i\Bi\NDONED Sq\Ft 2nd Floor: Watertl~p:~ED OR Sq Ft Basement: Jt'a~~-i2'eevJl.,{ PERIOD. Sq Ft Garage/Carport Elihgy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 I DEVELOPMENTlNFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPR\!l.VEMEM'si~reg~n~il~h;O;~~~~~; . tolibw rJ,bd.~ opte Y Il~li.!!re set forth Notification Center. ~~ah Q.AR 952-001- in OAR 952-001-00 v.o"")pFedSOY~les by 0090. you may obtalO C~te. the telephone . calling the cen~r. ~n Utility Notification number for the. reg 0-332-2344). t'ont..r IS 1-80 I Valuation Descriotion I Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page I on . . CITY 01< ~.r Kll~ uJ<!J!.LJ) Building/Combination Permit PERMIT NO: COM2004-01514 ISSUED: 12/10/2004 APPLIED: 12/10/2004 EXPIRES: 06/10/2005 VALUE: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fee~ Pail! I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Perm ServlFdr 200 amps or less Amount Paid Date Paid Receipt Number $7.20 $5.04 $9.00 $63.00 12/10/04 12/10/04 12/10/04 12/1 0/04 1200400000000001724 1200400000000001724 1200400000000001724 1200400000000001724 Total Amount Paid $84.24 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 In~nection~ I Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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 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 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 Pal!e 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ~~~~9.'~~~I!LQ....." ____'_, .~. ~', ~ ; -- '..- : .' , .. I .! ~ ~.._~..--.., JiilY of Springfield Official Receipt _elopment Services Department Public Works Department RECEIPT #: 1200400000000001724 Date: 12/10/2004 1:29:37PM Job/Journal Number COM2004-01514 COM2004-01514 COM2004-01514 COM2004-01514 Descriptiou Penn ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee. Payments: Type of Payment Paid By 1Iem Total: Check Number Authorization Received By Batcb Number Number How Received Amount Due 63.00 9.00 5.04 7.20 $84.24 Amouut Paid Check ESTATE OF ARC ELECTRIC djb 1505 In Person Payment Total: $84.24 $84.24 12/10/2004 Page I of I