HomeMy WebLinkAboutPermit Electrical 2007-6-19
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22S;iIFTH STREET. SPRINGFIELD, OR 97~77 . PH:(5~1)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPliCATION
City Job Number (. DiM 7.00 , ~ 0 D 3 b Z-
1. ffOC.4TioFrOF..1NST;TtATION~~.~
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LEGAL DESCRIPTION:
noZ3331
. JOB DESCRIPTION:
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Date b~( J -07
3. ~coll1PiffifFEESCHED(i1LE~BELOl\t~J;[i~\f~ ':-
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A. ~~Il~~~~~~:L~_,~_~t~!5~i~!.~.~!ill!l;!~El.~t~~!E~~!ID1~~~~~~t~
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
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 $5000
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E ectncal Contractor 11',' Itth ':ti' -:i140 , I \~W;l',!l!ps.or I~'!; r>-\)~" $ 63.00 .
r>-\\"'i\\ 201tf'nii1S \6?400\.AmPS . $ 75.00
Address ') J(ICl (\1,\'1.0-,' 0,,,1 :;;j-. Ave CGw.~dir~;s @'606 ~ps $l25.00
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(I.~'{ 601 Amps to 1000 Amps . $163.00
City cyc.6<-<."'" Phone -;41" ,ZI- ~'G Over 1000 AmpsIVolts $375.00
Reconnect Only $ 50.00
Supervisor License Number
Lj/rJ.. :5
Expiration Date. (e -0 f-';,
Constr. Contr. Number 14(, 74" .
Expiration Date
/. i~'~y
Signature of Supervising Electrician
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Owners Name -S-()y lee f4-p,yNCs'
.
Address 5"3 ~ 0 M Aui! ')'1
City S y,:' ~ Phone 73b - 80b"
OWNER INST ALLA nON
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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',. .em orarv ervlces'or:.l'ee ers."...;-jl;J~) !!^ .f;-~~ -~." . i~,i~' - ,"'&'~f:
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Installation, Alteration or Relocation
f\I}\O
200 Amps or less .:,,"'S 'h-,-,\\~.'YO.OO
20 I Amps to 400 Amps ('I \a'l'lle~."o.o('l v; ~69~00
401 Amps too6g0(b'ffi~~A 'o'l\'(\e.,~c. ate "~~106:00
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ov~f1;OO"A . 'O?<rORO'W:51~ see 'i8:l~\i Ve,}\eS \-'}
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New Alteratton or,ExtenslOn.Rer'Panelt-lo I
. ur' ~\\""J :\e~' \.)\\\,\.J A\
Onfc;ir5!!i({OI\ne ce{\ o;e<:30('l ,^" ??l' "'$ 43.00
Each\)A'ddition'ill CircUlf-or withJ()'''~ .
v..... _ 1y'\ . \'-~
Service or Feeder ermit IS $ 3.00
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E. \MiScellalieous. (Service/feed", notiiic1iidedr~E:i'ch"Iilstallalion~
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Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. ~s'{)nTofAi'OFAB();TE1~'W<"~~~1~
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8% State Surcharge If
10% Administrative Fee "
5% Techoology Fee 2 p:>
TOTAL 1 b/~
Shared Drive(T:)lBuilding Fonns/Electrical Pennit Application 8~6.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRIrIi\.J-I'IJ<..LD
Building/Combination Permit
PERMIT NO: COM2007-00862
ISSUED: 06/14/2007
APPLIED: 06/13/2007
EXPIRES: 12/14/2007
VALUE:
SITE ADDRESS: 5350 MAIN ST
ASSESSOR'S PARCEL NO.: 1702333106501
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Temporary Power Pole for Fireworks "Stand
Phone Number: 541-736-8064
Owner: HAYNES JOY LEE
Address: 5350 MAIN ST
SPRINGFIELD OR 97478
Contractor Type
Electrical
I CONTRACTOR INFORMATION I
License
146745
Expiration Date
01/18/2009
Phone
541-521-5690
Contractor
MITCHS ELECTRIC INC
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Fronlyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Speciallnstructioo:
Notes:
Description
I BUILDING INFORMATION I
# of Stories: Lot Size:
NOTIli-ieight of Structure: Sq Ft 1st Floor:
THIS P!YI!~~f,,",<:~!LL EXPIRE IF THE WOR~q Ft 2nd Floor:
AUTHO'cYrfm1i~~'iER THIS PERMIT IS NO~q Ft Basement:
Range Type: Sq Ft Garage/Carport
COMMEWb.-g9pi,lt'h!S ABANDONED FOR Sq Ft Other:
ANY 1 fSpfirikled:Bjii!<!i~g: n/a Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:,OU to
("tUIlt,;~ J
0(1 laW re" Utility
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1-" '0-' . . .,"~...~. _.~ ~_. ,.....
talloW .ruIEI'PUBmC-IMPcROVEMENTS;IJO~-
Notitica\iO(1 v01'00~ 0 \hrou\J" -jlhe rules by Sidewalk Type:
OAR 952.0 blain caples 0 hO(1e
1(1 90 You may 0 \Note'. the telep 1.lon DowospoutslDrains:
00 . . the center. Utility Notlt\ca
ca\lIng the oregon 2344).
number tor . ~.800-332
Gen\el IS
Total:
Handicapped:
Compact:
I Valuation DescriDtionJ
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Value
Date Calculated
Pal!e 1 of2
.
. CITY OF SPRIr~t.I1 H,LU
Building/Combination Permit
PERMIT NO: COM2007-00862
ISSUED: 06/14/2007
APPLIED: 06/13/2007
EXPIRES: 12/14/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L.Fp.p.~ P"irl I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Temp Power 200 amps or less
Amount Paid Date Paid Receipt Number
$5.00 6/14/07 2200700000000000959
$2.50 6/14/07 2200700000000000959
$4.00 6/14/07 2200700000000000959
$50.00 6/14/07 2200700000000000959
Total Amount Paid
$61.50
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
l..-P-ea uired -lnsner.t~
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 aoy 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
Pafe 2 of2
225 Fifth Street
Springfield, Oregon 97477
.
541-726;-3759 Phone
,
.
-iiii' '!........... -.' .
WiLl -
-., .
..................... ^. ...-
~ of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
2200700000000000959
Date: 06/14/2007
2:18:28PM
Job/Journal Number
COM2007-00862
COM2007-00862
COM2007-00862
COM2007-00862
Description
Temp Power 200 amps or less
+ 5% Technolog~ Fee
+ 8% State Surcharge
+ 10% Adminislrative Fee
Payments:
Type of Payment
Cred ilCard
Paid By
HOLLY MAHAFFEY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb T02572 In Person
Payment Total:
Amount Due
50.00
2.50
4.00
5.00
$61.50
Amount Paid
$61.50
$61.50
cReceiotl
Page I of I
6/J 4/2007