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Home My WebLink AboutPermit Electrical 2005-11-29 e 101l0wing project es~d has the following '&A . Ing end d::R~l~l!-~J~nd use w tlli~'l'!( .:<., onlng"~ -'. , ._f'< t_,:;r;~oJ)o.~ . FAX: (541)7Q619689 ,fJ"~1i~' "Ulhun..." blgilal;;'~e.::-p-.; ifff" 1:5 / Date I q~ lo~ . :tM' B ~ ~/,::~,- ,'.,," 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 ELECTRICAL PERMIT APPLICATION City Job Number ('tl M";).oDS ~OIIoS'l 1. ~ L.OCATION'..OF iNS.TALUjzON.\: "";:;';,'. '.' 3. (col\fniiiiFEE'SCHiwiJiEBEiofi;.'~j(.:;fYE<~f.i;,t~WiZ ."", .....,..,,"'...~....,.... ...c.",'.. '::;f'fl)AI~/O:/CP 0/2 ...., .';.. ..,..~.,.'. . ............"....--"'. "',,,. ..._..=,.:>...,4..,,,,,,.,,,.,.,,""<.>,.,, 531\'0 fYllHtJ s;r. 1rf-76 , / LEGAL DESCRIPTION 1'7 D2 ~7) ~J {)(Pf?Dj JOB DESCRIPTION ~ ~ toll- Permits'are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ",~ ..._ .r;', ',;,,'.;":" ":::'--";"::"...' . ",,'lr';:'\~" ","-:-""i-"'~",-;~../.:,n.':'"Y:r~''''';., - ' 0( :.CONTRACTORINSTALLATION ONLY.: 2. ~ ._-~:'"A::>I.:C."tj:<~~_;'':'',.u:.:.~..'!.~:~'':.io:...'o.' l--.d<:,t.'L?I:'\..;.:..a~~ Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name r7vA,fiif WffH ()fTilM{l h Address Cf 1- 2 WTlf sr City '9fZJ'rJM-I&:-td Phone _ H51:r74:13 OWNER INSTALLATION The installation is being made on property' I own which ?Eiij' / ~L/ Inspection Request: 726-3769 . '~,",:' .:" ,,i'~' '. ;'.:",:"\':,:J :t", ~i?,d~:~r".~';:~"""'_: ,~'" -!l';:7'. ,~).:~R~:r,~,~",:"'{:l;l":':.'~'" ~,\:-/~.;~; A. ~.New ~esi,dent~a,I;7::'SJ~gl~q(l\Ju}~i:Fa~i~rper..:dl'~e~liiig ut:J,it>: ~ .....,. ,._...........' ~ ''''-''''U ..._..~_..~.n.....' __",! ~'L~' .lw-;..."-.~_".........~..........~J:..-" ."".t.:.<L.~J:..,,$' Service Included 1000 sq. ft. or Jess Each additional 500 sq. ft. or portion thereof S106.00 S 19.00 Each Manufact'd Home or Modular Dwelling Service or $5000 1lt0'1lCE: to IF THE WORK .... 'l'Il<:.'D.' ~[]. ..~..,~U^'.LE. XPIRI.. '. ...<d"~'..""";'I"i''t.. -""..'" .,.'''.......'.".... B.;'g~\'\li~i n\' U(1!".. ..Sil"'E~~ltDd~Q~R~i~~~ti6l;~'~~ "'Al'lTH0 ~.~.ff; mThW1Jti~..,",-,~ "~'Q'R""'"'"'~"'""~''-~'''x"",;; 2dil(lMM1;,~{;fsD OR IS ABANDONED F S 63.00 20,M\){,~g~fl.'igWIOD. S 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps S163.00 Over 1000 AmpsNolts $375.00 Reconnect Only S 50.00 '.f"...",..:-,'.',......','~>ri<.,~'O;'."l.i".,"':"";;,?,!,.'V:~l.l..<C',"..~'c~:':<"'.t".~.~.. - . 'Y'I1l'~;~::~R'~'" 'l?i C '-T' "~"".'",, "'~"S- .",. ... ,d ,,'~-' F l~ d",'.A;), . ,l~' ;,',J- . -'''\1 - ,~w";;~':"'~1i%"" . ~. ~I . ~'\c,'!~!~o!:.~!t..~~rll\~;.s;2Jj:'...l!~;2~~!:<.i~~'~,~'~ 'l~~4::-,;,1f~'("\;:" \,,:t.tY> Installation, Alteration or Relocation .f c->o .- 200 Amps or less i $ 50.00 Q u. 201 Amps to 400 Amps S 6~.00 ~Ovt~~~~~~~~;;o.!~~;~~!.~.;i~.::~~~=._~ D. B..nch\ellcults1\!1.'ii:!ItI"R-i!~""'-m'A'",.~,"ot!"":""""'''~1 W>'~';"Q~~~?~661':Dtfi'(ftt1ro\;l~1i,,; . h~'e' ru\~~bY""M~'-~" New,~lteration or Extension ~eriPaneh ('.....~ v u may UUlon'.... t". - ~ p O,\'eGi~;u.~~ \\08 ~ef1.ter. (Note: the telep$ '43'.00 Each'AddlllOnal C"cUlt.ore~'th1 Utility Nott.lCatlon Service\or.Feeaef P~hr:i{' 80vO-3"''''' ~':" 1).. $ 3.00 Center IS 1- v_ , , ~" . . ,',-J'... ~_. \ ~"7-"'~<"''t-,.'''''~'' "1,'.-1'~-'lJ;~', '1-""'-"- ::,,_~~::~,"'-10'" ... ;>~...p,~~ E. ~~-Misc~~It'a;e~us"(~er~'lce/fe~d;..t~o'! i~c1Jj~ied)';Each irisdfl~H~b~: on...., "~.~ ~_ ,~..:",_!;, '-',oJ ". ,~';:~"';..~":;'c.,'\_~Q' .:<oJ,,~.,~...~-: .I,~-,>v:":)' .,l!:" '... ..c",-,~., "'~ 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 545.00 + Surcharges " ,~..'d.',""-:' ,l:,-~>~, ~', "i;':~.<:'-."..:."I:,'t.".1.:~: ;';"~~'''''i'f,;''''''',~;;,~",,~ 4. : SUBTOTAL OF ABOVE' :;,,:,:)t;,...:,~,(..";\ ; ':'.';-.:_. .;.'-J... ;.>:...~>. .'..t_:-:""..,;\::..:.,::,'='i ~:,:..:,:.'.::,'-,:;.'..,~},... 7% State Surcharge 10% Administrative Fee Sll.OO 3.50 -$,00 S)1 S1.) TOTAL Shared Drive(T:)1Building FonnslEll::ctrical Penuit Application I-03.doc . . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5350 MAIN ST ASSESSOR'S PARCEL NO.: 1702333106501 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01658 ISSUED: 11/2912005 APPLIED: 11/2912005 EXPIRES: OS/2912006 VALUE: Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New PROJECT DESCRIPTION: Temporary power pole for Christmas Tree lot for Crossfire World Outreach. .: Owner: HAYNES JOY LEE . Address: 5350 MAIN ST SPRINGFIELD OR 97478 Owner: CHUCKS ROD AND REEL Address: 5350 MAIN ST SPRINGFIELD OR 97478 ContractDr Type Contractor # of Units: Primary Occupancy Group: . Secondary Occupancy Group: . Primary Construction Type , Secondary Construction Type: ~ I # of Bedrooms: I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: ',Notes: Commercial ~~J~~~~6 ~~~~~ ~~~~~~~~TEI~~~~ ~n!-A~fN.GtU un I" ,,~{'1l:::8\1~1~ enD I CONTRACTORJNFORMA'fU!lN{fJU. License Expiration Date Phone I BUILDING INFORMATION' # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: S . k1 dB 'ld' gTTENTIC')' OregcO' ,~'" r"nt'~lrPilo you to prlD e Ul 1D: n a ccupan...oa:. . ". ... .IM ~"nntorl hv Inp (lreoOn Utility I DEVELOPM..." I m~A.iiMAI1J6Nl"nter. Those rules ar8 sellortn r 1 .-....n ,,~,.., ""("\1 in OAR \Jo~-uu1-001 0 throu9'REQUIRED'PARKlNG . 0090 You may obtain copies of the rules '-'I Overlay Dlst:. (N tTotal:ephonc # Street Trees Rqd:calling the center. ote:. ffi~aicapP'ed~ b f the Oregon Utll''', ,"uuh_,wv,l Paved Drive Rqd: num er or Compact: % of Lot Coverage: Center is 1-800.332.~,j4~J. I PUBLIC IMPROVEMENTS I Sidewalk Type: DownspoutslDrains: PaeeIof2 . . CITY OF SPKli'l\.Jt<u<..LJJ Building/Combination Permit PERMIT NO: COM2005-01658 ISSUED: 11129/2005 APPLIED: 11/29/2005 EXPIRES: OS/29/2006 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection LIne I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Ff'f'~ P3W Fee Description + 10% Administrative Fee + 7% State Surcharge Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $5.00 $3.50 $50.00 11/29/05 11/29/05 11/29/05 2200500000000001627 2200500000000001627 2200500000000001627 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. Temporary Electric: Approval required prior to Utility Company energizing pole. , By signature, I state and agree, that 1 have carefully examined the completed application and do hereby certify that all " information hereon is true and correct, and 1 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 Paee 2 of2 . .:;~ ~. Ilk. ! 225 FJfth Street ~piingfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-0 1658 COM2005-0 1658 COM2005-0 1658 Payments: Ttpe of Paymeut Check .:(, 'I 'II :1 :! ~.~ 11/2912005 'i. RECEIPT #: MJy of Springfield Official Receipt .velopment Services Department Public Works Department 2200500000000001627 Date: 11/29/2005 Descriptiou Temp Power 200 amps or less + 7% State Surcharge + 10% Administrative Fee Paid By Received By CROSSFIRE WORLD ddk OUTREACH Page 1 of I Item Total: Check Number Authorization Batcb Number Number 1444 How Received In Person Payment Total: 11:05:I5AM Amount Due 50.00 . 3.50 5.00 $58.50 Amouot Paid $58.50 $58.50