HomeMy WebLinkAboutPermit Electrical 2004-12-23
. ,- i CITY OF S:.: ~JNGFIELD, OREGON "
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~;. (541)~
ELECTRICAL PERMIT APPLICATION '1G>~o <>~Q .s>o..;%<}>
City Job Number Co... zooy - Of '::>b 1 Dale I Z - 2' '2 -6 \{ "'.><> ~~ "0,.. ~
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''r^~OZR333 L O<[(pD A~;;:;~~~:''''''''';'''.- '~~i """I
JOS DESCRIPTION 1000 sq. ft. or less 06.00
Each additional 500 sq. ft. or
i2.ez:...oVl""t:~, O!Vf..7 portion thereof
Permits are non.transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
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2. lJ;X?1'ff.IM91fll}nyST.A:Yi;!'TI,9.1y,pN.~r;;j
Electrical Contractor ~4 ~C
Address f9 '70 rJ 2fjTfI :;, T '
City~, 0qfi B9Phone 7 4-7 u~
Supervisor License Number Z4'3:>~ ~
ExptrattonDate ID-( -O.q.~
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,
Constr. Contt. Number /2.-1"7 z..
Expiration Date S -2. z.~
1'-
, .
Signature of Supervising Electrician
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{wners Name CA+'^.r,::-' 0"" b +r.......rr-
Address g-02.oo )0,&+ CrEElc..
City ~ e-i< ~ Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. t~~,S~,~M;i~~, ~'t ~F"e~d~f~::';:ih',s'ialla-:t,i6J;"AI,t~~~ti6;1~'.~;iRe,~16'c~,tirin,':.t-. J
f.~... '.,V... '.,;-' ,..,' .t:. ..r..l<-..l""-l:",,:.. ~",.'-,' ",:. .....1......'..I~._,P..<< ',.~...t'-'...c.. ,~.
i
$ 63.00
$ 75.00
$125,00
$163.00
$375.00
$ 50,00
-,---0
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
60 i Amps to 1000 Amps
Over 1000 AmpsN olts
trn'loo
Reconriecl'Only
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THt.1:; D'_',
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c! \ 'l.Tem(lOran'l~er:\ic~'~r)Eeooers?,f: ii'~+rc{r;:"~"f;r~ }~;.-~~r.:{','" .,'; t:;:/l':'ti',t
.....~"l-.- .-'fltt~'~"\""'rh... ", ~ti'rft!i~/"'''' ,.\_"....,,'),..g.l.;:<':.^'....:..,.";l,..~ "'(",
'0i,,'ti~':/I';u UNDER l/.J'! E IF THE
InstaUation,f'AJteralion or/Relocation WORK
IOU 0 v,.,-"';) AB '~'lIVl/r IS
200 Amps1,r leijRIOD ANDON"0;-_ Nar50.00
201 Amps to 400 Amps UK $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "S" above.
D I' B-~-.~I.~~C:i.l.,."..,.,,;..:,:i", :J<-:"!t:....~:J'.'1'f;.:'J-'~''J'~~...(.: 1 :"\.;},'--:~~1-..'1 ':;-'i",,:c.>)],:,:
. ranel. Ircults...~!/1t~.::.J,' 'd''1,}..t:_>-',,~..,''- .:,.;,;\1;;<I.!.~..J;'1.'J"i-
"'A '.,',.,".~ ".. "_,,,._.._. .'. ,,",'~ ", .'".-,....,,~... . ~. '~<"'''''' ~." ....',.. '..J ,-.-",t~, '_ "..;y. .,'..'l'
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
b~i~l"~'ij;'~"iill<~~;;,::'t'~(:'{j/~ <ll;ti'i::-,;~'~^''''''T'~_ .;,!..'t~;:~.~.:...:\..H ,A . <:,.,"..:",<,,;.t': ".-';."Uiiit~;1-,; ..:t:J
E, ti~~~!Nl<at~~'l~e"~),'f!J:i~S!l'!H!!,,_~,Y2'!~t
les adopted by the Oregon l (,,"
Pump !?\\9,'~a\Wn C t Those "oI,,~ ~,,$.50,OO
. Mnti~i\<atlon. en er. "
SlgnlUiItll\\T=l1i5~:Bl)1_0010 thrn",:,h .','I..i$,50.00 .
Limill1fu~~r~@ffi~'lY~!ain cooies 0' t:1E$r~5f~~GY
Limited tll.\\lll1,{<ffi!!,m;~i~ (Note: the telf$)45'J00'
L , 10 nrPflnl1 Utillt" Notification
Minimum Elwtrlli:RermittMSpeetion F;e.e,is,$il5.00 + Surcharges
__,n!D.je 1-8 n. .1<::'<::,j'f'f).
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4. "SUBXOTAV:OFABO,' ".
.~ . "~tl1~~Il~:'~i$;:ri~ ,_ ;.u:.;.'. .:.k'
5D
7% State Surcharge
10% Administrative Fee
'3S0
5'''0
~B~
TOTAL
Shared Drive(T:)IBuilding FOrrn<ilElectrical Permit Application )"()3.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
e CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01S69
ISSUED: 12f22f2004
APPLIED: 12/22/2004
EXPIRES: 06f22f200S
VALUE:
SITE ADDRESS: 5007 MAIN ST 6
ASSESSOR'S PARCEL NO,: 1702333204600
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Reconnect only
Owner: KA THRIN S LAMB TRUST
Address: 80200 LOST CREEK RD DEXTER OR 97431
Contractor Type
Electrical
I, CONTRACTOR INFORMATION I
Contractor
ALERT ELECTRIC INC
License
12772
Expiration Date
OS/22/2005
Phone
541-747-2213
1 BUILDING INFORMATION'
# of Units: NOTICE: # of Stories:
Primary Occupancy Group: THIS P~f3MIT SHALI!I~ig~!fq[~!r~~W.r~VORK
Se~ondary Occupa~cy Group;\UTHORIZED UNDEfT~p,~I~f~l~~\lIT IS NOT
Primary Constructlo~ Type COMM~CED OR Is~~t~~ly,~'~:':D FOR
Secondary ConstructIOn TypeANy 180 DAY PERIC~,ange Type:'
# of Bedrooms: Energy Path:
SprinkJed Building: nla
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
, Storm Sewer Available:
Special Instruction:
Notes:
Description
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
, DEVELOPMElu m.ORMATlON I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
. I PUBLIC IMPROVEMENT&. I to
ATTENTI(JN:durt:t"'~' b'y~~;'~-O;egori Utility Sidewalk Type:
follow rules a op e t forth
Notification Center. Those rules are se 01!>ownspontsmrains:
, AR 952-001-0010 through OAR 952.0
I~O~O You may obtain copies of the rules by .
, . he center, (Note: the telepho~e
calling t, ~ ~ .... ~ ".on,," Illilitv NotilicatlOn
lIu,,,u~'~~nier is 1-~UU-.,.,,-.;';;7-il'l
'I'-v3lUatlOn DescrIotlOn
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Value
Date Calculated
Total Value of Project
Pal!elof2
.
e Lit 1" OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01S69
ISSUED: 12f22f2004
APPLIED: 12f22f2004
EXPIRES: 06f22f200S
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
L.Ff'f'~ POliti I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
Receipt Number
$5.00
$3.50
$50,00
12/22/04
12/22/04
12/22/04
1200400000000001781
1200400000000001781
1200400000000001781
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.
L.Rf'ouirf'd Insnf'~tion~ I
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 of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO'OCCUP ANCY 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
225.Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
Job/Journal Number
COM2004-0 1569
COM2004-0 1569
COM2004-0 1569
Payments:
Type of Paymeut
CreditCard
12/22/2004
RECEIPT #:
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
ALERT ELECTRIC
a!'~_~~_~~,.""_,,.,. ,','
Wit, ;,
-, " I
'.' ~,,- ,
'-."i !
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>> of Springfield Official Receipt
.elopment Services Department
Public Works Department
1200400000000001781
Date: 12122f2004
Item Total:
Check Number Authorization
Reeeived By Bateh Number Number How Received
djb 022619 In Person
Payment Total:
Page I of I
1:37:4IPM
Amount Due
3.50
5.00
.50.00
$58,50
Amount Paid
$58.50
$58,50