HomeMy WebLinkAboutPermit Electrical 2004-8-6
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225 FlYfH STREET . SPRlNGFIELD,OR97477. PH:(541)726-3753 .FAX:(541)726-~9 O~<$>~';~~,~ ~'-J
ELECTRlCALPERMl1'APPUCATION ~ <$>~" -0 '7,,' ..
City Job Number 6JWl z.0CA.( -00967 Date 'X' -t;' - 0 '-( "~O~. ~-? "" ",,~
.~ ;;.;"""::::;;,;;'-'noN '" <;O"""'.~"E'iM;.'VP:~;. ~ ~~,~
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LEGAL DESCRIPTION ~~nlial-:- ~l.lIg!<?iM.~IIl~Fa . ng 1I':~':l.."
_LLQZ. 3'2-~1 ~.\tIfl~. - '0 "O'~"'.;.
JOBDESCRlP110N . .~_~":-~o~st~^ '. .. '"
~f' ~~.~~"W"sq;ft,or
2CYi -::niKiU~~~\eltOjl.t"'':~e
Permits are non-trallsrerabl.g .wa~~~~ U;~np;~\IoH~me or .
notstortedwitbinl80days nEe~_{t. U\I~i:Service,or., . $50'00 'I
Sus~ended for 180 days. ..." ~~. . . . .
2. : CONTRACTOR'lNS'I'1~~ " B. ;'~~'Ic.sor ....d.... .,..lml.Uallon, All.ration, or Rcio~.lIon:
Electrical ContractorD.",u(,l \1.\ IhP.'" Z-.leL-tY1 L
.J
Address l~ ? 'z.:~:>,c\ f\\J e..
Ci~ 7_~~~ Phone .Lt~ St<oD
---,
SupelVisor License Number
Expiratioll Date
COllstr. Coilb'. Nwnber
City
Pholle
OWNER INSTALLATION
The installation is being made on ......~t'.....~,1 I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection R"'Iuesl: 726-3769
."
, .
200 Amps or less
201 Amps to 400 Amps
40 1 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsIVolts
Reconnect Only
!
b3
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c. f.'Te~p~nl'" Se.vkeH or. Fe~",en"., <
-..' . > -., ..
Instoilation, Alteratioll or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volts see "8" above.
1- _ '. ~ - "- ,
D. (I.lra.ndiClrcult,.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
. ~'.~
$.43.00
$ 3.00
E. '\~!SCelf,~n'n\!,,(Sc~.ice/r.;"I.r ;"~'{jJ~ .,.Each 11I,I.natloll .
\\o_'<>r irri .~\. t~~\~~~~~1 \.S ~t\150.00' .
1\-\\~il"i~\1e ~ 1\-\\S O~t.Q fQR $ 50.00
~~r sA~O . $ 25,00
~\l . l\,J&~jal $ 45.00
1VI1')\~,fMklrlfc l'e~it Inspection Fee is $45;00 + Surcharges
4. '~UB1:07::\A;~5~OV~",~"" : b "3
<"10 Stale s~ge I.( ~I
10% Administri.iive Fee 0 ~c:>
TOTAL 7~ 71
Shared Drive(T:)IBuilding FormslElectrical Permit Application l..o3.doc
Status
Issued
225 Fifth Street, Sprillgfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 IlIspection Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00967
ISSUED: 08/05/2004
APPLIED: 08/05/2004
EXPIRES: 02/05/2005
VALUE:
SITE ADDRESS: 4287 MAIN ST
ASSESSOR'S PARCEL NO.: 1702323103000
Springfield TYPE OF WORK: Electrical Work Ollly
PROJECT DESCRIPTION: 200amp service change
TYPE OF USE:
Owner: RULE JOHN S
Address: 250 S 43RD SPRINGFIELD OR 97478
Contractor License Expiration Date
DOUG P ALMER CO~.. n.-ntt laW requrooZSJOU, ~ 05/03/2006
foil,,' ~ctit....aRim ~O~I "et'(,f'O"~
! \,U:ol r.W JWIs I\n
NotIflcatiOl\ t4)ll4oS through OAR 952-001.
R_3ln OAR :=bIdl5l:Jl_iS of the rules by
Q09O. ,Vi I iYM!"a1(Note: the telephone
VN calling t~8IOiegon Utility Notification
ftUI1\bef aRMr T.fqeso0-332-2344).
ergy 'Path:
Sprillkled Buildillg: II/a
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvemellts:
Storm Sewer Available:
Special Instructloll:
Notes:
Descriptioll
Type of Construction
I CONTRACTOR INFORMATION I
I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Alteration
Residelltial
Phone
541-434-5600
Lot Siz.:
Sq Ft 1st Floor:
Sq Ft 211d Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
NOTlCE: rtxfJ\MW"ITlE WORK
lHIS PERM\l ~~~~W\'Il.qlliQJ).ihlJ.S NOT
~~~~r~Z~~D OR IS ABANDONED FOR
AN'i 1BO DA'i PERIOD.
I Valuation DescriDtion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amoullt
Total Value of Project
Page 1 on
Value
Date Calculated
.
. CITY VI< ~rKll~GFIELD .
Building/Combination Permit
PERMIT NO: COM2004-00967
ISSUED: 08/05/2004
APPLIED: 08/05/2004
EXPIRES: 02/05/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 IlIspection Line
I Fm tiWU
Fee Description
+ 10% Admillistrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$4.41
$63.00
815/04
815/04
815/04
2200400000000001011
2200400000000001011
2200400000000001011
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 \Iwlections I
Electric Service: Approval required prior to utility company energizillg service.
By signature, I state and agree, that I have carefully examilled the completed applicatioll alld do hereby certify that all
informatioll hereon Is true alld correct, and I further certify that any and all work performed shall be done III accordallce with
the Ordinallces of the City of Springfield and the Laws of the State of Oregon pertaillillg to the work described hereill, alld
that NO OCCUPANCY will be made of any structure without permission oftbe Community Services Division, Buildillg Safety.
I further certify that only contractors alld employees who are in compliallce with ORS 701.005 will be used on this projcct.
I further agree to ellsure that all required illspections 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, alld the approved set of plalls will remaill on the site at all
times during construction.
OWller or Contractors Sigllature
Dale
Page 2 of2
.
225 Fiftl1 Street
.. .
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00967
COM2004-00967
COM2004-00967
Paymellts:
Type of Paymelll
CreditCard
8/5/2004
.
RECEIPT #:
8~.:
~....~.:
.." .
-----.. ..
filMy of Springfield Official Receipt
.elopment Services Department
Public Works Department
2200400000000001011
Date: 08/05/2004
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Perm ServIFdr 200 amps or less
Paid By
DOUGLAS PALMER
Item Tola.:
Check Number Authorization
Received By Batch Number Number How Received
djb 000464 005846 In Person
Payment Total:
Page I of I
1:15:36PM
Amount Due
4.41
6.30
63.00
$73.71
AmoulIl Paid
$73.71
$73.71