HomeMy WebLinkAboutPermit Electrical 2005-11-8
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225 H~ 1.[1 STREET ~ SPRINGFIELD, OR 97477 . PH:(541)726-3753 ;, FAX: (541)726-36~'
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ELECTRICAL PERMIT APPLICATION . . "'0 ~,~,
City Job Number C/) "'" ?;;'or - 0' 'S b 7 . . Date 11_ ,.' ,-"."
Permits are non-transferable and expire if work is Each Mailufact'd Home or
;, not started within 180 days of issuance or if workis Modular Dwelling Service or
Suspended for 180 days. Feeder
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2 ,eo7\1JTJR'~'efi!irgTi\i$T1' '. " up;,Q. . ')rego,B!, egj~'!.!!i!'eeae"..:-, f:il!l\li.o_n~terll:"_"':"_L;tI;eoca 011:..'
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,..... -' . do. ted by "'~ ~. "~ t \ort\"l
Elccnical Contractor C h fl.,1 S f"->t 'sii'i'\W IV~J~~I~ 1\"1(200 ~p"s ~~J~2-001'
NOtl1IGd"U" -" . "10t\20IuAiil (]P,t'l400A~;" .
.").. l-l I ~< 952.\l01-00 . Ib~ '8H" ,v~sl
\./U\.....:- in ~p.~.IV~>'l obtain ~oP~ps to R-OO:t\mps
~ uu~u. ....~ _ l",lnte: tl Ie l~ t""'
--lIir,9 the center. 6Or~ps!<?lI000?Aii1ps
Phone 1//t,'f)):?J1 the OreQWer.\'iiOO'AlriPslVolls .
. 1 B,.(J-,)v'-~""
center IS " Reconnect Only
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/I ZL{ M,4.rA! ST -APT C.
LEGAL DESCRIPTION
170] :? 5l{ ( 0 l{ L.( 00
JOB DESCRlPTION
Add. tf Ct~,K
City
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,...
(2 (.y..-L-
Address
'-ioler )
1611/ Of
~&,/lll'-l G
1111vL>
'-m'""
V
Supervisor License Number
Expiration Date
Constr. Contr, Number
Expiration Date
OwnmName Wllil..'i-A- \(..Jj..vL
sLf71.{ SF>l4A16- "t-LIIA
Address
City ~Phone
3. ~'~€OA-4: ;;;;:;:;;;:iiii;;St/iiiilli317iE!:JiE.i(j"i .
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. A. ~~~-=f,""":;;Fainil'" er"d\y;.1I,~-;;..ani~
_' Jf:= - ~g!.eJ.Q.J;"ii!! - - - '.1".': - ~~,
...J ""~!= the to\lowmg
.....rl use
Service Included
1000 sq. ft. or less
Each additional 500 sq, ft.or
portion thereof' .
$106,00
$19,00
$50.00
$ 63.00
$ 75,00
$125,00
$163,00
$375,00
$ 50,00.
c.~~_
Installation, Alteration or Relocation
200 Amps or leSs
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volls see "B" above,
D. t,m'in~if.(~~;r,~. ..- ,,' -;_. ..
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New Alteration or Extension Per. Panel'
One Circuit. / $ 43.00
Each Additional Circuit or with 3,
Service or Fccdcr Permit $ 3,00
$ 50,00
$ 69,00
$100,00
.
41
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~"-""_""""A{;~.n;;.~",,,.........'tl~~tNt::;l1:;."\\'M~L~~:~a!)~ ..- - "~~~
Pump or iIrigation $ 50,00
Sign/Outline Lighting $ 50,00 .
OWNER INSTALLATION Limited EnergytR.sidcntia1 $25,00
The installation is being made on property I own whi~ . Limited En';'gy/CO~awOp'\<' $ 45,00
is not intended for sale, lease or rent ~O \~~qM~6r~~~ :~RWdP~MOFee is 545.00 + Surcharges
111\S 01:7 ...' ....." . -'....."')j S '7
Owners Signature: ^"iHO<w.- .-' .. . . .' " ' ~';'~" L--
C()tlll'Jl~N ..'. "~""'>!>Iti<.W. , ",.' J.~
fl,N'i \~ OPJ~Ps~W~&-charge 3b~
_ d ~~ ~% Administrative Fee . ::5 Z
~;'f\~~ TOTAL . . . . boB:L
. ~ . Shared Drivc(T:)/Building FormslElcctric:i1Pennit Application Hl3,doc
Inspection Request: 726-3769
.
. CITYOFSPRINGFIELD.-
Building/Combination Permit
PERMIT NO: COM2005-01567
ISSUED: 11/04/2005
APPLIED: 11/04/2005
EXPIRES: 05/04/2006
VALUE:
. Status: Issued
225 F1fth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1124 MAIN ST
ASSESSOR'S PARCEL NO.: 1703354104400
Springfield TYPE OF
Electrical Work Only
TYPE OF USE: Addition
Commercial
PROJECT DESCRIPTION: Add 4 circuits
Owner:
Address:
MIRKA KRYL
3474 SPRING BLVD
EUGENE OR 97405
Phone Number: 541-
Contractor Type
Electrical
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.'...os" ,,'.hl
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I CONTRAC3roRINFORMATlON'f~~_
:r'il:.~ \'~ <; a.OO?'''- noSe \V'Y;"',,?> '00<- Os \.'1
Contractor "\\0>N l\lle'rel\\el. \ "lo\l9fI:;jceJ;lse\\e Expiration Date
,,, -. 'OIl' "'" "Ol\b
CHRISTENSON :v]:"'.~_GIOJ:)~.~-OO\ . _ roolec64!37,\e?" .~" 07/1412006
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II' 'PBUILDlNG lNF:ORMATlONIIO \
OO'!)v'.:" \nB '-'v' Ole9u" - ?--2.;1\1\').
~\\,#afSto""o. 00-'82>
C<- 0 nes. '_I>
I.-..e\ ,'" ,5 \
1\\l{\Heig~tof~(
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled
Phone
541-688-6121
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nJa.
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street
Storm.Sewer Available:
Special Instruction:
IPUBLIC IMPROVEMENTS I ~Cl~'t-
Sidewalk Type~\~t. \r \~~ \~ ~Cl\
~ Do n',,^l.~-~Y'~'?t.\l-~ rCl\l-
\\O"'C t.~~\'~?'\'i'\ ~~Cl\J~t.Cl
\\\\~ \~\lt.Cl \J Cl\l- \~ ~'O
~IJ\~ ~t.~Ct.Cl ,?t.~\OCl.
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I Valuation Descrintion I~
Notes:
Description
Type of Construction
$ PerSq Ft
or multip6er
Square Footage
or Bid Amount
Value
Date Calculated
1 of 2
f/
.
. CITY OF SPRINGFIELD '
Building/Combination Permit
PERMIT NO: COM2005-01567
ISSUED: 11/04/2005
APPLIED: 11/04/2005
EXPIRES: 05/04/2006
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
Fp,p,s Paid I
Fee Description
+ 100/0 Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$5.20
$3.64
$43.00
$9.00
1\/4/05
1114105
1114/05
1114105
Receipt Number
1200500000000001681
1200500000000001681
1200500000000001681
1200500000000001681
Total Amount
$60.84
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. Ail 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.
Rough Electric: Prior to Cover
Final Electric: When aU 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 wiD 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 wiD remain on the site
at all times during constructiolL
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
SpringfwId, Oregon 97477
541-726-3759 Phone
.
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City of Springfield Official Receipt
.veIopment Services Department
Public Works Department
Job/Journal Number
COM2005-0 1567
COM2005-0 1567
COM2005-0 1567
COM2005-0 1567
Payments:
Type of Payment
CreditCard
,
..
:j
11/4/2005
RECEIPT #:
1200500000000001681
Date: 11/04/2005
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
LARRY CHAPMAN
Item Total:
(;beck Number Authorization
Received By Batch Number Number How Received
djb 004782 In Person
Payment Total:
I of 1
9:30:20AM
Amount Due
43,00
9,00
3,64 .
5,20
$60.84
Amount Paid
$60.84
$60.84