HomeMy WebLinkAboutPermit Electrical 2004-7-9
,
SPRINOFIELD .---.~
lj\~j
225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)~.o ''''" 0.. ~ ~ ~
ELECTRICAL PERMIT APPliCATION :Oro~;I""';"".or. ,
CityJobNumber Cowt2.00u-OO'6'"Z- ~ Date 7..- ~,-rJ q "'oG~%"I'l
--5. ..,. "'OI}:.~O, 809:
1. 1,I;OCATIONOFTNSTAI.LATIO}v' ' 'i 3. ItOMei.ETEiEES~__, :~~ L~~~~~:it~O'~~-'_~j
~DJ:J ~~ st Sf'WI em- ~lJ C(l1.f78 ':7:=7i."'O",".r.' ,,~~'ll(,r.'" ,';- ,:G~;~~%~r' '-1
LEGAL DESCRIPTION q A.I: NewR~idential7 Single or M~' .Fa", " '~~Jng ~~%~"'"j
1 ~020b{ I
(') fDO (:)
Service Included
JOB DESCRIPTION ,n! {j1000 sq. ft. or less
I ~ .f'_ ~ t 11M> ~ Each additional 500 sq. ft. or
Re.~l)vl> 0 tl ~ LVI tt;>\'1l <>>1 Gl~ W1et"",portion thereof
. Permits are non-transferable and expire if work is Each Manufact'd Home or
Jo not started within 180 days of issuance or if work is Modular Dwelling Service or WORK S5000
Suspended for 180 days. ' ' ~Ol\C~eede_l E't.PIRE ~f1H~ err _' _~_
I ',' ,,',.., 1H\SPt~~ rl'>..'T\.\lsr~H~ I
2. 'CQN'I'RACTOR1IY~T~TIo.N O/VLY I ' (jt\ iM~OJrI'tttlermrs!,lpu!llJ,l, Alterations orReloclltion: ,
fCcrYlle-rs ~ecJQlc ~e'f,., eJa.1UxJ.... .J,\A,I,liO~~f,D 0\'fI~ MIl\N \'Ill" '
Electrical ContrnJtor ~ ,"~~ 1~~\l9U. 4::- $ 63.00 .
, ,,",~N'( 1 Amps to 400 Amps $ 75.00 '
Address ~I?~ ti~~u('e K\L 401 Amps 10 600 Amps S125.00
...t. ,601 Amps to 1000 Amps $163.00
City ~/.1.......rI\~e.~Phone ~I.- Over 1000 AmpsIVolts $375,00
Reconnect Only $ 50,00 '5' 0
Supervisor License Number ':2,q / (, ..:;:
Expiration Date I f) -I -Ot{
Constr. Contr. Number 89 ~B b
Expiration Date ::3- 2-.<./ - b h
c. I Temporary SerVices or, Feeders
Signature of Supervising Electrician
. ~" r!.~ i<1 t! bA-M
)
Owners Name
~
f
Installation, Alteration or Relocation
200 Amps or less 1B'iJ cdruI~ ~b~
201 ~ri e<~B~bl) U''' oragors~~~mll
40 I ^t8n'>W 6O\))M\~~P ....oS'" ",!\es are ~~, .
t\ (t~!'ter, I" .~.hnAK95~' I
oveIf60tif!\ri\~~ltQo~~~~~iru~\J
D. ! BrlThl,rotl:'~gW~a'n ~~~ts\epM1\e
New Z:e:illA~ 6'i1lEi&\\~~'&rOti \)\nit\J Notitlcatlon
One CIrwYinber tor th~\.. ~.80()-...~~.2344)& 43.00
Each Additional CiiIliIDtJrwltli-
Service or Feeder Permit $ 3.00
12..
A.... ;~~ S1' 51" rl~~~
City Sf r I hone
E. t' Miscellan~ous (SeniceJfeeder not included) ~Eilch Installation i
OWNER INST ALLA nON
Pump or irrigation
SignlOutlin~ Lighting
Limited EnergylResidential
Limited Energy/Commercial
S 50.00
S 50.00
$ 25.00
$ 45.00
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is 545.00 + Surcharges
Owners Signature:
4. LSUBJ:OTA!- OFABOvE'
. I
_"---_~-..;.........__I
50
'J'>';'
)',,0
8 ~.,
S" -
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding FonnslElectrical Permit Application I-oJ.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00829
ISSUED: 07/08/2004
APPLIED: 07/08/2004
EXPIRES: 01/08/2005
VALUE:
SITE ADDRESS: 4056 NORTH ST
ASSESSOR'S PARCEL NO.: 1802061101000
PROJECT DESCRIPTION: Reconnect
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
Owner: DEGROOT MARK D
Address: 4056 NORTH ST SPRINGFIELD OR 97478
Contractor Cf: LisEI\rTHE ~'kttion Date
FARMERS ELECTRU01\y;:.rlAIT !;~f\lL ~~~:OA^\T ~s..N@1124/2005
, I ~~\i'VJ\NKO~'lr.40NIONE\) ~OR
, ~Ct.U J~ I:J .
C~ ~iIl1'I i'ERIOO. Lot Size:
I\~i oT!>j'ructure 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:
SprinkJed Building: n/a Occupant Load:
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rcaryard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Spccial Instruction:
Notes:
Description
Type of Construction
I CONTRACTOR INFORMATION I
Phone
541-998-6772
R-3
VN
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist: J:~1D
# Street Trees Rqd: ~lt~~ged:
Paved Drive Rqd: ~ C'l~~
% OfLotCoverag~o~~~~~ ~~~~
~.:_~I'1S, S"~"~ 'r~;.
I PUBLIC IMPRO~~~$\~~~~;~
~Of>-~ ~ (\\~HreWaI!fUo~
r$~~\\f\9, r(i\Q s:
~eI~P
I Valuation DescriDtion ,
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee 1 on
.
.
CITY OF SPRINGFIELD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2004-00829
ISSUED: 07/08/2004
APPLIED: 07/08f2004
EXPIRES: 0110812005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
L.Fp.p.s Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
$5.00
$3.50
$50.00
7/8/04
7/8/04
7/8/04
Receipt Number
1200400000000001060
1200400000000001060
1200400000000001060
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.
I Rp.ouired Tnsop.ctions 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 OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
1 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
COM2004-00829
COM2004-00829
COM2004,00829
Payments:
Type of Payment
CreditCard
7/812004
RECEIPT #:
.
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
JAMES FARMER
.~i
Wit..;
..ity of Springfield Official Receipt
.evelopment Services Department
Public Works Department
1200400000000001060
Date: 07f08/2004
Item Total:
Check Number Authorization
Received By Batch Numher Number How Received
djb 000434 008949 In Person
Payment Total:
Page I of 1
I:15:32PM
Amount Due
3.50
5.00
50.00
$58.50
Amount PaId
$58.50
$58.50