HomeMy WebLinkAboutPermit Electrical 2003-5-29
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX:~n6
ELECTRICAL PERMIT APPLICATION approval
. ? ~ ~~
City Job Number L6lN\ We:. J _ DC;] '7 b Date S - z;r- 0-.:>
Date .c;-~C;-(1 ~
1. I LOCATION OF INSTALLA110N 3. I COMPLETE FEJ!lSIiIJfAlj)tflvGl&'LOW c:Kt-J
l, Co:3 AJ 0 {J~+f.. Ii r15 ,P
LEGAL DESCRIPTION
1703 Z-b ( 7... (') (I.{ l2
JOB DESCRIPTION
/), R /~,,,,{p~/ ~T PUAf}-
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. I CONTRACTOR INSTALLATION ONLY I
Electrical Contractor i( ~ F.J t".rtJur / ~JI-
Address O. (j I> VI,6 Z ff' 33
o
City ~ r~
J
.Phone ~f~ -02..::Jb
.upervisor License Number . :]' {If r 7 S
Expiration Date 10/ / loy ....\\)~~-(
r r ~'(,. ~v'
Constr. Contr. Number '7 L) g*",:&.,'\ :SC\~
~\' ~\'&.'\) \-
Expiration Date I~.~J~~
. ";)\"..l~'<;'~-
S. <'t-Sfi. .00n: -6l~ ..I):
Ignature~, ~~~Sl\f",,(e~l$>la~
~~~~~~~ .
~,~\;, ~
<:,~ ~'Q .
Owners Name ~Z,..., R.f~' ~ II-
Address 1",?3 '}/d/-t.'~/,
. . G>
Phone ;;Vb ~C/iJ 70"
City
~ 6' ,Vl
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
ecl as submitted haslhe following
not reqUire specific land use
A. I New Residential - Single or Multi-Family per dwelling nnit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50,00
B. I Services or Feeders - Illstallation~ Alterations or Relocation:
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163,00
$375.00
$ 50.00
c. I Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 VOIIS see "B" above.
D. I Branch Circuits .
'10'"
New Alteration or Extension Per r."nel~s \)\1\\\'1
oJ<lte",~ ,0(\ ..~
One Circuit 0\ \ 1'3' f"lte j $63,00
Each Additional Circuit!b} (Xithl \~~ \ectlO :~?OQ\
Service or Eee&~'P~it\a -0' Sa tU : ,!l.~$"3~00:; '0.
1(,.-' S \>~. '\~ 1\ ~ t\)\~
j)..\ ..,,\0 \~p."(. _.'~,,"U<;.\ _ ~ ~"e .,......A
E. I Mist'ellan~Qus' (s~~Yic.lf~~deT nOt j~e.l~de'd)~~'aClilhslallatioll I
NO"" g>:><- - OlJ"" ~O\'<>.'. ~U'"
pump,\qf.i~1iati9li. {1\a.'Ica(\\at. ~ ~(\ \)\\\1\1,,$,5'0.00
. ~(l' 'na ate"" <,<--.
Sign/Outline Lig!lling .~e <,\""-'3-' $ 50.00
.. Ca.'" -::.!,ot '. . ~.u
Limited Energy{Resloenl1al; IS $ 25.00
n"" - ea\ ,,-
Limited Energy/Commercial $ 45.00
l-O
:>
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.1 SUBTOTAL OF ABOVE
Lfb
']21
1./60
S3K~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding Forms/Electrical Permit Application l.o3.doc
.
. CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2003-00396
ISSUED: OS/22/2003
APPLIED: OS/22/2003
EXPIRES: 11128/2003
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 663 NORTHRIDGE AVE
ASSESSOR'S PARCEL NO.: 1703261201418
Springfield TYPE OF WORK: Heating System
TYPE OF USE:
PROJECT DESCRIPTION: Install heat pump, air handler and ductwork
New
Residential
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Owner: HIATT SHARI R TE
Address: 663 NORTHRIDGE AVE SPRINGFIELD OR 97477 ~\)~'f..
\'(.. -""i\
- ~r \ :'\ \~ '
, CONTM0TOR~~Il@RMATION I
~\..". io-';)' ~'(,.v'
Contra~.t~.\::. :\ 'O\\~\)S~ \~",~\)\J
KS EI:EC.TRI~\~ \)~ \'0 ~
COMm~f'.'K~g-~\) \)~ ~{~\).
HIATT'$H~RI,,~~n;--d '?~
. c,1J~~'\'C1;:) i "BUILDING INFORMATION I \0
"'~ . \leS 'l~\})\i\i\'l
# of Stories: ,,'lecCot,Size: \0(\
\,0." Gi'e~- -.
Height of Structure . legOl1 t\'le S'l<trtst;FW~h'l
Type of Heat: ~ \ \\J\~'V ~teo 'O'l e I~Sq'F!.~I,l'd~F1~~~:o.
Water Type: t:.~ 'eS a,OO ,inOS . 'lSq<Ft Basement:,
J"-' t\}\ :\.e\O \r'I~ov.J I'f H'''' r.n~
Range T~B~,;)';oJ . II Cen .\)\)'1\)\\' ,,~q,Ft ~~[.~iiiijCa\w.ort
Energy Path:,ce.\\O"-,,.\)\)'1 ",.~ill cO:,SqIFt'Other;:Ce.\\
~O\" 9"" 0"'<' ~\O\~., ~IU"
O",t'> (\\e.'l 'el. ,\.. I"lP'~ljvlous ~urface Area:
",(\ ,,"U _,,(\\ .....'C"\ U I"'If:\A&.\l
I DEVELOPMENl'lNF.ORMAT{(~N31~1~.eCl(\''-'~'' -
",0'" tel,J REQUIRED PARKING
n\}I" cell
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
License
70889
460
Expiration Date
12/30/2004
0612712003
Phone
541-686-6236
541-726-0100
Contractor Type
Electrical
Mechanical
Owner
R-3
VN
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Total:
Handicapped:
Compact:
Rearyard Setback:
Solar Setbacks:
% of Lot Coverage:
'PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspoutsffirains:
Notes:
Pa2e 1 of3
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00396
ISSUED: OS/22/2003
APPLIED: OS/22/2003
EXPIRES: 11/28/2003
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
Tvpe of Construction
$ Per Sq Ft
SQuare Foota2e
Value
Date Calculated
Total Value of Project
Fpp< PlIilIJ
Fee Description Amount Paid Date Paid Receipt Number
-Mechanical Issuance Fe..... $10.00 5/22/03 1200200000000001304
+ 10% Administrative Fee $4.50 5/22/03 1200200000000001304
+ 7% State Surcharge $3.15 5/22/03 1200200000000001304
Air Handling Unit Up to 10,000 $8.00 5/22/03 1200200000000001304
Heat Pump $12.00 5/22/03 1200200000000001304
Minimum/Adjustment Mecbanical $25.00 5/22/03 1200200000000001304
+ 10% Administrative Fee $4.60 5/28/03 2200200000000000939
+ 7% State Surcharge $3.22 5/28/03 2200200000000000939
Add, Aiter, Extend Circ $43.00 5/28/03 2200200000000000939
Add, Alter, Extend Circ Ea Add $3.00 5/28/03 2200200000000000939
Total Amount Paid $116.47
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 J?P'lWrN' Tn~
1 Rough Mechanical: Prior to Cover
2 Final Mechanical: When all mechanical work is complete.
3 Rough Electric: Prior to Cover
4 Final Electric: Wben all electrical work is complete.
Pa2e 2 of3
-iF
.
. U 1 :t' OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2003-00396
ISSUED: OS/22/2003
APPLIED: OS/22/2003
EXPIRES: 11/28/2003
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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, ond
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
Pa2e 3 of3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00396
COM2003-00396
COM2003-00396
COM2003-00396
Payments:
Type or Payment
Check
5/28/2003
City of Springfield'
Development Services Department
Public Works Department;
Official Receipt
Receipt #: 2200200000000000939
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
I'aid By
KS ELECTRIC
10:55:27AM
Received My
djb
Date: OS/28/2003
Amount Paid
Item Total:
43.00
3.00
3.22
4.60
$53.82
l:beck Number Confirm No
.
How Received
In Person
Payment Total:
Amount Paid
53.82
$53.82
.
Page I ofl
cReceiPLrpt
'-~
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00396
ISSUED: OS/22/2003
APPLIED: OS/2212003
EXPIRES: 11/22/2003
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 663 NORTHRIDGE AVE
ASSESSOR'S PARCEL NO.: 1703261201418
Springfield TYPE OF WORK: Heating System
TYPE OF USE:
PROJECT DESCRIPTION: Install heat pump, air handler and ductwork
New
Residential
Owner: HIATT SHARI R TE
Address: 663 NORTHRIDGE AVE SPRINGFIELD OR 97477
VN
I CONTRACTOR INFORMA nON I
--\u- .~~~
.",06~Lic'inse"", Expiration Date
.v n~ 0" ~v
,olJo;O,eF'46!!<:i ,~'/: '\; 06/27/2003
.~~ 'IY q)J ':,.,0""
,\: ,V\.0 ",l'o _~ ,A"). _0.
-,. .. n ~ ... -J U" :\0'
I BUlLDING'INFORMA:nON'I'~0~~ ~O
)"'. ",O\r ",," t<:-,..r. fl."" 0,0 ~,c,
~ '-'II ofiStori~S:!\~'1 rO~'0''S' ,,\~O '-'. Lot Size:
"(.,,, .f>J coV'....,q ,<\.v ~. .~,., ~l>l'
....\ ,,'Height of.Structure.O . ,-is:-' n<:J Sq Ft 1st Floor:
....' ~' .\' ~". ,,"," ~ V n.v
T' ~O ~'!'YP'~of~~iit:l\.0" 'r:b0~ ~~... Sq Ft 2nd Floor:
,0 ~,c, JY81er\Typ!:,:~ 0,0 ~\j'0' Sq Ft Basement:
~O o~Railgi T'Ype:~0 . Co'\' Sq Ft Garage/Carport
.... rh'" ... \:...
.~ ~C?Eit~rID' ~a'thk-\.0' Sq Ft Other:
\j c,'I>' ~'Q0 00 ImperviQ/ls Surface Area:
-,,\: .....Q.~
I DEVEUjPMENT INFORMATION I '\'(..~ ~~~\)'\
\<(-.~ \\~'\ \~QUlRED PARKING
Overlay Dist: \51J.. ~S 'X~ ~~\) <;; Total:
# Street TreesJ~qd: S'(..~~~<(-. '\~ ,:?--~\)\:j Handicapped:
Paved Drlv.fftqd:}.\\ ,\~\:j "-- ~'O Compact:
~~ '\ ~~' \) v . \..,
% of DOt €~~ra&f;~ \) \)~ ~\)\).
'\ \'\\'(..I,)\G~"~ ~ 'X~
\>..V ,.J\\.. (\~
_...~ \~\
I PUBLIC IMPROVE.~ENfS I
,
Phone
541-726-0100
Contractor Type
Mechanical
Owner
Contractor
COMFORT FLOW
HIATT SHARI R TE
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
SETBACKS
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspoutsffirains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
Square Foota2e
Value
Date Calculated
Pa2e 1 of2
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L.F~~s P3id I
Fee Description
-Mechanical Issuance Fee-
. + 10% Administrative Fee
+ 7% State Surcharge
Air Handling Unit Up to 10,000
Heat Pump
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
$10.00
$4.50
$3.15
$8.00
$12.00
$25.00
5/22/03
5/22/03
5/22/03
5/22103
5/22103
5/22103
Total Amount Paid
$62.65
I Plan Reviews I
.
CITY OF ~rKJ1'lt.FIELD
Building/Combination Permit
PERMIT NO: COM2003-00396
ISSUED: 05122/2003
APPLIED: OS/22/2003
EXPIRES: 11/22/2003
VALUE:
Receipt Number
1200200000000001304
1200200000000001304
1200200000000001304
1200200000000001304
1200200000000001304
1200200000000001304
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.
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
tbe Ordinances of tbe City of Springfield and tbe Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made ofany 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.
i~,~l;n~~U-o ~
L.Reouired-w~n~~t\llmJ
1 Rough Mechanical: Prior to Cover
2 Final Mechanical: When all mechanical work is complete.
Pa2e 2 of2
~J7)j63
Dat; I -
l
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00396
COM2003-00396
COM2003-00396
COM2003-00396
COM2003-00396
COM2003-00396
Payments:
Type or Payment
Check
512212003
City of Springfield '.
Development Services Department
Public Works Department "
Official Receipt
Receipt #: 1200200000000001304
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Air Handling Unit Up to 10,000
Heat Pump
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Paid By
COMFORT FLOW
1I:20:l0AM
Received By
djb
Date: OS/22/2003
Amount Paid
Item Total:
3.15
4.50
8.00
12.00
25.00
10.00
$62.65
.
(;heck Number
Confirm No
Amount Paid
How Received
In Person
Payment Total:
62.65
$62.65
.
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