HomeMy WebLinkAboutPermit Electrical 2004-10-20
02/06/04
CITY OF SPRINGFIELD
I4J 001
'0
. >'<0
'. ~.
~ "'-
215 FlFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (S4~;!26-36~ "0' :.o~
ELEchuCALPERMIT APPLICATION '1""'>0 <> ~~. 0<>",~"C)~
. /I IJ 2 4 '> "'- 0 '"
CIty Job Number CDM l.e;>04 _ () I J I '1 Date I' () r 0 <><>", ~ 7~<> "'''0
- '~ ~~
1-~~~2&1tig~gl~~'~:~;&iI?~~;i.~~~ 3, ;gg~1-E~~F~@i~I~;~t':_1;"Jr:J:~~ij.!5t ".:;--
9.1.3 WEsr /)L VI11Pt'C' ~'~""'__"":"_"_'__."__=:T~-F"'~__'d.i.O....$() "\;<>'ob _" '."
LEGAL DESCRIPTION f A..~.~e;w:R.!Srdiii.til!1~,5'm~f",,:~~~ "-, ',,' c ';;<;\"'~~. ,:.
i70<.27r.{Z- OiOIL ;~:~~;;~~' "" -~'~"-""--""-"'''~"~:B,-g.~<>_.~.
JOB DESCRIPTION 1000~q. ft. or I ,
.? f..L ~ " "q. ft. or
fkUJLQ C~ /;-1___. f?fl/1/e-L ~. ~O~ - 5 19,00
Permits are non-transferable and expire ifwor~'}~~4~~:'i'r
~::;:~:~ ~~~o r::y:.ays ofissuance~~ ~~~~~~e or 550.00
~"."'.,."-'-.-"----..~-".-.._'_..".".~'~' ", ~~~.' ~""'.--. -.1t:.,,--...'i<;;~--'-'~""'""'--'-'-"--"
....~.. . - - ..~., - . '~--' \ - '_','_A _' ~~m I .~ ~.- ~t ..~, . ... - -,,' ."-..:t;,-.~.- _ .
YC.O~eFORiINSTA.t1M. . ,0 j''''. .' ,-"JD' ntlio "':;Vre"iiilii'riS:or.'Relocntfon:'"..
:~~~:::::~'''-7:;:'-;;;~~<<~~~~t~_~:fS'.~'~''&'-'C;"<'~;::~~:"~"Z;.~..
- d;~:r~~~psto400AmpS . S75.00
Address 4fj SYt:!U-1EJ c:,,("'-~ rV 401 Amps to 600 Amps 5125.00
601 Amps to 1000 Amps S163.00
City S,::t:::O Phone 74,- 0 ~ If Over 1000 AmpsIVolts 5375.00
Reconnect Only S 50.00
Supervisor License Number .3 rv'- S
Expiration Date / tJ - / - 0 I
c. ~t!~E~~!fl~.fj~~~~~~~NJ~A~~~~~~.~~[~i1~-N~ti~!~;'
Const!. Contr. Number
01 "" ~ <:;(
~-X---o5
Inslallation, Alteration or Relocation
200 Amps or less - . . ,,-,,".
201 Amps to 400 Amps " S 69:00
401 Amps to 600 Amps ,\\1: \NG"', 5100.00
.\~i~g~~~~i!I'~~~>~I~~~S~~;-";"""'!8:'-'"''''':Ii-'';;'''-';'':' ~"~""
M"D. ~.~:~ndi~ ii$., ..~~~. 1~i'..I!~~',-~;~:",:"'h"~.(,,;' ,;t,{:~,.. L: I
\~~\~~~~;?:~~~~~~~~:pnn~;' "--...--,. ,..,." , ,'M,,' ""----,., .
[>.\SBile C~ \) ,-~\'ij\). . S 43.00
c,lE~"Ad~~i1'Circuit or with
l\WlmrFe~Permit . S 3.00
E. ~!!~~~iI~I!~~~~~J~ii~~;~~t~~~~ili
--- ~
",- .
Expiration Date
Signarure of SupeIVising Electrician
J~_C-r/ -./'
(J' "
Owners Name 151U3'f ~'<t.C'I'l.-1.tnf
Addre... gZ::3 V r:::I....."",IJ. ,-.
l- ,
~Jc=--r.--...
City >Y U.J
Phone
,
~-
Pump or ilrigation $ 50.00
Sign/Outline Lighting S 50.00
Limitcd EnergylResideotial 5 25.00
Limited Energy/Commercial 545.00
MInimum Electric Permlt Inspection Fee is 545.00 + Surcharges
OWNER INSTALLATION
The instaJlatioo is being made on property I own which
is not intended for sale, lease or reot.
Owners Signature:
4. i~~;~~~~!ff~~;~'~~~i~j~lfl
7% State Surcharge
10% Administtative F ce
t... 3 0:::2-
4 'tl
h ~"
73~
Inspection Request: n6-3769
TOTAL
Sb..1m:I Drivc(T:)lBuilding FonnslElec:aicn~ Permit Application L...o3.doc
02/06/04 FRI 08:09 [TX/RX NO 63291
-liE
.
. CITY OF ~rKll~GFIELD
Building/Combination Permit
PERMIT NO: COM2004-01314
ISSUED: 10/25/2004
APPLIED: 10/25/2004
EXPIRES: 04/25/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 823 W OLYMPIC ST
ASSESSOR'S PARCEL NO,: 1703274201012
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Replace electrical panel
Owner: BRET FOREMAN
Address: 823 W OLYMPIC ST SPRINGFIELD OR 97477
,Q
I CONTRAGfORlINFORMATION I
~'\'" 0'" v ,\Q' "
Contractor _,>\ \e~\e~ \>1> "'~nP~ 'O~ License
LHMORRISEL"~~(;:\e'iJ'<>~<<--C'j)..,,,0" n 01838
. O\e~e\.1 ":'iU:JILDING.INFORMA;fION,
"',o~' ?:P~ .\ ,'(\,- ',e'" e '-~ ~\\~
_,'- ~ ~e\' \)' r:," ,,<,,; ~o
# of Units: ~.... .s-'3'iJ 0<:' S;P' \~#)~f~to~~'t~:'~I>"'"
Primary Occupancy Grou~ 'l-.O~ ~ .,~gs;P\' 0",,7> t-teig~tOf,S,t.ructure
Secondary Occupancy Gro~ .&\,,~ ~,?'l; ~~ ~,e\Ty-!?l' of~at:
Primary Construction Type~o'~ 'r~ 4.'l1> ~ 0 "e '3 o\i",~Type:
Secondary Construction Type~ 0 f!P' ,~Q, 'IS' 0\ 'IS' \'~ange Type:
# of Bedrooms: 1;)\$ ,,~' ~0\~ 0""e Energy Path:
~"'~ G Sprinkled Building:
Contractor Type
Electrical
Expiration Date
06/08/2005
Phone
541-747-0811
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION I
REQWRED PARKING
,<:0-<:- :\
J:<;fal:~
~Fr~r(diwped:
~ ~ '~llml!aH:
'X~ ~~<(.~~
<<J.b ~CS
,'v -\"'.~
I PUBLIC IMPROVEMENTS I. -< C:J-<:-~~<<;~ ~'
- '~' '0'-. " ~'
,\,'- ~'<.-<<' ,SilIe~aJli'T~:
< ,',) c.. ~ ~\,\.vr<()>, <x'<,;
v ~J ,:<:-CS D~)\'nsf-OutslDrains:
~ ~"\ ~'<,;S'::,<v
"f- \)~ ,'0
\3~
"f-
Overlay Dist:
# Strect Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Page I of2
.
. U 1 t' OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01314
ISSUED: 1012512004
APPLIED: 10/2512004
EXPIRES: 04/25/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
I Ff'f's P.'1id I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
10/25/04
10/25/04
10/25/04
Receipt Number
1200400000000001504
1200400000000001504
1200400000000001504
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 Insnections I
Electric Service: Approval required prior to utility company energizing service,
By signature, I state and agree, that 1 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 descrihed herein, and
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 projcct,
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, tbat 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
I 225 Fifth Street
T Springfield! Oregon 97477
541-72,6-3759 Phone
.
~
.1Ily of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
1200400000000001504
Date: 10/25/2004
IO:16:53AM
Job/Journal Number
COM2004-01314
COM2004-01314
COM2004-01314
Description
Penn Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
Check LH MORRIS
Item Total:
Check Number Autborizatlon
Received By Batch Number Number How Received
djb 112182 In Person
Payment Total:
Amount Due
63,00
4.41
6.30
$73,71
Amount PaId
$73.71
$73,71
10/25/2004
Page I of 1