The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2004-6-17 ~IlC!i-c - . . ~/, r. f\~./~c /' t25 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (54I)726-:f6il".9 'O"",~c-.~~- .~.) Ob'~ ".." "~ ELECTRICAL PERMIT APPliCATION _) () ~~ 'J0'~4'l< .'- City Job Number COMlOOlf-OO 702.. Date ~ ) r?(0-( "Iv" "1$ ~'J/.' $"'J:C'/~.. ~o. '1q ~~ ""6 'J~ $9. ~. 3. COMPLETE FEE SCHEiJtJ[# L v/';'$ ~$O' ~'" 6 t'l....~,,~$ ~~ )-.,::-c! "4;....'1 ....6 /. ",t.; \9" A. , New Residential- Single or Multi-Fa ily p b , ing u$;;>a:.4>",,^ " ~ ~ " I ....._.........t, CITY OF S:~)NGFIELD, OREGON , I ~. . t. LOCATION OF INSTALLATION 7....b::;{;, riVtlll f'1 L. <:::. +- I LEGAL DESCRIPTION -1'?P~2:~4t 99.10,4. JOB DESCRIPTION IIVSTfhL LICHT;$)J/ ToH A(1)5{ Permits are non-transferable ~'ex~e if work is not started within 180 days of issuance or if work is Suspended for 180 days. v 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 $50,00 2. CONTRACTOR INST~_r.~,An...()~!!NLY. ' B. Services or Feeders - Installation, Alterations or Relocation: Electrical Contracto~ OtZ t UJN E L.[ {Iff (, c;f.:t1L1..f 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 Address 10/0 .::; l Ll1Jf /J VE , City ?Utl{L-.~ PhoneS(g-S3~-J(,S2 () Q C}j')..{C( Supervisor License Number LI t.( (;, 05 to j, lOLl Expiration Date Constr. Contr, Number a b-C;c.;: c. ll/SO/OS Expiration Date C. Temporary Services or Fceders M01\r.f.: .' . .. . vOIRI" II" iH~ WORK I~ ii<faUatIOD,\mt!lr.dilon OI"Relp~alIon NOi S 1 KN\\ t v'" ,- . PtKNIII \.:) iH\ ~ i.A~ iltIIiSf.R iHIS NeO cnR $ 50.00 Alli t\Afe~~Qd~~lM'NOO . . $ 69,00 ~~'i ~~'YYA'/"i6QA\.OOpS $100,00 Over 600A!'lP~ .or 1000 VollS see "B" above. D. Branch Circuits Signatur~e O.f s{uoerviS, ing ectri<;jan ~ New Alteration or Extension Per Panel One Circuit ) . ' i) J Each Additional Circuit or with S (/ LI 'I ! '" 10/2. F /.5 Service or Feeder Permit $ 3,00 Owners Name ~ n , V lA/ Vl, \0 Address L;CfO C> tL-,fXJtA G?vSou. ti)" L:l:.r.u.Mu~ ~\\ilJJ3neous (Service/feeder not included) -Each Installation /I (2 ION' U'~~~;9tego ~10rtl'\ ' City P-cc Vj{() 1J11'Iit~\~~~~~&st}t~e~!'(j01gation $ 50,00 ;L S~ '-I'd, 10110'/01 '~'~-centef. \':"'OU",\OIS'i\! !iI'e!lLighting $ 50.00 'fcat\O" -00\0 "" "01\1\'9 OWNER INST ALLA TIONlot\ \ '" 952-00\ .-'n COpieS r:i~rgylResidential $ 25.00 in Of>:f'\ aV 0'0""" ~ . \\'Ie1\llel'''atlnll.. . The installation is being madelN~",~-.:ertYi'citenWic~\'lO~e:}\\i~li- nally/Commerctal ~ _ $ ~ tS not tntended for sale, lease or rffif;\in9 tfle l'Ie oregon ~2jiwtB!lElectric Permit Inspection F~ is $45.00 + charges nl.lfl\bedor t r IS \-80 /' Owners Signature: cente 4. SUBTOTAL OF ABOVE " 4:::,-.... ~ ,,;\* ~ Inspection Request: 726-3769 4300 $ 43,00 . . :-:: 7% State Surcharge 10% Administrative Fee .~ 3U , Lf )-Q 1:. 5Z ~ ,~ - TOTAL Shared Drive(T:YBuilding FonnslElectrical Permit Application I-03.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 54t-726-3769 Inspection Line . . CITY OF ~.nuNGFIELD Building/Combination Permit PERMIT NO: COM2004-00702 ISSUED: 06/15/2004 APPLIED: 06/14/2004 EXPIRES: 12/15/2004 VALUE: SITE ADDRESS: 2656 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703254100102 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Commercial PROJECT DESCRIPTION: Install light and switch at dsl site Owner: WARREN WIMBERLY M Address: 12033 NE MARX ST PORTLAND OR 97220 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Fronlyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description I CONTRACTOR INFORMATION I Contractor License OREGON ELECTRIC CONSTRUCTION INC 203 Expiration Date 07/0112004 Phone 503-535-2652 BUILDING INFORMATION. . \'It \NOR\\ # of Stories: l\\01 \CE', l 't.qtiSIie: I~;~ IS 1'101 Height of Structure S PERWlII S\'If"\~li~\Il'1:Jft\RlO~o}.1 OR Type of Heat: I iiI ORI2EO U!'IO 'Sq J\t\~n~ol*f Water Type: r..Ul\1 !'ICtD OR \~aIWB~sement: Range Type: COWlWlE 0 Or..'/ PERIlSli Ft Garage/Carport Energy Path: r..!'I'/ '\ 8 Sq Ft Other: Sprinkled Building: nla Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive R9~~l) \0 % of Lot ~~ ~\\\\\'I..... \~~ ~e eQ,O eJ. \0'''' _ .~(\o~ .ne 01 ~tl'l '" _ n(\'\' ~~)\u{i~IC,~~'IErmf'O'l F'-" I}\e'i> ~\l" ...tvJ~ 'i ~ ,- ..n~0 ~\O~ I. ^ G\l~ 0,\0\\' ,,\as 0' ...\e9'.... ,..(\(\Sidewalk Type: \0 . 2-\\0" O\-I) ~~ CO... ~El "" '~\~"'" ~O\\'\C <;. 9':J'2.-1) :oj 0'0\'0. ~o\e" '~~ ~o~ Downspouts/Drains: \~ O~.'{OI}~: ce~\eot;eQ,O!\ ~~~~). 00':> 'Q,~' ,,,,a o~ c'(}.\\f'i al \O~ v' t \S '\~ (\I}((I'O ca!\\0 I Valuation Descriotion I Total: Handicapped: Compact: $ Per Sq Ft or multiplier Sq uare Footage or Bid Amount Type of Construction Value Date Calculated Total Value of Project Page 1 of2 . . Ul l' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00702 ISSUED: 06/15/2004 APPLIED: 06/14/2004 EXPIRES: 12/15/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I rm ri,..wJ Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid $4.50 $3.15 $43.00 $2.00 6/15/04 6/15/04 6/15/04 6/15/04 Receipt Number 2200400000000000775 2200400000000000775 2200400000000000775 2200400000000000775 Total Amount Paid $52.65 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. 1 Rl'ouiff~d 1~ 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 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 Pal!e 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . .p~mN~"~ ~ ~_'~ : WiL, . . .~-- .- Job/Journal Number COM2004-00702 COM2004-00702 COM2004-00702 COM2004-00702 Payments: Type of Payment Check 6/1512004 RECEIPT #: 2200400000000000775 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Minimum! Adjustment Electrical Paid By Received By OREGON ELECTRIC CONSTR djb Page I of I Jiij,ty of Springfield Official Receipt .velopment Services Department Public Works Department Date: 06/15/2004 Item Total: Check Number Authorization Batch Number Number How Received 20387 In Person Payment Total: 10:14:01AM Amount Due 3.15 4.50 43,00 2,00 $52.65 Amount Paid $52,65 $52.65