HomeMy WebLinkAboutPermit Electrical 2003-12-18
..12/12/03 FRI 10:57 FAX 541~89
CITY OF SPRINGFIELD.
raJ002
ect as submitted has the following
not require specific land use
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~15 FIFTH STREET 0 SPRINGFIELD, OR 97477 0 PH:(541)n6-3753 0 FAX: (541)72G:-9il8'9
ELECTRICALPERMITAPPLICfAtTION Dalei~":''i( ~'D ~
City Job Number Ca11 ZOO:> _ 01 Lb( Date I Z -/6 -O::s' Authonzed Signalure +<tJ
1. ~~~g.k7'~fl1{:~~i!t~~iI 3. t?!~~Gl!~~:::I~~_i~~~4~1~}2i~P1.
3520 "y'fIVlP, '- o::.+-
LEGAL DESCRIPTION
\ 707-3oDC>
0/927
JOB DESCRIPTION
~:'~:.~:~~~pue~workh
not startEd within 180 days of issuance or if work is
Suspended for 180 days,'
A. ~~~R~lilfl~~]I~iW~ij~~i~!~~~~:1
Servit.1ncluded
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion th=:of
Eath Manufact'd Home Of
Modulat Dwelling Savioe Of
Feeder
$106.00
$ 19.00
$~O.OO
. F,:,;:,,,,,,~~,,,~"..':c:\""c";""n3Jim'l1i B ~;:;;"~."""'1ii=~i~"","',"'.;:~~~"k1F'~~~r.t""'R"':,,<;,"""':ii"~'lf,ili
2 ':-'~"~_~~"J'.~.~~~ "~- _..:.~..~ . ;~~~~~":,,,,:,,,~~t 1~"*'5.~~~~.~~' ,c:.=,. ~...~~~~~~~~.g:-I::~..~~
. ~~'ll:to:.~1...:."""...~~~";Ji:=- ..n lil1Lil>:i~~' = "i.i:e.\~a~-~~' ....~. r_',' '--w=u..."..~"";~"'~;.'l::u.
Electrical Cootnu:1Or ~h"hI'N\ ~lOGh)dY'G' I b 3
Address I~ % Vdllelj\JLQ10lt7kL.
cityQl?./ ~S Phone ~
Supervisor License Number f) ff1?i:.
.., , . .-
Expiration Date \ 0\ 0 \ \. {')l\-
Constr. Contr. Number RJ??f1
Expiration Date
011Z-31D4
Signature of Supervising Electrician
200 Amps or less
.201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN oilS
RecOlll1OCt Only
$ 63.00
$ 7~.00
5125,00
5163.00
5375.00
$ 50.00
f!'ii:""'~""'-"fj;'3'1~J:rr..:-<R''''!''''~'!:''''._'~'t:.-..i'k<~~' ~-- ""~"',,_.
C~ ~,~""..,~~~{~..):.e,JYI~!9~l~,~~..:;j,~!,::.~~{ _' 'A" ~ l'!f,lC-:~.,(..!t.,,~:t~" "..~~
_ '~'",'.._ _ ,.lM;:.':f'"..w.>~(~\",~~~",.I):-.- ::t'._.","r~ .':W'. _:s!.~.W<o;;;.~.,"",
Installation, Alteration or Relocatlun
200 Amps Of less
201 Amps to 400 Amps
401 Amps to 600 Amps'
Over 600 Amps or 1000 Volts see "an above.
D ~~9at'i'Ir~'i.~W.jj',f;:$;l!~~~'ltjl"~a?~~4"r;l;"~lE&~
. l1i~... -'.~~~'~o~o;~l;t}~it~~~~~~~~~~~&~&l~
$ 50.00
S 69.00
5100.00
/J. (\ IJ~ New Alteration or ExteDsioD Per Panel
~ r---- One CncuII $ 43,00
Ea~ Additional CilCUil. Of with 4 S 3:00 1 Z
Owner.; Name Lc:vJ I ~ /(2.IA.":::./'-./ SetV1tec~~~~~ ;,'!\~';\\e' vcu.t.:
- ";<l;.= .. . .'.t"!"'~ . ,.~- .. ""'~~";1i"
Ad.-- ;'\" ~ 0./ zb'3 Z I fil! I d. I 'i~~~(~Mr,&~~jjiiiiliicltiife'ai~ii'ail$.HIl~I;j"n;S
W~ rv r \ ',"'- - ~~~~"-~~~"",.~"o.~~-&e.~......:-=.=>",~~,,,. -.\- '".~-~:';''l',!lM':>.l.!
cityll.I>Ao/."l... .11-/ Phone ,.~L ,',~~'.:,'.:,:~p.,~r.i~~.,,2;~ -;,'I;~",'~.;.f)C~' $ ~O.OO - -.-
~., .OA ."" . "sig;,iq~tlinei.;ghting.' '''~ 'I'\~S $50.00
," .. ." - I " .........,.'..1
OWNER INSTALLATION 1)0';\ '. '. "'.' ~tedEDergy/Resiileoti3l-~ . "J $ 25.00
,.....,n""" ,~ '.! . . ..,,-._.l\'.-~j('~3\lUI'
The iostallalion is being made OD r'-r~~' I own whicli . .L~ted :Encrgy/CiiiMl,,",i";l' .' $ 45.00
is not inlcndcd for salt, lease or teDl. nUl'T~ . MbumUIO Electric Permit fu~~~~OD Fe. is 545_00 + Surcharges
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4.';.0:" '~., .-: TjtT~tJ.,;'::- ~ '.' , ., ~ii1r;1j(:ir~.~';;J:..i.il.~~J'i1:~ 7 ":>
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NOTICE: 7A"M~I#9\1Wae . . 5zf
THIS PtKNII13HALL EXI'IRElm4.~~~veFee 7 'SO
~UTHORIZED UNDER THIS Pr:nr" 'jC; <27JI
IospeetionRoquost: 716-37utOMMENCED OR IS ABANDwl)WOR -r 0
ANY 180 DAY PERIOD. Sbm<d on.e(T:)IB.ildinB FonnsIElectricol Pennlt AppliClltion 1-o3.cloc
OwnetS Slgoatute: .
2
.
. CITY OF ~rK11~lJ1<mLD
Building/Combination Permit
PERMIT NO: COM2003-01261
ISSUED: 12/17/2003
APPLIED: 12/16/2003
EXPIRES: 06/17/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa,
541-726-3769 Inspection Line
SITE ADDRESS: 3520 Olympic St
ASSESSOR'S PARCEL NO.: 1702300001927
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION: 200 amp service and 4 circuits
Owner: TRUSTY LEWIS S & CHRISTINE J
Address: PO BOX 26321 HONOLULU HI 96825
, CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
JOHANSEN ELECTRIC INC
License
51539
Expiration Date
09123/2004
Phone
503-698-3417
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Impervious Surface Arca:
, DEVELOPMENT INFORMATION I
SETBACKSNOYICE: . IF THE. WORK
Frontyard Setback: THIS PERMIT SHII.LL EXP~R,li.. ~tNOT
Side I Setback: AUTHORIZED UNDER THI ;jSfi' v. ~~~ Rqd:
Side 2 Setback: COMMr.NCED OR IS II.BII.N '\"e'Rqd:
Rearyard Setback: ANY 180 D~'( PERIOD. % of Lot Coverage:
Solar Setbacks:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
;'.! I:"':". . 'Sidejyalli.'typ~:'" I "!,,,IC5 yr.:Jlo
',;'.::(,'.", I ~L- __ l"~l' ,pi~.lJ toy ill-.. (J; :""I,Jlll~t.,;ti'
\I( , ,; , Downspout~lDrams: ......, ,'.' .
. ...1. '.l . \. . .. I,'. I,' ", I lor
:!~ O.'t', '"': " I' ,.,\" i' II!I ~/\.',' "',.ne
GOtJn. \','" r' '\' ,',+.. 'r ,;... -,' p,... .,!" 1 ~
Notes:
Ct11:ill("l .;. . " I
,''''', '.. . -.. ..!....'"".~.':3
I Valuation Descriotion ,
~. .- ~
, ,'- 11I11 lUUII
- ,...... '" 'J ~" . -)
.. - - I":,.
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculatcd
Total Value of Project
Paee10f2
.
. L.11 i' OF ~rKll~GFIELD
Building/Combination Permit
PERMIT NO: COM2003-01261
ISSUED: 12/17/2003
APPLIED: 12/1612003
EXPIRES: 06/17/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa,
541-726-3769 Inspection Line
I Ff'f'~ P'ilid ,
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, E,tend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$7.50
$5.25
$12.00
$63.00
12/17/03
12117/03
12117/03
12/17/03
1200200000000002625
1200200000000002625
1200200000000002625
1200200000000002625
Total Amount Paid
$87.75
, 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 Rennired InSDl'ctinnsJ
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefuny examined the completed application and do hereby certify that an
Information hereon is true and correct, and I further certify that any and all work performed shan 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 Safcty.
I further certify tbat 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 tbe 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
c"
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-0 1261
COM2003-01261
COM2003-01261
COM2003-01261
Payments:
Type of Payment
Check
~
Ilk.
Receipt #: 1200200000000002625
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
Paid By
JOHANSEN ELECTRIC
Received By
djb
Check Number
Batch Number Authorization Number
"City of Springfield Official Receipt
Development Services Departmen~
Public Works Departmen(
Date: 12/1712003 2:18:25PM .
Amount Paid
1Iem Total:
5.25
750
63.00
12.00
$87.75
How Received
In Person
Payment Total:
Amount Paid
$87.75
$87.75
.
.