HomeMy WebLinkAboutPermit Electrical 2005-8-24
The followIng project as ~s the 'Ollowlng
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< CITY OF Sf........NGFIELD, OREGON " "
. "
. .
225 F'WTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)1Jar.,3689
ELECTRICAL PERMIT APPLICATION
City Job Number ! () IlIA z,.:>O S- - 0 114 cr
l\u(ll'8';<J..Si99~e .
Date 6't.-'f ~
1. LOCATION OF INSTALLATION
") 2 <...~ I Ph f:;A-Sp,JJ:SO-
LEGAL DESCRIPTION
1703. Z'2. I '3
3. COMPLETE FEE SCHEDULE BELOW
oobOD
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
JOB DESCRIPTION
ZOO AM I
1000 sq. ft, or less
Each additional 500 sq, ft, or
portion thereof
Each Manufacfd Home or
Modular Dwelling Service or
Feeder
Sf:rt.vlc..e
(.A.,,~e
Permits are non-transferable and expire if work is
nol starled within 180 days of issuance or if work is
Suspended for 180 days.
$]06.00
$ ]9.00
$50,00
2.
CONTRACTOR INSTALLATION ONLY
B. Services or Feeders - Installation, Alterations or Relocation:
b3
~ru]:re ofsupervtng E~DL
_' . - \{0\\g~ch A~d~j~~~]\q!"~~inqt'y;tJ\\1E ~~V[l"
r _ --- __' ,/I ,/ 0A(L<' 7.-r- 'A AI .,-U\S Se7,i,c'e or;Feederpermit PEP-Mil Ie:. NOI $ 3,00
OwnersName 'DrfJ-.l"O'f'Y n-~ =tr-/rt'V 1[1,' ~ 'ItOUliOER \11\;:' EO FOR
7>~~AJ < ~He"'t.;4.vf- P.Ulc~~~liscellaneOu'S'(S€~.i~~}\1~er not included) -Each Installation
Address " CONl\.\t"uk~ PE-RIOD,
City '5 ~ f>\\ Phone Z 1., 1- 4247- I\N'< p\!"ml], Qfirrigation
Sign/Outline Lighting
Limited Energy/Residentia]
Limited Energy/Commercial
200 Amps or less ..D<.
....~. r~.nuires YOu-'.'"
EN~tt.f(!J\'e\Jl<llO"""mp"::: e on Uti''')'
Address f.1),g~x '1138'1 fATT,\ w r4.0.L..a'1lllptolllOWAlllPpr g e set'nrlh
o 0 UIe1> ,,,,<>se rules ar
_ ~ Notificatie\\lGefifiilrlO Utm Am\l('OAR 9~?-001-
City t.~c.2IJc DR. Phone {na -27jLjn OAR ~ell()~fIil~~~~~~s olthe rules by
''0'/0'( 0090. Ycfu:mll1j~IYNote: the telephnne
calling the center. ( Utility Not,licatlon
Supervisor License Number 1-\ BAt", S nun{ber bn\\lBRry~\lA-,1~es _~IJ!\\',')~.rs
Center is 1-3()O-::l""
/ fj ) f) / / 0 7 Installation, A11eralion or Relocation
,
Constr, Contr, Number \ 1.\ ~ q3 7
Expiration Date /2- Z 7- oS
Electrical Contractor
A-( tLet[Qlu
Expiration Date
200 Amps or less
20] Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above,
D. Branch Circuits
New Alteralion or Exlension Per Panel
One Circuit
OWNER INSTALLATION
The installation is being made on y,~y_,;, I own which
is not intended for sale, lease or rent.
$ 63,00
$ 75.00
$125.00
$163,00
$375,00
$ 50.00
$ 50,00
$ 69.00
$100,00
_~.J
$ 43,00
$ 50,00
$ 50,00
$ 25,00
$ 45,00
Owners Signarure:
4. SUBTOTAL OF ABOVE
Minimum Electric Permillnspeclion Fee is $45.00 + Surcharges
7% State Surcharge
10% Administrative Fee
Inspeclion Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding Forms/Electrical Permit Application I~03.doc
63
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73?L
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01l49
ISSUED: 08/24/2005
APPLIED: 08/24/2005
EXPIRES: 02/24/2006
VALUE:
.
-Wt.~~~~~I;I~ ,
; ;
- -
_'U_m ._ -0'_ '
,Status: Issued
. 225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3241 PHEASANT BLVD
ASSESSOR'S PARCEL NO.: 1703221300600
Springfield TYPE OF
Electrical Work Only
PROJECT DESCRIPTION: 200amp service upgrade
TYPE OF USE: Repair
Residenlial
.'I\J~~
y...S '<' ~\\J\
_ ,.;. \" \S \'"
IPUBLIC IMPROVEMEN:fi;I'?S'\'o.\~~ "<,\JY--
\\"V \~". \'\\)~
",~. :0 '0\ \,S'\'o. ,,-\'.~\J Sidewalk Type:
'.;\\'V ",\~ '0~\J c. \>.\J
\~\} S V\; \:l\:.\l '\)<;>-. \'" ~. Downspouts/Dralns
"\ '(\'\ '0\)\'\ ~'<-\'> S'\'o.\\J
\,-',j\ \\S;.\:.~ \'>~ '?
c,\)\~ \ i0
w~
Owner: DERAN PARSEGIAN
Address: 3241 PHEASANT BLVD
SPRINGFIELD OR 97477
I CONTRACTu", U'rORMATION I
>l~\\ Vd
Contractor ee.\li\ef> 1 \.l\\\\\l:l License
BRYAN!t~MU,.~x){e9Q~ c.~\ql~ 149937
~~OW. ~~9\eo b'j ~~ I'/o'BiiitDlNG iNi10RMA nON,
P' 0'I'l (U\aS e: {\\al. \'(\~IQ\l9" . ,\'(\6 \ ':"' 0.6
# of Units: \O\~ a'UO{\. e6 ,.()()"\\) ~ CO<;J16S Q #\l!f,S,t~,~~:~
Primary Occu~~'($:Mg2.'()() O~ 0\6', \'(\:l\.~tght-of
Secondary Occul\~ '10\1 t{\a'l {\\el. \.~ {\ 'J\I\lt!?:!1!<\of Heat:
Primary Construc~Q.lI~~f6 \'(\0 ee e\f!j.e90 Q.'2>'2>'2.-Waler Type:
Secondary Construction~ \ el \01 \'(\ is"\ lor:) Range Type:
# of Bedrooms: {\\1t{\'O Ce{\\01 Energy Path:
Sprinkled
. Contractor Type
Electrical
nla
I DEVELOPMENT INFORMATION I
. Front yard Selback:
. Side 1 Sethack:
Side 2 Sethack:
Rearyard Sethack:
Solar Sethacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Street
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
or multip6er
Square Footage
or Bid Amount
Type of Construction
1 of 2
Phone Number: 541-221-4242
Expiration Date
12/26/2005
Phone
541-606-2797
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Fl Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Value
Date Calculated
.
. CITYOFSPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01149
ISSUED: 08/24/2005
APPLIED: 08/24/2005
EXPIRES: 02/2412006
VALUE:
Status: Issued
225 Fifth Slreel, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Tolal Value of Project
Fees Paid I
Fee Description
+ 10% Adminislralive Fee
+ 7% Slate Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
$6.30
$4.41
$63.00
Date Paid
8/24/05
8124105
8124/05
Receipt Number
1200500000000001235
1200500000000001235
1200500000000001235
Total Amount
$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.
IRpnlli~
Electric Service: Approval required prior to ulility company energizing service.
By signature, I state and agree, thai 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 wiD be made of any structure without permission ofthe Community Services Division,
Building Safety. I further certify that only conlraclors and employees who are in compliance with ORS 701.005 will be used
on this project. .
I further agree to ensure thai all required inspections are requested at lhe proper time, that each address is readable from
lhe street, that the permit card ..located at the front of the property, and the approved set of plans wID remain on lhe site
al all times during conslructiolL
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
I ,
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9
<lllliity of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200500000000001235
Date: 08/24/2005
9:20:15AM
Job/Journal Number
COM2005-01149
COM2005-01149
COM2005-01149
Description
+ 7% State Surcharge
+ 10% Administralive Fee
Perm ServlFdr 200 amps or less
Payments:
Type of Paymenl
CreditCard
Paid By
ROYALE CONSTR
Received By
djb
Item Tolal:
(;beck Number AulblHization
Balch Number Number How Received
191757 In Person
Paymenl Total:
Amoont Due
4.41
6.30
63.00
$73.71
Amount Paid
$73.71
$73.71
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8/24/2005
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