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Home My WebLink AboutPermit Electrical 2005-2-22 . . Sj:O=: tij 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)7~~~2 ~-- . ELECTRICAL PERMIT APPliCATION. ;o.o~:~ o~'" 3IIIIa... . City Job Number c.ov.. 200')-02>'/ tzz. Date Z. -/ b -0 )' ~ ~../ ""c> 1>.0 f. I"~ Q: ....0 .5.-'- ~ o~ :7", .-.. ,,-..,' . '," .&. I. fJi"ii",","''''''.' . ;~"~f"--ST~"!N~ ~~,.Qm_.f.@Yl_c...-" ...J1J ' , IT") I '//t:'-cit/V'\)~ + $" f- LEGAL DESCRIPTION i 70s 2 '5> 2. JOB DESCRIPTION 01;200 A-bt\ Z. Cl d-UA.-' +:r Permits are aon-transferable and expire if work Is not started within 180 days of Issuance or If work Is Suspended for 180 days. 3. 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 "'R~. ....-~te.;r.'''..,.".,~T~<..... 1~:.-~..~"""'''CJ'~''''''''''r'~.~--~ i'l'.'.5V'.iW'~t::.;~~8i!~ """'~~~''.'t'''. .1\,l:~~'r:'t';"...~~.rJrf' ~l~;:.bl 2. ~~!~~1J.!!l~li&'fi.r~ B. e!",J~es'.9rJr. ~em n.tilllJit.o ~!W!;"'!i.9P:'M\lt!.l'Js~.~ . ---;) / ('L'/ L. T..",. ~:. ": ,ni':: Oregon law requires you to Electncal ContractorKcJ1 ') ~e/ j / / r!.{'IJ1 .. 'rlll?.oOd~3'~~t:"<'il,Wthe Oregon Utility S 63.00 nil D.,~ v 2132/ . .\ : :lcatiorfVE!~iW.1/' tl'rt8U'fI1P.es are setlnrth $ 75.00 Address n) rJIJ ^ :.. JAR 95~4.CC\1}Wlttl ~qfl~Pr'OAR 952.001- $125.00 ~ 1-01 \:r Illfl~O' You \>R!.ri'-lJIll~J91IgQ9JM1PJfthe rules bv $163.00 City QJlQ_ Phone Voo'v'N" ailing tlil.YUE.~Q!I.(tA~~ol1Se telephone $375.00 number fB~oen!'~\'.99bll Utility Notification S 50.00 CEWlf:)~ 1_~.~~?-2~~\ c. lIiJ'~iji~t.I!:y;Sem~~~d~~~~~~ New Alteration or Extension Per Panel I 0-9n,e eircuit . L ~$43.00 ~ 'E!chLXdditional CircuiNii'WiihlF \ Mt "ulli\ Owners Name jAiojlC€, IS (2.00 ~ \ ~\i~~~ne51~tt~,,;y\~\S p~~~:~~ ~~NC$' 3.00 "3 '.-=:> 1E''''-~ira'Gl',~"",,:t'''''''''''''''tl'~.f ,<" :;",.....,-,,~.:r.r ~,.'"'.~;-'l I "3 '5 / ,. "'c-~v'^-o-.. .... CI8I-l.~.,~'!~Jt,.,,~~~$j['i!'~.1!!.~I,!'iLel!l,i,~I.a~J~~"< . - A.NY 180 DAY I"tl\IUU. S ? I~ ~ Phone Lf g \ - /400 Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Supervisor License Number 41 LI'-l S \OID\\O"l \Sl,...\nlt\ Expiration Date ~ I ''-1 ! D 5 Expiration Date Constr. Contr. Number Signature of Supervising Electrician ~.A. ~ Address City OWNER INST ALLA TION The installation is being made on property [ own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. mJ:'ir~JG~c $ 50.00 S 69.00 SIOO.OO If;' Minimum Electric Permit Inspection Fee is $45.00 + Surcharges JiB~~"4._~'P"".- 4 "rr'l." ~';''' ._-t .'f- . I At" - _ ~ ~., - I : l(b JZ-z. L{ bO 5381. 7% State Surcharge 10% Administrative Fee TOTAL Shared Drivc(T:}'Building Forms/Electrical Pennit Application l-o).doc . "ou to law requires, . . . . _~, ,1"\,:','-\' ')leg"'.~ . .hOOreqon Ut\\iW.~ .. ""':>~ aOOtJlv",,:. '-J __ ",lIpS are ~t;;\ ....... r CONifIMCNOR'INFORMAlJII0N...01- W-:'.I\l, 52.001 .UU' v .... . - \ \\1e rVI"!' b~ Contractor in .?pJ\~u rna~ obtain cOPI~~\1~L~~Se>~e Expiration Date ROBS ELECTlm::r.!:'~n lhe center. \N~t~,;;laJ~!Jllcat\on 08/14/2005 ;,d~umDiNG'INFGtiMM'I6N\ ' \J~l !.f... # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1331 PIEDMONT ST ASSESSOR'S PARCEL NO.: 1703253204200 PROJECT DESCRIPTION: Add 2 circuits Owner: Address: JANICE BROOKS 1331 PIEDMONT ST SPRINGFIELD OR 97477 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00172 ISSUED: 02/17/2005 APPLIED: 02/14/2005 EXPIRES: 08/17/2005 VALUE: Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Residential Phone Number: 541-485-1400 Phone 541-686-5444 R-3 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: VN n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: . OverIay,Dist: lHE WORK N#1s.viJiTrees<Rqd: L \:XPIRE IF "11 IS NOl .~ r.0!1"11I I..ll..'~ pCDh. lPaved'Drive.Rqd:,cD lHIS "n D - n.~r. \ \ ,,,u,,n ONcD FOn A."1,":of,CotGoverage:S A.BA.ND " COM\III~~~~S ~~~\OD. ...., ~ .. '., - I PUBLIC IMPROVEMENTS I Sidewalk Type: DownspoutslDrains: I Valuation Descriotion , $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Page I of2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00172 ISSUED: 02/17/2005 APPLIED: 02/14/2005 EXPIRES: 08/17/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project F""<P:aidJ Fee Description + I 0% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid . $4.60 $3.22 $43.00 $3.00 2/15/05 2/15/05 2/15/05 2/15/05 Receipt Number 1200500000000000196 1200500000000000196 1200500000000000196 1200500000000000196 Total Amount Paid $53.82 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 Rf'ouirf'd In<nf'di'WLI Rough Electric: Prior to Cover Final Electric: When all 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 Page 2 of2 225 Fifth ~treet Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-00 172 COM2005-00 172 COM2005-00 172 COM2005.00172 Payments: Type of Payment CreditCard 2/15/2005 . RECEIPT #: ~ jIjlY of Springfield Official Receipt .elopment Services Department Public Works Department 1200500000000000196 Date: 02/15/2005 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Paid By DAVID LAWLER Item Total: Check Number Authorization Received By Batch Number Number How Received djb 032313 In Person Payment Total: Page lof1 1:25:33PM Amount Due 3.22 4.60 43.00 3.00 $53.81 Amount Paid $53.82 $53.81