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Home My WebLink AboutPermit Electrical 2004-8-2 10,0 . f ' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)7-16-3\89 ELECTRIC# !,ERMIT APPLICATION / v0q", City Job Number{JJf?1l00<-J - 0CA5~e (0 X C) L J Od ~&O' &. , I T z 1. L.t )2..0D~~~ ')~ LEGytfB~t40 64?1l1-- O~ JOB DESCRIPTION (Zeeo yv Wl-c:?\ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Address City ~(~~n0 Phone Supervisor License Number 3GGG---s.. Expiration Date "5' /2 L 10 (p I / Constr. Contr. Number 7?, C{ q ~ Expiration Date c: / L L I () (:; - I / Si~~7::j~ OwnersName ~ I~o) \(a;v) Address 6J 52 C) r a fY1 &iJ L S--J" ........... City ~O~ Phone '17Y7~ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 3. 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $ 19.00 Each Manufact'~fIj'l~~ . . Modular Dwelling Servlc~ gf'J. Oregon law reg}I/res you to Feeder Tmlow rUles adorted b" tho ~g.OBn Ut"'~ . . . J 9 /IllY B. . You may obtain copies of the rules by 200 Amps or le~alling the cente+:-{N:::te: ~r?~.P~epi jU/ Ie 201 Amps to 4~ for the Oregon Uti~tz,s~8tifi-cQiju.. 401 Amps to 600 AmPSCenter is 1-800 33~~49R. 601 Amps to 1000 Amps $163.0.6 Over 1000 AmpsNolts $375.00 Reconnect Only I $ 50.00 j c. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. r:"'. cr-i=' ~O - '6.SJ 5.00 SK.SO 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2004-00952 ISSUED: 08/02/2004 APPLIED: 08/02/2004 EXPIRES: 02/02/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: ' , 4520 DAISY ST . ASSESSOR'S PARCEL NO.: 1702324304302 SpringAtffIENTBW: ~e'Q~ r~~tr~t~ Only follow r' 11r>~rlQDt~~bY the ~r~gon Utility . . , 1 l: OJf u.: A dIfi.OJl t f rt,ResldentIal Notification enter. nose rill S a,~ se o. n' in OAR 952-001-0010 through OAR 952-001- r...- - .. - '_,L_:., '--rl'~~ _4 .h'l P..IOC' hv vV.;;Jv. lVU IfnA, .....-..-.., --1- ..--- "" .' .=. calling the center. (Note: the telephone ! number for the Oregon Utility Notification ~ l . ~ f'\('l!'l "n" "....1'~) V1;i11 ~I ,..., . v_.:, etJ;~ -- "." PROJECT DESCRIPTION: Reconnect ONly Owner: BOLKAN ROBERT 0 & JULIE A Address: 4525 CAMELLIA ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION. Contractor Type Electrical Contractor CAMPBELL ELECTRIC License 73995 Expiration Date OS/24/2008 Phone 541-744-0705 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure. Sq Ft 1st Floor: Type of Heat: NOTICE: Sq Ft 2nd Floor: Water Type: . THIS PERMIT SH~&. FJ!~~l!"fttlHE WOR Range Type: ..Cl.UTHORIZED UNGs~Ft-~ar~erc~rfog K Energy Path: COMMENCED OR ~B Ft l,Jt'berfK I I NOT Sprinkled Building:ANY 180~~Y PER~~~~~tlLQ~;O FOR I DEVELOPMENT INFORMATION' REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS. Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total ValueofProject Paee 1 of 2 ._.1iJJ'aJ.!~fj;I!.!;Rr ~, ,~ I. f, . \, rl;' Status , Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00952 ISSUED: 08/02/2004 APPLIED: 08/02/2004 EXPIRES:' 02/02/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line LFees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Service Reconnect Amount Paid Date Paid $5.00 $3.50 $50.00 8/2/04 8/2/04 8/2/04 Receipt Number 2200400000000001000 2200400000000001000 2200400000000001000 Total Amount Paid $58.50 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 Insoections I , Electric Service: Approval required prior to utility company energizing service. 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 ~:k'~ O~ner or Contractors ~ignature -6/'L/OY Date! / I Pal!e 2 of 2 225<~ifth Street " .. , 'Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00952 COM2004-00952 COM2004-00952 Payments: Type of Payment Check 8/2/2004 RECEIPT #: Description . Service Reconnect + 7% State Surcharge + 10% Administrative Fee Paid By GLEN A. CAMPBELL r:+v of Springfield Official Receipt felopment Services Department Public Works Department 2200400000000001000 Date: 08/02/2004 Item Total: Check Number Authorization Received By Batch Number Number' How Received nJill 3513 In Person Payment Total: ,. i,' Page 1 of 1 2:12:02PM Amount Due 50.00 3.50 5.00 $58.50 Amount Paid $58.50 $58.50