HomeMy WebLinkAboutPermit Electrical 2004-3-11
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DEVHOPMENT SERVICES DEPIIR7MFNr
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The following project as submitted has the following srnIN(3F1E/.P, on 97,/ ;-,-
: zoning, and does n.ot reqUI~S ecific land use
(54/) 726.3753
approval.
Ft1X (5,1/) 726.3(j8.o
Zonin'k _ \ -0 -.4J j . ~CTRICAL PERMIT APPLICATION
9747Uate, ,/ t. . , /7 "- /'V\ '\<'r.J
726AUilo~i~ed Signature ~lA.i. Ci ty Job Number LAJ/?? -;;){)V<f- tJ...-O'U6
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. I LOC.ATION OF INSTALLATION
(() 09:: 4+.}j
\ -l0~ ~~40N n1 ~WY)
3. COMPLETE FEE SCHEDULE BELOV
A.
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Sum
Items Cost
. . ' , 1000 sq. ft. or less
~. l~e(j1Lra e())~l1l~ Each addi tional 500
~ sq. ft or portion
Permits are non-transferable and,expireo thereof
if vork is nO\~IAt:..?-O\%~Ol'}i.lhbvirBq~03~~9Y.\, Each Manu,f' d Home or
of issua\i1c~~r' 't'f'~orfuJ6y~l'=IeO~ ~ttity Modular Dvelling
180 dayfl)\loW rules a op Th se rules are set for Service or Feeder
-.1otification Center. .0" OAR 952-00
2. CO~~21NSTAlfi.:httf0tf~Yf the rules' B. Services or Feeders'
.n Q. You may obt~~n Cople.s 0 ,~ne Installation, Alterations
Elec t rii:Ck~ IC?P.1tf,~Cc,~Jtt~'M~tr~ !el~~ .,~~ or Reloca t ion:
calli IY 0 egon UtilitY l'lUlI ,vuti
. Address /AJJ~)~d~N~~O:~.Q(V,_~~?-?~44)' .
Ci ty [,Uc\en-e Phone 't<iS0-oCfdd.
JOB DESCRIPTION
rep\o('f' fh VIP I
$ 85.00
$ 15.00
$ 40.00
,'\
200 pmps or less I $'~SO_.-OO ~ S, ere
NfroUCtamps to ~OO amQ~ ~ TI' $, ,60.00
THf~ ~E<w)I?\Q $8A6.b<f)Pn\~s Ir- III[ W~PrPO. 00
A~<froll' ~l!l ~DElpP~Hl:ljnpsK l\IIl i IS t$G ~O . 00
cm~ ~1\~ON.Ell.LOR$300.00
~ \j'(I~ Y..D $ 40.00
ANY 180 DAY P u. -
4'rvh . Temporary Services or Feeders
o{~l~ Installation, Alteration or Relocation
Supervisor License Number _?-;2CfO -- S
Expiration Date ItJ-I-O'f
Constr Contr. Number;;)\)'1 J.c.
Expiration Date )0 - 1"'04-
Si~e of superVising.,Electrician
-U(~1~fl~./J--. }p.
Ovners Name .p1I';?~ Cb.,~~ -r: ~Cl n
Address~q\7 P~oM 5'/
.r'"
C i t y(::::{J. cbJ6 a1-- Phon e
q, LI og
OVNER INSTALLATION
The installation is being made on E.
property I ovn vhich is not intended
for sale, lease or rent.
Owners Signature:f\ \\ ~t .\ ,,~p s$\
~~~\)~o:~
\,\ \ .
_______________________________________ 5.
DATE:
RECEIPT 1t:
RECEIVED BY:
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B" above
Nev, Alteration or Extension Per Panel
$ 35.00
One Circuit
Each Additional
Circuit or with, Service
or Feeder Permit t
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
SUBTOTAL OF ABOVE
7% State Surcharge
J~ Administrative Fee
TOTAL
3.cr-O
$ 2-QO
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
, 6V
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F'
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00258
ISSUED: 03/08/2004
APPLIED: 03/08/2004
EXPIRES: 09/08/2004
VALUE:,
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: A~08~if}fI~~tJ5fE:2~on law reqUlresp'Jfb'~h~d TYPE OF WORK: Apartment Building
ASSESSOR'S PARCEL'~ld.: lrJPWe'M~Qj)bY the Oregon U IlIty
, to. ?W ~u ~enter. Those rules are set fan TYPE OF USE:
PROJECT D ESCRIPT-i()~f'a~~Glaffi P-m5~ ~nd1~yng::Oi.roill62-00
- n OAR 9o~-U I , ' f the rules \
_ \;.. \'C -.' -,,.;,, nht~1n COPies 0
UV;;:JV. .~_.. - J . h telepnone
Owner: HANSEN T ~~tP-A<m.10PA (S'Jot.~}. e _ , '
Address: 2917 POWD~lMl~f~T ttWJl!t~B~ErORI19~~&8')tlflcatlon
~ ______;,. 1_pf')n_qq')-?~44).
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor NOliCE: License Expir~p~~~~RKPhone
BUILDERS ELECTRIC INC -,~'-IIC: P~R(~~cr6SHALL EXP\_~f(O'lPRg ~\nT541-485-0922
BUILDING INFORMA91rciN ,JNOtK ~;~~~ONE~ fOR
"\ IlV\MtNlvtu OR IS
# of Stories: '.IV 180 DAY PERIOD, Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Impervious Surface Area:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
-x
SETBACKS
I DEVELOPMENT INFORMATION'
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
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 Value of Project
Pal!e 1 of 2
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2004-00258
ISSUED: 03/08/2004
APPLIED: 03/0812004
EXPIRES: 09/08/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number.
$6.60
$4.62
$3.00
$63.00
3/8/04 .
3/8/04
3/8/04
3/8/04
2200400000000000215
2200400000000000215
2200400000000000215
2200400000000000215
Total Amount Paid
$77.22
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 Insnections I
1 Electric Service: Approval required prior to utility company energizing service.
2 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.
J~~Mo~
)
3/~~D4
v
t actors Signature
Date
Pal!e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
,.
Job/Journal Number
COM2004-00258
COM2004-00258
COM2004-00258
COM2004-00258
Payments:
Type of Payment
CreditCard
if
.r
Receipt #: 2200400000000000215
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
nJm
Check Number
Batch Number Authorization Number
Paid By
BUILDER'S ELECTRIC
000317 0845488
City of Springfield Official Receipt
Development Services Department
o Public Works Department
Date: 03/08/2004
1l:17:48AM
Amount Paid
63,00
3.00
4.62
6.60
$77 .22
Item Total:
How Received
In Person
Payment Total:
Amount Paid
$77 .22
$77 .22