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Home My WebLink AboutPermit Electrical 2004-11-29 , " ott.:, 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (5~)726"'3~?~";-? ELECTRICAL PERMIT APPLICATION ,I / "9(" ~t'(9 ~. ~ City Job Number c..o~ z..cOt( -OIL{ S-~ Date 1(/ '2-7/ 0.'1. ~o?j." 'c"1> , '(90' ~ " "- 1. 3. Y 1$ i BRootDALc LEGAL DESCRIPTION, )70>Z-Z\{L. Electrical Contractor ~j cc..Qoc . 200 Amps or less 315 J. S 3 A~~lI~~ 'pre~q~ law req~~e&~~OO Amps Address fUl1vvy i d",,:;; 1i~ the ~96lm~~t~~ Amps Nottficatiop, C~nt~f./ Those ruleOOlrA~ i6'Q uvO Amps City 5f f(;D Irfb'AR ~r!,)lnh141t61~ffi(ro~gh O~f0'08-A)~psNolts 0090. You may obtain copies d{e.~rredfedrw calli tlle,center. (Note: the teleohone Supervisor License Number f'-:J.~:;2.,.4r1 ~A Oreaon Uti~~ ') 8el'lter is 1-80Q-332-2.A4). Expiration Date / 6 ~ 0 /. b Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1 000 Volts see "B" above. D. DLfY.OO JOB DESCRIPTION 5Ef!VJC( CI/AoG-[ f-vf(/Vf}C(., i/c.. I . J 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. Constr. Contr. Number )(7770 IO~O/' oS Expiration Date Signature of Supervising Electrician ~H t ~ , Owners Name -SOfl/V Cf<05/ AI< AddressY ~ ~ gf(oO/cDALc City '5 f ~ (,0 Phone 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 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 $50.00 B. $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 r; 3,0 0 $ 50.00 $ 69.00 $100.00 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with LJ Service or Feeder Permit $ 43.00 $ 3.00 ) 2.00 E. Pu~p or irrigation $ 50.00 t:Ol~F~f~nSH~rtneXPIRE IF TH[ \^.'gg~ 50.00 THISIRm~~d'Energyl,ReSi'aent1alpERMIT 1(' I\lgTl: 25.00 PUTH~lbt:~ UI\l~~li I HI~ ,"".. I~ ~~Of\lifjIEl\leEDe~ m>"~~T~~ONE[}...F.0P. $ 45.00 injinum.tlectricrP~rmit Inspection Fee is $45.00 + Surcharges 1\1 AY t"LIlIUU. ~ 7r 5-Z.~ 7% State Surcharge 10% Administrative Fee TOTAL 75-'::::' 87 7.5=-- Shared Drive(T:)/Building FonnsIElectrical Permit Application 1-03.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 482 BROOKDALE AVE ASSESSOR'S PARCEL NO.: 1703224204400 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01455 ISSUED: 11/29/2004 APPLIED: 11/29/2004 EXPIRES: OS/29/2005 VALUE: Springfield TYPE OF WORK: Heating System TYPE OF USE: PROJECT DESCRIPTION: Service change and 4 circuits for heat upgrade Owner: JOHN CROSIAR Address: 482 BROOKDALE AVE SPRINGFIELD OR 97477 New Residential Phone Number: 541- I CONTRACTOR INFORMATION I Contractor License EASTSIDE ELECTRIC INC ,~,.,,~ \/ou \0 117770 . _~1. ~'~1l.v."",t. ~ . .L~.\nu ON'. ored\oBM~~~~~~~JON . ~llEN1'\ doptea oy U \eS a"e ~e"\: # of Units: 'O\\OVJ tU\eS a. tel'. 1'\iO#~I~fod~ 99~:Q;:J ~\ Primary Occupancy Gro"i\=Ot\'\CatiOR~e~ -OO~ 0 \fIi1eih~i Wi ~t~c, ~~ ~1 Se~ondary Occupa?cy Grd1~I\R 952.-00 obtain <FYp~o~~{1~~f~~t~9~J Primary Construction TYP~~'2 -=-90 '{olYN'a'l .e. I\~ ," .' ',.; '*p.,~'O'i\'\C%l}9R . el'h h \ UtI" :!-::Iv.'''''' Secondary Construction Ty. :ca\\i119 the C ored3~l;e' ., 1}~~1: # of Bedrooms: roOet lot the, ,\,~g.e~Patli: (\U center \S Sprinkled Building: Contractor Type Electrical Expiration Date 10/04/2005 Phone 541-915-9828 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I Frontyard 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: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC.IMf.~QYEMENTS! E \f 1HE 'NOR\<. ~~IS" PERMI1 SH~~R \'^:~P'l.lMTh~:N01 . A1I1HORIIEDD lI~R IS A\3.Q;QWb:s~~iitj~}1ins: , ~~~~i~~~y PERIOD. Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Paee 1 of 2 Value Date Calculated -_~JJt8.t~9Jr,'~~i .-:st _ ~i Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01455 ISSUED: 11/29/2004 APPLIED: 11/29/2004 EXPIRES: OS/29/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid' .. Fee Descrip,tion + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add . Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $7.50 $5.25 $12.00 $63.00 11/29/04 11/29/04 11/29/04 11/29/04 Receipt Number 1200400000000001660 1200400000000001660 1200400000000001660 1200400000000001660 Total Amount Paid $87.75 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a;in. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ,Reouired Insoections , Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work i~ complete.' , ' By signature, I state and agree, that Ihave 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 Law's 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 ofthe property, and the approved set of plans will remain on the site at all times during construction. : Owner or Contractors Signature Date Paee i ~f2 225 Fifth Street Springfie)d, Oregon 97477 541-726-3759 Phone a.,~~~"E~!LO-,'iii.,,'~, ""'.. i,' WiLl " i , f' ":'" t"" { :~,: .J',f ~ -,J ';**"*t'l't..;:_';'~,_"1.,..,,,"r . ,"- '. r'l;ty of Springfield Official Receipt ~velopment Services Department Public Works Department Job/Journal Number COM2004-01455 COM2004-0 1455 COM2004-0 1455 COM2004-01455 Payments: Type of Payment CreditCard 11129/2004 RECEIPT #: 1200400000000001660 Date: 11/29/2004 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By ROGER KING Item Total: Check Number Authorization Received By Batch Number Number How Received djb 035001 In Person , Payment Total: Page I of 1 lO:31:19AM Amount Due 63.00 12.00 5.25 7.50 $87.75 Amount Paid $87.75 $87.75