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Home My WebLink AboutPermit Electrical 2004-8-18 225 FIFTHS1'REET . SPRINGFIELD, OR 97477 · PH:(54~)726-3753 · FAX: '(541)719~{ 9 ELECTRIC4L PERMIT APPLICATION \ J I C' I .... 0'/'>&0- City Job Numb~ u..,J'A. i -- 01 02"6 Date X!-1-.lJ.f 2- c"\ u <: f I.S'~,,~ . ;:':~"':;'~>>-::~~:*/~1V~~.:f!1'fii:;;~'t-.:;~,;.,t;~;) '.7;: ~..'.;.:'?(~\~.'\"*:;;C.,:'.--"lf;:~>.t:?;.:~;~ '~"', ~\i'(~>>' i;,'";":/';" ~~ -;',,,~;<o;\',::-,,,,',::;.-' "l~-~< .,^,t"';<(.:~~~;.s~; "t1-E;:;~?"- ,("F1j,':.'C~2'-"':-,';; :':~~~,,"~:r- 1. ';(L{JCA'tIONOl?INSTAJJLA170N5Y 3. ;?~C01l'IPLETE:FEEfSCHEj)(TLEBBLO . /' , ~'.....,... "'''''-.'>C',."''~':''ii;;,~.'l?wi,;'..:;;~'^';;,,,,,,,,,,,, ".. ',.L" ~;~vk\l":."'i0X;'li'l,;;i:a,:("",:,,,,",;N<~.'t' ""6.ibr.J;,~,ji!;';' .:::i';;\:k~",,"';l,E\,,. V}S( C{l~ E: ~J-r . . LEGAL-D~SCRlPTION A. . ~~~~~lR~!~~~11~r~:~@:~t~:~!~r~~t~~:L~",~ \I()~~ ,~Lf )\.)O?J ("~9 JOB DESCfrTION ~ '~(i('{'+I(jilf: ~"(1dL0~) Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended fO,r 180 days. fjF!Jf2!3r~~~k;'~-::'$,->~:'f;..,~,:'f{."f-,>:;'-':':;'-:":'!WiT;t~"Ff~W:%\ ~;-;:/4~v2";;;Er-y.E:"'!'.:f0'\rT2,~:.'~~;.~f'-1 . ~.:'C.ONERACXOR!)INSTALMT16N{ONEY/;; B. 2. UYttQLf~i5i~J~,*}L:~#;;lkk2#~~:-~~\/~J~t;_iV~;;'T4<,0Xl'i~~g;j~;;<Y;r~~~:)i>>iJd0fu1~~-lhi Electrical con~'act:'rRrlos BQCW \~. 200 Amps or less ~ CL 0 I;) 2 " 201 Amps to 400 Amps Address K') ~:.Jf'\X' L.{') _ 401 Amps to 600 Amps - \ r::..J 11 III 601 Amps to 1000 Amps Phone t8.~- ~'t . Over 1000 AmpsN olts Reconnect Only A ~ 1& 0., F- . :0 ~ o~ '" i9 o~ ot- . ~ ~ ~/ "0- i9.o ~ %~. o (\lIS' &(> ~..;.. ., i"~ i9 01' IS' ~ 1S'''6 ~..~. ~... ~ <9 & ~,i:>: ;,~ ~ lS>F- ~ o~ .;;f':c;;:;<::~'~~, _UJl~t.::~,,':~ ..>~ ._'" . .x.~,,,,,._';.';:-';' . Service Included City 1=~ ,OLr\L -- (j 1000 sq, ft. or less Eac~ additiona~~fltf~~)~r, ~/ ,,:. ,- , " .' poruonthereoLf' II 'Ir.\.I~c -c': ,,c. ~. $19.00 o O\\! '-'\I~.' .. ..... Each ManufaWtdiRroffi~;@r C,; i' eJ I '- Modular Dw~&roe-St8\ ~OO'I 'v ,i 1. ,', ' F d Y 00,.,'11" . $50,00 ee er 0090, au maY , .,;." , . ,..'J~~2R~~~1~~~t~~t~";-,,) Center is 1_806~3"~2~~344)"'.""""'''''~'<'"'''\''_J;'''' $ 63,00 $ 75.00 $125,00 $163.00 $375.00 $ 50.00 Supervisor License Number 4'1 YiL~ Expiration Date I [')-() \ -D'-\. Constr. Contr. Number \~ It-,tr. '-1 ~ Expiration Date ~ - \ L\ -D C:J c. . Signature of Supervising Electrician Installation, Alteration or Relocation 200 Amps or less 201 Amps to 409 Amps 401 Amps to 600 Amps Over 600 ~B_s or 1000 Volts see "B" above. D.'frc ~~~::>>.;--' $ 50,00 $ 69.00 $100.00 j)~ ~~ New AIteratiqn or Extension Per Panel O C" ",," I \-""\-'C ,/:- -rL'ij; ../.,J"'ofil'K neJ,f~\llt'._ .,il ~;I;.\L,- :..A" I\Ljr 11\ll't..'lJ'I.ul. Each .~44,tion..~1~if9~N)~~i~frliS Pf)ii~ilT IS NuT Servi~~~or ~e~d~r~~enll~R \S ABAi~JuN[3 ~dtfo u t...: , " ~ j i-I'l u ~ U \J E, 'ff;1imlfJ~5tiP~1~e~~~~frijjl;ffi~1~J~:d)2~fuI~h'1A~f~llitio~i' ~;';'i,;';''''':''~~'~tL:;.,'J;;::&-~~:.~ :.:~~:<, .'.-' .+. -'0'':''''' .' . ;;;.;";';;';';'~,<;a.:,_i:,-J;,:dt,,,O;;..,.,",,>L6::::;;. :., ''''.'.'~'-' ~...::v::;;';j.;_;;.,,~...-,';.,: ~,::...~_",j:"":,,u ~~) -:> \"-.:> Owners Nam:J:::rt V\ D e LDi2. \ O( ,t-.o' Address (O<-::I._O(p ~.~) \ S-:'.-"> City C:>;<-Jf.,?> Phone t .' -...... ..." OWNER INSTALLATION Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 S 50.00 S 25,00 S 45.00 The installation is being made on property I own which is not intended for sale, lease or rent. . lVlinimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: 4. </ & ()1-~ \..~. -~~ /.....j &7 (: ,<JfJ ~, ("yo """'\ vp 0 (5' . ~).-; 7% State ,surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)IBuilding Fonns/Electrical Pennit Application 1-03.doc ~~.P'R, IN"., GF,I~ iii, ,.,.,,',._,' ',..,'" ~~ ' . .' ,.... /'1\1}~ ' ! .~.\ ~ ' ". .._,_" ,______'' ___.d_ ....." Status Issued CITY OF SPt<ll'1lj~lJi,LD . Building/Combination Permit PERMIT NO: COM2004-01028 ISSUED: 08/18/2004 APPLIED: 08/18/2004 EXPIRES: 02/18/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6566 E ST ASSESSOR'S PARCEL NO.: 1702341300309 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Heat Pump/Air Handler Owner: Address: ATTJ=f\IT!()t\" f'I'~"M. 1_"" v - -. .~...."" . ---.....1"...411 \",;V yuu LU ELDRIDGE DAVID K & TRACEY R fol.'?W ~ule: 6d:)/-i,3G by the Oregon Utility 6566 E ST SPRINGFIELD OR 97478 .Notlflcatlon Center. Those rules are set forth In OAR Q&:;9JI"1 (\rH {' ..1.....-, '1 i\' ~- - . -.... -~~ . ,-,."r I i;J..Jt:.'"vv I- I CONTR1~p.~~'6~TioN'~es of the rules by ~ L..L.. ~I Jv~: the telephone number for the. 2ft~SleUtilit~j}ifiitiOOlDate Center 1~~~9~-332-2344J08/14/2005 Contractor ROBS ELECTRIC INC Phone 541-686-5444 Contractor Type Electrical 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: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Buftl@\liCE: n/a Occupant Load: I DEVELOPMENT I~~QNiM~tIALL EXPIRE IF Jii COMM <-LU U/vlf.'JER THIS PERtVfiTijdN1lBft PARKING Overlay Disf\NY 18~NCED OR IS ABANDONEl1~1J~ NOT # Street Trees Rqd: DAY PERIOD. tta~Rapped: Paved Drive Rqd: Compact: % of Lot Coverage: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 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 Paee 1 of 2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line LFees Paid' Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid . $4.60 $3.22 $43.00 $3.00 Total Amount Paid $53.82 I Plan Reviews I Date Paid 8/18/04 8/18/04 8/18/04 8/18/04 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01028 ISSUED: 08/18/2004 APPLIED: 08/18/2004 EXPIRES: 02/18/2005 VALUE: Receipt Number 3200400000000000213 3200400000000000213 3200400000000000213 3200400000000000213 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. L Reouired InsDections . 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 Pae;e 2 of2 Date 225 Fifth Street .. .Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-0 1 028 COM2004-01028 COM2004-0 1028 COM2004-01028 Payments: Type of Payment CreditCard 8/18/2004 RECEIPT #: 'ty of Springfield Official Receipt ~~velopment Services Department Public Works Department 3200400000000000213 Date: 08/18/2004 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By DAVID LA WLER/ROB'S ELECT. Received By nJm Page 1 of 1 Item Total: Check Number. Authorization Batch Number Number 000477 018481 How Received Phone Payment Total: 1:42:58PM . Amount Due 43.00 3.00 3.22 4.60 $53.82 Amount Paid $53.82 $53.82