HomeMy WebLinkAboutPermit Electrical 2004-1-14
ct 85 submitted has the following
0\ require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)7~6~9 lJ;:;iZ-
ELECTRICAL PERMIT APPLICATION 0ale,._.., __,_._..J~H- 04-
City Job Number CO Ni. ~I" ~~ Date 0 \,.. t ?J . O!t. .'C,LlihG,';zeG Slgnaiu;'E: _ '..... ...~v.J.
1. LOCATION OF INSTALLA110N
~)~Vl'tZ-(( -::"l \
3. COMPLETE FEE SCHEDULE BELOlV
LEGAL DESCRIPTION A. New Residential- Single or Multi-Family per dwelling unit.
t"'Z () ~ ~::; \? (') 5 "~oa Service Included
JOB DESCRIPTION 1000 sq. ft. or less
() -1, . ^ /\ Each additional 500 sq. ft. or
K( IOvt-J: t~ <i S'~'-"~1 \-JtlfvVlctq-e. d. fVl-e.if v',-, portion thereof
PerrJits are non-transferable and expire i~ work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days, Feeder
$106.00
$ 19,00
$50.00
2.
CONTRACTOR INSTALLATION ONLY
B. Services or Feeders - Installation, Alterations or Relocation:
Electric" Contracto' C! ift:>.-.- ~ f (.. cf" ,~-
Address 8 () t ,g cJ '"1--- 2...& Y
City LA/tt~vvJ, Ilt Phone 7 L{l{ -07 0 ~
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
fo:) 0,:"'),)
Expiration Date
Supervisor License Number '3 G "'-5>
tD(( )-/ (:) ~
l /
'7 ,.{),.- 2-- cl q t.
c. 'Temporary Services ~r Feeders
Installation, Alteration or Relocation
200 Amps or less
,"t.. 201 Amps to 400 Amps
1"'\','" <. A
~\\J ;..:)'('tOl Amps to 600 Amps " $100.00
{<., ,,'~ ,-"'"
~;v~~,;~ ~~.OV~~:~~h~~:~~'OOO :l~~~~~~V:
': (" ~ v?\.vv & ~o ~ 0' ,
C( ~X'$.';) ~~.. New Alteration or ~~fe~ ~ ~~0l?) 0
. " '_' ~ _,v.;~ One Circuit ,r& _'$'@ ~0'b ~ f'~.,'} O~ .~<i:3,OO
,..S:;. .~, "'{)~YJ~ {.> '(-' Each Additio~~rt#~~O o",,~ }..0<:("<:'.CJ~
ro ~~~ 1\b~ ~~:, Service or ~~~~<<ft O.;s~ rl" ,f!i 6~~ $ 3.00
Owners Name D:t", ~~i )0~ 6-~~~ ,"&'.tJJ~s.' ~~ o~"l .~:~~ tl<~' ,
Address '"l ~ \. '\'<~\'<~<;\'$~" ,\ E. 1V~el!81te~~"tv~~:eYf~ei~t p~luded) -Each Installation
S 't~~~,:,'Q~ '/1 /f'r / ^~~~~0 s:-. (Jl' ~~.: rW''7'r ~~ 0(:. 'rP"t"I, '
City ~,!--\.~ ~ ~.L YV~~)}e \'--\"" l~~b ((0 .~~~ ~~)10~ 0~'"" ~0~Q-~~' $ 50.00
" '. \'?~e kJfh~~0 0 c ,,' $ 50.00
,. L~ier&~~~~~r $ 25.00
" ~-~ ~ ("<-
The installation is being made on property I own which Limi~ t9"l~or€mercial $ 45.00
is not intended for sale, lease or rent. Minimum Elect~Permit Inspection Fee is $45.00 + Surcharges
$ 50.00
$ 69,00
Constr. Contr. Number
Expiration Date
/ {/ /LO f fl ~
f / - ,
Signature of Supervising Electrician
/Ie,
OWNER INST ALLA TION
Owners Signature:
4. SUBTOTAL OF ABOVE
so,~
7% State Surcharge
10% Administrative Fee
;:~ t ~r" D
Inspection Request: 726-3769
TOTAL
_S \ ex}
F, () r G1'l
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Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03,doc
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2004-00044
ISSUED: 01113/2004
APPLIED: 01113/2004
EXPIRES: 07/13/2004
VALUE: '
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 737 E ST
ASSESSOR'S PARCEL NO.: 1703351305300
Springfield 'TYPE OF WORK: Singl.e Family Residence
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Reconnect
Owner: KANE DONALD P & SHELLEY R
Address: 5405 SUMMIT WEST LINN OR 97068
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
CAMPBELL ELECTRIC
License
13cnS-
Expiration Date Phone '
!5/~1J.t,4 5iI/-7L/L/ - ~7O::;-
,
I BUILDING INFORMATION I
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
, Impervious Surface Area:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-l
SETBACKS
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:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
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
Pa2e 1 of2
c-.
Status
Issued
225 F.ifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
ServiCe Reconnect
Total Amount Paid
L Fees Paid'
Amount Paid
$5.00
$3.50
$50.00
$58.50
I Plan Reviews I
Date Paid
1/13/04
1/13/04
1/13/04
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT. NO: COM2004-00044
ISSUED: 01113/2004
APPLIED: 01113/2004
EXPIRES: 07/13/2004
VALUE: ,
Receipt Number
1200400000000000044
1200400000000000044
1200400000000000044
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
1 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
times during construction.
"
Owner or Contractors Signature,
Pa2:e 2 of 2
Date'
225 "Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00044
COM2004-00044
COM2004-00044
Payments:
Type of Payment
Check
..o.i
Receipt #: 1200400000000000044
Description
Service Reconnect
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
GLEN A. CAMPBELL
Received By
jmp
Check Number
Batch Number Authorization Number
3410
City of Springfield Of udal ~ec~t
Development Services Department
Public Works Department
Date: 01113/2004
2:14:51PM
Amount Paid
Item Total:
50.00
3.50
5.00
$58.50
How Received
In Person
Payment Total:
Amount Paid
$58.50
$58.50