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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 - '\ 0) '...._" ;; 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