HomeMy WebLinkAboutPermit Electrical 2005-1-27
225 FIFTH STREET · SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72!b~jgflo;,
ELECTRICAL PERMIT APPLICATION ~.or;l).9, ;o~~
City Job Number tc:Jry,Z00'5 -00\07 Date t {1..1! ~ /.-q( i'JQ' ~.or%
. \90' ,,/
1000 sq. ft or less
Each additional 500 sq. ft. or
portion thereof ATTENTION' 0 $ I . 0
. f . regon law req .
Each Manufact'C1~llWes adopted by th 0 urres ou to
Modular DweINqtm~Center. Th e ~~~~n Utility
Feeder In OAR 952-001.001 0 t~se rul aPe seHurl/ I
B.
f . r number for th O' : e telephone
Electrical Contractor ~c.. lEJ.li n.J~I/Ic.t. 200 Amps or less C ~ regon Uti/1{fN~tificatia_
201 Amps to 400 Amps enter IS 1.800-332~l:ijl. '.
Address l.2tJ mt)/II~6 ~. 401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts $375.00
Reconnect Only I $ 50.00
D~C\OO
JOB DESCRIPTION
re.,"'-c~
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.
City Eatw E
Phone 3L/l/- 3b'fc I
""1 -:L 3 r- (i
Supervisor License Number ~ T ..:::> V
Expiration Date ( () /, / rJ...O 0 +-
,
Constr. Contr. Number 9 () :l CJ D
Expiration Date .3 ! J 1- / 0 ~
Signature of Supervising Electrician
CY/1~ /1;frJ .
0-
Owners Name V()~ Dltt ttimzQ
Address 57fl E. St.
City S~. Phone 7"6~ -3t>~S.
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
[nspectioll Request: 726-3769
3.
A.
Service Included
gun
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
. Over 600 Amps or 1000 Volts see "B" above.
D.
$ 50,00
$ 69.00
$100.00
E.
$ 43.00
Cl'ivlI\ t) ti t\N
PumPi9r~i[ri~~~oBAY PERIOD.
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Conunercial
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
'~!Ia
4.
Sf).d)
3.5"0
6'.00
5<6.50
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drivc(T:)lBuilding FormslEleclrical Permit Application 1.o3.doc
Status
Issued .
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-00107
ISSUED: 01127/2005
APPLIED: 01127/2005
EXPIRES: 07/27/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5711 E ST
ASSESSOR'S PARCEL NO.: 1702331403900
Springfield TYPE OF WORK: Electrical Work Only
. '.
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Reconnect Only
Owner:
Address:
WOOD DONALD PAUL
5711 EST
SPRINGFIELD OR 97478
ATTENTION: cpmate~lrequiretJ yell-ft965
fO~/?W ~u/es adopted by the Oregon Utility
NotifIcatIon Center. Those rules are set forth
In r'I," n "r'" ^nl f)'';l .
-. ] u,_ ~U V 13 L111UUYII VAN ~b;C-UU1-
I CONTRACTOR INFO~Rfio~..may obtain copies of the rules by .
...~lIl1ll:ff1e center. (Note: the telephone
Contractor ~ for t~fitMtlniJDa~6'JotHhQMn
EUGENE ELECTRIC SERVICE INC 90200 Center is 6~OOtoo!-2344)541-344-3561
I BUILDING INFORMATION I
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building: NOrlC[q/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
11 un ........--_.. h_
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFO~;mQ~,'.j~~ ul1f-\LL tXfJlRE IF THE WORK
COMMENCED ~~DI~~1~~Qi1JiREDSP~JUNG
Overlay Dist:.. ANY 180 DAY PERIOD ~Pa~ED FOR
. # Street Trees Rqd: . Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Dr~ins:
Notes:
I Valuation Description l
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
.541-726-3769Inspection'Line
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Total Amount Paid
Total Value of Project
LFees Paid I
Amount Paid
$5.00
$3.50
$50.00
$58.50
I Plan Reviews I
Date Paid
1/27/05
1/27/05
1/27/05
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00107
ISSUED: 01127/2005
APPLIED: 0112712005
EXPIRES: 07/27/2005
VALUE:
Receipt Number
2200500000000000101
2200500000000000101
2200500000000000101
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..~eauired Insoections I
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 dohereby certify that all
information hereon is true and correct, and Ifurther 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
Pa2e 2 of2
Date
275 Fifth Street
~Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2005-00 1 07
COM2005-00 1 07
COM2005-00 1 07
Payments:
Type of Payment
CreditCard
1/27/2005
RECEIPT #:
Description
Service Reconnect
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
EUGENE ELECTRIC
City of Springfield Official Receipt
lelopment Services Department
Public Works Department
2200500000000000101
Date: 01/27/2005
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 027282 In Person
Payment Total:
Page 1 of 1
9:07:04AM
Amount Due
50.00
3.50
5.00
$58.50
Amount Paid
$58.50
$58.50