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HomeMy WebLinkAboutPermit Electrical 2005-6-20 zoning; and does not requirLP..L)~d use g S'i"r;;;n:'A;fF,z;:u..D , r--- (f}/~OI(jJ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (540726-3689 /1.I/~, . < f,dnonzed Signature I U I /;":;;'j\,,, ELECTRICAL PERMIT APPLICATION / / mr> ;;<S;'PJ City Job Number COtA-('t.Oos--eo7S"", Date c:'/zo/Or '-A./r I I 1. ,LOCATION OF INSTALLATION 3. COMPLETE FEE SCHEDlILE BELOlV 0960 ~397D ;lo..~d~ IS.,. R.d LEGAL DESCRIPTION (702. I c,t(( 00 ~OO 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN oils Reconnect Only ..., "lmqq~~~~~~O .......,~ r..tdN~ ,are>>pa.1.' sea~ \!I~\it1}rs ?, I L ,J\~ .1'1 ,t,; Gdnptstt bV {he set forth f,.\;.HO.','N \:~l8,~ ~~tJali. foQf~U\iu. s.are~lli4...1. tion "",,~,'I':('n Cerv:w . \1rougfiu1ffi~~ l~~~~'\;;~'~:'P:C~l1frOOd. ~ psto~ ll~~~ 01 tne rules b ~ $ 50.00 :n \'.:1 II ",,,~ fqZltl~tEIP~~~~~ritJltV"110i1e $ 69.00 ;'&J~' ..""~ '~o... i.t1~i ~ , ~ ~s.i\inn t!\\~~~~~r~{jsfi~~ot\hcatloH $100.00 r.urn'''13!;Gb~ef~~~~teM~Olts see "B" above. ~~;'l~ra~ch Circuits ' JOB DESCRIPTION j2epla ce.. sr;v-"-"\ d~~e 70 j'~VVIC<2 Permits are non-transferable and expire if work is ,i' not started within 180 days of issuance or if work is Suspended for 180 days. CONTRACTOR INSTALLATION ONLY 2. Electrical Contractor Q"'7J...-d ~ Ie..~\ Address c.5'9 s <:/ /fa. ~ d -e. AI IS f" I?. cl City Jf -P I cL Phone ?II ~2.S96. Supervisor License Number 36-;;;</ 5' Expiration Date 9 - ~ - b ...., Constr. Contr. Number f/7' I..{ S Expiration Date II - /0 ~ 6C Signature of Supervising Electrician " ~Q~ Owners Name W / LL.. Address -:s 7 ~ 0 City S 'i> p- ~ 13 c>i v- /~cI~ ?:/L Phone OWNER INSTALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. A. New Residential- Single or Multi-Family per dwelling unit. 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 $106.00 $ 19.00 $50.00 B. Services or Feeders - Installation, Alterations or Relocation: I b3 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges . , ~ ~r!\{ < " _" ~~T-4;:~ -'StmtoiAL OF ABOVE ;~< \. '.. ~\. ; ,.,- "\.-' rh\ \_ t.t'-' \\ .::,.. '~'v 'l\i\.,.J \ ~ '_or, \ v\I~-. _- r'.\,,;-.~ . -\ fl\S ':'~~~~\:~ i\ U \~ \) 1..:.'(\ \ i I'U.. I \;~'\\l?PJ. SUt{e Surcharge \' \ ' \ ' " - \C' \ \, u . ;..\J \1 i' _' ;~"~0 0',\ u :\ -,-,,, 10% Administrative Fee CU\\\\\\U\;'u~\:\ ?b~\CJI). 726-3769\\\ '\ bU Dh I \l" Owners Signature: Inspection Request: b--;!> 'Il{( b'"Jo 737/ TOTAL Shared Drive(T:)lBuilding Forms/Electrical Permit Application I-03.doc CITY OF SPRINGFIELD Buildin'glCombination Permit Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2005-00759 ISSUED:. 06/20/2005 APPLIED: 06/20/2005 EXPIRES: 12/20/2005 VALUE: SITE ADDRESS: 3960 HAYDEN BRIDGE RD ASSESSOR'S PARCEL NO.: 1702194100800 Springfield TYPE OF Electrical Work Only PROJECT DESCRIPTION: , Replace storm damage to service TYPE OF USE: Repair Residential . Owner: ~ Address: WILLARD BOHRER 3960 HAYDEN BRIDGE RD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION. Contractor Type Electrical Contractor G MILLER ENTERPRISES INC Licens e 87145 I BUILDING INFORMATIONI # of Units: # of Stories: Primary Occupancy Group: R-3 Height of you to Secondary Occupancy A.TTENTION: Oregon~I%'it~": Utility Yrimary Constructio? TYP1~\IOW ruYE!l adopted t)ft!t&<1s;Grset forth Secondary Construction .t. t'on Cente[ ThBlagYl"P\f. 2 001 Notl lea' . ...~...b ~-^D. 95 - . # of Bedrooms: R 952-001-001 0 tp.wuu~.JC.8l1U b In QA btain ij~idmlOi the rules Y n/a nnQn You may 0 ... l... :1':'3 +i1ophnne ;.; calling the ~_.""'II\l\TION I number tor t -23 ). ' Center is 1-800-332 " Overlay Dist: , # Street Trees Paved Drive Rqd: % of Lot Coverage: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Phone Number: 541- Expiration Date 11/10/2006 Phone 541-741-2596 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Street Storm Sewer Available: Special Instruction: NOTICE: IPUBLIC IMPROVEMENTS I THIS PERMIT SHALL EXPIRE IF THE WORKSidewalk Type: AUTHORIZED UNDER THIS PERMIT IS NOtDownspoutslDrain~ COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Notes: I Valuation Description I Description $PerSqFt or multiplier Square Footage or Bid Amount Type of Construction 1 of 2 Value Date Calculated Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00759 ISSUED: 06/20/2005 APPLIED: 06/20/2005 EXPIRES: 12/2012005 VALUE: Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6.30 $4.41 $63.00 6/20/05 6/20/05 6/20/05 Receipt Number 1200500000000000865 1200500000000000865 1200500000000000865 Total Amount $73.71 I Plan Reviews, 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. 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 certity 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 wiD be made of any structure without permission of the Community Services Division, Building Safety. I further certity that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I 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 wiD remain on the site at all times during construction. Owner or Contractors Signature Date 2 of 2 '/ '= ~. t 2~5 Fifth Street S'luingfjeld, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt )evelopment Services Department Public Works Department : Job/Journal Number Ii COM2005-00759 ~ COM2005-00759 '::c c;pM2005-00759 Payments: Type of Payment CreditCard ':~ f.-,' " " i 4 4, . ~j~ t, ; < , rr :~ , ! , " ~ ~. ,1; ~~ ~ ~ ~i Ft~ .: , i f': ~ f 6/20/2005 RECEIPT #: 1200500000000000865 Date: 06/20/2005 Description + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Paid By G MILLER ENT Item Total: Check Number Authorization Received By Batch Number Number How Received djb 117111 In Person Payment Total: 1 of I 9:17:13AM Amount Due 4.41 6.30 63.00 $73.71 Amount Paid $73.71 . $73.71