HomeMy WebLinkAboutPermit Electrical 2005-6-20
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (540726-3689 /1.I/~, .
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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
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.......,~ 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
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Owners Name W / LL..
Address -:s 7 ~ 0
City S 'i> p- ~
13 c>i v-
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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
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;~< \. '.. ~\. ; ,.,- "\.-' 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
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726-3769\\\ '\ bU Dh
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Owners Signature:
Inspection Request:
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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
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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