HomeMy WebLinkAboutPermit Electrical 2004-1-2
.' Tl)!> fnllnwinl'{Pfol8ct as submitted has the following
225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX~",M~7Jtfu-m't~ not require specific land use
ELECTRICAL PERMIT APPLICATION a[Jprova\ J...7)tL-
City Job Numberc..OW1 ZOOLf - O(!)OO 7 Date I,.... Z ,.... 0 f(' Zoning _
'Date /pf. -..5 - 03 \
3. CO~MPLETE FEE~~~lf.!1.11g,~\J}.t7LOll1 ~e-J
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50,00
OWNER INSTALLATION Limited Energy/Residential $ 25.00
The installation is being made on property lawn which Limited Energy/Commercial R\\ $ 45.00
is not intended for sale, lease or rent. N01\~imYJll..:ElJ\'\!t!{RaUi\n 1~Jt\$1~~MiS $45.00 + Surcharges
1\1\S PERM\ \ ~n C:~A~~~~RM\\
Owners Signature: f\\..l1\1dR\2ity~'FS~~~OR) D
MENCED OR \S
COM ?fA.~tii~\$\GDrarge
AN\{ 180 Uf'
10% Administrative Fee
1.
LOCATION OF INSTALLATION
OIL\OL-t
332-0
LEGAL DESCRIPTION
/703 ZZl 2
JOB DESCRIPTION
I2EP/.kqr S6a-VL~ I/Yl~ +-
I
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
D3300
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor bel ( ( ) zj e{l.J!? ,'(,.,1
Address I 0 . I) tJY ,) ~- '70 '7
.;
City {u G,e.tllf
o
Phone 9,"15-~
, - }7:ft/
~ IJf-5
Supervisor License Number
/IJ - oL1
Constr. Contf. Number I O'l f /., l.f
, - .
J ./ /)<'
,
Expiration Date
Expiration Date
Signature of Supervising Electrician
!')
/,: 1)._ 1/ f),1
V ~ ~-^~fI1".
Owners Name ~--=t'L-~ ~~ a /1 l' 0 /' ~s
I {_
Address .3"3 2-D O~Ot.-&> 'S"
City 5~ e~
Phone
Inspection Request: 726-3769
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:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
~--o
C. Temporary .Services or Feeders
Installation, Alteration or Relocation
200 Amps or less \0- $ 50.00
'\IU~
201 Amps to 400 Amps q\l\{6S J U\\\\\.'J, $ 69.00
401 Amps to 6Q~t\.~ {eO{e90~~ taf\. $100.00
",to...\.Q{eg ~e ~~.. - .
, ~"O'OOO'~ ~0~'9 '{Q\0~~{'. .;,~.\
JX\! lbol:l: ~ ,. ~OS ~O~,., .\6$ \
,~B~ {Ul'Hn.cll ~UIU'k~O\lgP ,.. '\"8 {\.it,..
\0\ -",t\OO ca 1\0'\0\.\0 \A! g~o"e
-\o\\\\\fWW~'\tMj ~~~QQ'r{l\~\~::\i\t MO"
\'\ O~.J @r~'l o'Of! 'C. ~t-\o\e" " ~o\\\\ca: $ 43,00
009Q;a?~~i6RJi'~i~i'O~\J,'\~%344).
~Wl~ ~bf~W~~313~ $ 3.00
be{' \5'\ ;.t:jV'"
n\ltD. apt'\,~f.. . .'.
E. Miscellaneous (ServIce/feeder not mcluded) -Each InstallatIon
TOTAL
~o
3)
)O.::J
S-B-~
Shared Drive(T: )/Building Fonns/Elecltical Pcnnit Application 1-03,doc
J
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: COM2004-00007
ISSUED: 0110212004
APPLIED: 01102/2004
EXPIRES: 07/02/2004
VALUE:
SITE ADDRESS: 3320 ORIOLE ST
o
ASSESSOR'S PARCEL NO.: 1703221203300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Replace service mast
Owner: GEORGE CHAPOGAS
Address: 411 CHERRY DR EUGENE OR 97401
Contractor Type
Electrical
I CONTRACTOR INFORMATION I
Contractor
PHANTOM INC
Phone
541-935-2154
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
License
109864
BUILDING INFORMATION I
Expiration Date
0111412005
# of Stories: Lot Size:
R-3 Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Fd!JU to
VN Water Type: on\~~~~e ' t\\\W
Range Type:A1\E.Nl\ON:Oret~d b~titG1:ftQ~e sA{QM\'
Energy Path. VII ru\eS adOP lho~8 t\!l\efhW. Q~2-00'
to\\O . ceoter. TmDl~trv@d\~1fi"fa~~ A{ea:
'I"\tif~C!'~~~_;,e 1 nn1? thWO,:-~ s~ .n~ rUleS-
I DEVELOPMENT I}','~'t\J~x;:rWbtaln c~re: the te\e~hO~e
, 'J\)~v.. - the center. {N Ut\\\t~~~OPARKING
Overlay Dist: c:~;r tor the.or~~~~_332.-~A.1~'
# Street Trees RlPd: ' ,...r.....~.. ,0::: '\ , Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage:
NOlttE PUBLIC IMPR .V- ORK
1\1IS PERMI ~Nt-'.DER 1\1IS PERM\1 \ NOlidewalk Type:
1'\10RIZED U ONtO fOR
I\U, NCtD OR IS I\BI\NO Downspouts/Drains:
COMME 0
I\N'i "\ 80 Ol\'i PtRIO .
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Value
Date Calculated
Total Value of Project
Pal!e 1 of 2
Status
Issued
225 Fifth 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
I Fees Paid'
Amount Paid
$5.00
$3.50
$50.00
$58.50
I Plan Reviews I
Date Paid
1/2/04
1/2/04
1/2/04
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00007
ISSUED: 01102/2004
APPLIED: 01102/2004
EXPIRES: 07/02/2004
VALUE:
Receipt Number
1200400000000000002
1200400000000000002
1200400000000000002
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
Pal!e 2 of 2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00007
COM2004-00007
COM2004-00007
Payments:
Type of Payment
CreditCard
,;.>
Receipt #: 1200400000000000002
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
PAUL VERMILYEA
Received By
djb
Check Number
Batch Number Authorization Number
000265 037903
City of Springfield Official Receipt
Development Services Department
Public Works Department-
Date: 0110212004 '
10:55:05AM
Amount Paid
Item Total:
3,50
5,00
50.00
$58.50
How Received
In Person
Payment Total:
Amount Paid
$58.50
$58.50