HomeMy WebLinkAboutPermit Electrical 2003-5-20 (2)
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CotM Zoo J - 6> 0 J j. '1 Date 5 - 2 0 - 0.3
1 I EOCtf.q'cJON'OF INSfi'~Btfj;I(jJNfr~ ,:,~ ?'r~;;~1
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~.~ 45'15 DAI~t.(
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A. ~~~J.8~~lq~~Ji~t;~'}~ingf~~r,M~lti"Fam.i1Y per dwelling unit.
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Service Included
LEGAL DESCRIPTION
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JOB DESCRIPTION k'e-- W/~t.:
(.) /I ff1 /It-t?b t2 i?1 S
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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
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50.00
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B. l,;:~~~v;i.c~,~'~~:r:i;f;~~tJ~!l,J~~~,lI~ti,2\~' AI~er~tions or Relocation:.
t''''<<'<'<f<M'''''''''''''''''''' . '''W''~:''. L .
L ,j,{. A1d~te(S t?lec.r
Electrical Contractor
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Am-ps
'V.U-,.
Over 1000 Ampsty,oltstlCt
Reconnect Only -'tuttiS PflT. :
l' "~' ." CfjiJt;.;,~/;!{Jlil!!$};-8blA
c. ,mel.nno'rar~S~(;Yji1~1l9l(md~t.S11II '.1'".
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100 '(f;-~ % PIRt
Installation, Alteratio~r}Rpi.fifl1JOJI:/iIS PEt r/it
200 Amps or less " RIOL{ r.l/Nf)(}/lJ5f$.()9'1.!!J2a.~
20 I Amps to 400 Amps $"f9190 I,) No;'
401 Amps to 600 Amps $100.0~1i .
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50,00
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Address
Phone 7 f 7 ~ 0 r-I (
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City
SO?)'-~
Supervisor License Number
/0-04-
O/~3<iS
Cr- f- 05
Expiration Date
Constr. Contr. Number
Expiration Date
Over 600 Amps or 1000 Volts see "B" above.
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D.=ilcIH,@ircuit
Signature of Supervising Electrician
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Owners Name t::'a.1.A\ 1"7
~ew Alteration or Extension Per Panel
.f' 0' ;'C. . I $ 4300
'0/ . ne, 'lrCUlt .
.IVOI1/;EachJaCHtional Circuit or with ~
I __ '\. :'1} OLi.Jetvic~'%-rcf,~~cteJ:~gennit ") $ 3.00
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5' L( C. .ED '.;'. . .' ce; e er.notm'i'CIUlIed)> Each]'Dstallation
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. "~6 '{) ~I} 'C:Jya;: '0 fA ~€l r. Ul'e t:'S j/j
&1't,pu1hp6-or iriigationtolJ. lI/€ls '{)O" I 0" In $ 50.00
C ~~~O~UrneQ!:ktin .fJhO iil'€l "'lilt 'I.. $ 50.00
191]~6U1..:. O~ V'v.O:l.-,~ ~!:\ Si,':' _"
L'(.':J~. d'E:'> oIR' 'dS' "".'1'7 $1:' (fo $ 2 00
lmlte 'neFgyesl entia ~ v:? '/"fft, 5.
v 1..0;''''' {h. "/€ll' .'6r. ~V
Limited EneroylCDotnmefCial 1I/~_}, $ 45.00
. '8~9. . 'Y I\Ii "'1)1) 0;;0:: 6r
Minimum Electric P~lrii\1!.g~e'cti~~(Fee'iS $45.00 + Surcharges' ",
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Address =? 0 55 Cr-
City ,tA.. v./$ h-- Phone
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
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7% State Surcharge - .
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application I-Q3.doc
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. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00339
ISSUED: 05/19/2003
APPLIED: 05/05/2003
EXPIRES: 11/21/2003
VALUE: $ 25,000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4595 DAISY ST
ASSESSOR'S PARCEL NO.: 1702324307400
Springfield TYPE OF WORK: Fire Damage
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Fire damage
Owner: EQUITY LIMITED PARTNERSHIP
Address: PO BOX 54 THURSTON OR 97482
I CONTRACTOR INFORMATION I
Contractor
WARRIOR CONSTRUCTION LLC
L H MORRIS ELECTRIC
EQUITY LIMITED PARTNERSHIP
J
I BUlL~FORMATIONI
# of Buildings: ~ '\'9\~~ies:
Primary Occupancy Group: R-3 ~~~ ~~~~bl Structure
Secondary Occupancy Group: U-l~ ~ ~ <\.@1e'ofHeat:
Primary Construction Type *'~'\~ ~\)""water Type:
Secondary Constructio~~\." CO ~ ~<o~ Range Type:
. # of Bedrooms: ~'\" ~~~\..\) ~ (J~ f:> ~\). Energy Path:
~~~c.:~{J~~,~<v\).1 q<V~ .
~~ ~~~\,~~ \)Y'" I DEVELOPMENT INFORMATION'
SETBACKS '-l tl..~-4.. '\ REQUIRED PARKING
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Front yard Setback: Overlay Dist: 0S ')0 ~~{F9tal:
Side 1 Setback: # Street Trees Rqd: eo..\j.'~ ~o(\ 'U \~~~icapped:
Side 2 Setback: Paved Drive Rqd: \ \'Q.~ '\ e O~e ~e s0,<:;'Q.rnpact:
9P' ",\ \~ eS ~ 9J~(; 'Q ·
% of Lot Coverag~.0\0 00'0., 0 ~\j." O~~ ~\j.vaS
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I PUBLIC IMfi~N'EM'~Nis'I'()()~i,(\ co~~.\~e "~o\"'V-
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.Contractor Type
General
Electrical
Owner
License
150837
01838
Expiration Date
04/21/2005
06/08/2005
Phone
541-729-8824
541-747-0811
Lot Size:
SqFt 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Paee 1 of3
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. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00339
ISSUED: 05/19/2003
APPLIED: 05/05/2003
EXPIRES: 11/21/2003
VALUE: $ 25,000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriution I
Description
Tvpe of Construction
$ Per Sq Ft
Square Footaee
Value
Date Calculated
Total Value of Project
~
Fee Description Amount Paid Date Paid Receipt Number
-Mechanical Issuance Fee- $10.00 5/19/03 1200200000000001232
+ 10% Administrative Fee $26.94 5/19/03 1200200000000001232
+ 7% State Surcharge $18.86 5/19/03 1200200000000001232
Building Permit $224.40 5/19/03 1200200000000001232
Minimum/Adjustment Mechanical $33.00 5/19/03 1200200000000001232
Vent Fan $12.00 5/19/03 1200200000000001232
+ 10% Administrative Fee $5.20 5/21/03 1200200000000001273
+ 7% State Surcharge $3.64 5/21/03 1200200000000001273
Add, Alter, Extend Circ $43.00 5/21/03 1200200000000001273
Add, Alter, Extend Circ Ea Add $9.00 5/21/03 1200200000000001273
Total Amount Paid $386.04
Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
willbe made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
1 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
2 Ceiling Insulation: Prior to cover.
3 Drywall: Prior to taping.
4 Final Building: After all required inspections have been requested and approved and the building is complete.
5 Rough Mechanical: Prior to Cover
6 Final Mechanical: When all mechanical work is complete.
7 Rough Electric: Prior to Cover
8 Final Electric: When all electrical work is complete.
Paee 2 of3
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. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00339
ISSUED: 05/19/2003
APPLIED: 05/05/2003
EXPIRES: 11/21/2003
VALUE: $ 25~000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 ofany 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
I . 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
Date
Pae:e 3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt .~
-
~I
Receipt #: 1200200000000001273
Date: OS/21/2003
Job/Journal Number
COM2003-00339
COM2003-00339.
COM2003-00339
COM2003-00339
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Item Total:
Amount Paid
43.00
9.00
3.64
5.20
$60.84
Payments:
Type of Payment
Check
60.84
$60.84
.
Paid By
Received By
djb
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
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5/21/2003
8:18:43AM
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