HomeMy WebLinkAboutPermit Electrical 2004-5-24
t as submitted has the following
ot require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(54~)726.3753 · FAX: (541)7~TJR~9
ELECTRlCA.{r PERMIT APPLICATION Date'
City Job Number ~~. {f)lc;(1,cJDate Authorized Signature
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LEGAL DESCRIPTION
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J?B DESCRIPTION '
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A.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$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 fo.r 180 days.
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
-f5F;;;~T7,,;,:.~,?;i)';'~:-\.. :'~,~:!<:~:<- "'- -:': ~,w:,'-:' >- - T', {",t::-{':;j-<?,;;C;_' >'/f;':l';,\~\,~;," ;":41 _>f""?'~: ','}-L)H:-::-.':_'.>.<~7,,":1
2 ':PQWR4C1'PRWST4J,Ef1,TI{iN;P1;fLX..'> B.
. \;;.....;2X..A.."'...c;....:;l!:Gc.@;..;...:.n:.'''.>~u~'''::.."::!'~..'&~.1,M!:!,..:i0...i:::l,.; ,
Electncal Contractor {t:Jf)5 &f!LflI e,R. 200 Amps or less
Address jJ() PYJ ~ 28'2-1 ~~~ ::: ~: :~~ :::
~ r>~Jr J n' /.. 0/ dJ/f/ Arr. 601 Amps to 1000 Amps
City 't:LftU ~- Phone. t:ZY7/::;;-Q., fOllOW ~cJ01JJ?9:fi~lsN olts
U tJOtificat~b~ law f'eqUlfi
Supervisor License Number 'f 71.(t;S ~~~u
I/'..- /Ir ~ / / CalJing ,;:ay O?J~,.~oughlJ/t~a Set (Of/h
Expiration Date / / / l/ L-- :7. number f~ ~fer. I~OI ~'i Of the ~BB 1.
IP{') / --J ~ C ~ sse: the tal rUles t}
Constr. Contr. Number :;;1. (?"JC 101 &f1l~~'f~~t.JJ~tvo:~hon~
r/_ /. // _-A r:- 401 Amps to ~~). "cation
Expiration Date ,"><\' ~t () I Over 600 or 1000 Volts see "B" above.
D.
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
$ 50.00
$ 69.00
$100.00
Signature of Supervising Electrician
~?--- ~
Owners Name ~ Q.rl E\n1 mJ 1 j
Address ~~ ry\ryJCLChf\ E.
City ~~\_\(!J(:1iJdPhone ,
. ,-"', :.. _. Sign/Outline Lighting $ 50.00
OWNER INSTALL~. nON . '. -" Limited EnergyIResidential $ 25.00
The installation is being made o;leWt~m~~ Limited Energy/Commercial $ 45.00
is not int'nded for sale, lease or A'thHORIZEO U N O~~ ~~~I,:~~.::~;~~~e~~~:urCharges
Owners Signature: COMMENCED OR IS ABANOOi~ti)f.lJPJ:,'()FAnO-v.E"'; . .' .... .. '. ~ (f)
ANY 180 DAY PERIOD. 7% St:~:~~~:~;;:"";;""''';"k'''''' ..... '5: l CS
~: 1/6"& '01\ 1 10% Administrative Fee L\.~
. OJ;'ectinn Reqnest: 726-3769 TOTAL ~ ti · Ld.S
New Alteration or Extension Per Panel
One Circuit I
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
4~.W
$ 3.00
Pump or irrigation
$ 50,00
Shared Drive(T:)/Building Fonns/Electrical Pennit Application l-03.doc
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2004-00606
ISSUED: OS/21/2004
APPLIED: OS/21/2004
EXPIRES: 11/21/2004
VALUE:
~~
,
I
n
lY~
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2735 MAlA LP
ASSESSOR'S PARCEL NO.: 1703251406600
Sl?ringfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
PROJECT DESCRIPTION: Add one circuit
Owner: BRAMLEY DONALD E TE
Address: 2735 MAlA LOOP SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION.
Contractor Type
Electrical
Contractor
ROBS ELECTRIC INC
License
156678
I BUILDING INFORMATION I
ATTENTION: Oregon law requires you to
# ~f Units: follow rules adopted byth~ ~W'I Utility
Primary Occupancy Gry--y.8iification Center. Thos~ ~~~Mf~th
Se~ondary Occupa?cy G;o~R 952-001-0010 thrabHlf efAilfgS2-001-
Primary ConstructIo? 1\?1l~~ 'Vi u ma obtain co~eofTh07ules by
Secondary Construction l.fYP~:. 0 y 'K~M~~I~B.ehone
# of Bedrooms: calling the center. (~Oi~~n; ~~: .
number for the Oregon ~~iJ.\w1 ~1Wfiff~Rt~: n/a
r.AntAr i~ 1-800-332-2344\. .
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Addition
Residential
Expiration Date
08/14/2005
Phone
541-686-5444
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:
I PUBLIC IMPROVEMENTS I
NOTI~ewalk Type:
THIS Pfi~lp~~:iXJ?IRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD,
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description I
Description .
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Total Value of Project
Pae:e 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
I Fees Paid.
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/ Adj ustment Electrical
Amount Paid
Date Paid
$4.50
$3.15
$43.00
$2.00
5/21/04
5/21104
5/21/04
5/21/04
Total Amount Paid
$52.65
I Plan Reviews I
CITY OF SPRINGFIELD'
. Building/Combination Permit
PERMIT NO: COM2004-00606
ISSUED: OS/21/2004
APPLIED: . OS/21/2004
EXPIRES: 11/21/2004
VALUE:
Receipt Number
2200400000000000628
2200400000000000628
2200400000000000628
2200400000000000628
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 ,
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
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 Eifth Street
. Springfield, Oregon 97477 .
541-726-3759 Phone
~~ty of Springfield Official Receipt
_~evelopment Services Department
Public Works Department
RECEIPT #:
2200400000000000628
Date: OS/21/2004
2:36:16PM
Job/Journal Number
COM2004-00606
COM2004-00606
COM2004-00606
COM2004-00606
Description
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard ROBS ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
llh 00390 021609 Phone
Payment Total:
Amount.Due
43.00
2.00
3.15
4.50
$52.65
Amount Paid
$52.65
$52.65 .
5/21/2004
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