HomeMy WebLinkAboutPermit Electrical 2003-6-10
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-c~!i~~ubrnitted h~~\ct land use
. 9 prole ' . speC\I
ELECTRICAL PERMIT APPLICA. TION lhetol\OW\~ does not requIre -.-.i?
4 . . if zoning, an jj.Jl'-
CIty Job Number /j)YYld{l)()~ - DOt.i1o. Date aoproval. . /O.~
.. ZonIng" '0 :.,I
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~.f\ (>:. . r:\r.-\I '-.~l'-'" ~ t.,....... ....'~l~~.\,j~,1 ~.' 1:.-"'"
; /' It f.l~<:\' '\(J'~ ,', ,.~""., !\,~..::,v-;. ..' ,\"....:.;~..: .,"
...((/Ylf(L{t -.I~200Amps"o,l)\tfS~j'li.",..\ "~:\\\~'V' ..1..' $63.00
I .'"'\,)01..,.... r~~r:",..C~"....._...'
20'l'Airips,to.40.o~Amps~ n "f.r:-' .'. /' $ 75.00
4'61'~J'p"s:~~;'60.0An{p'r.r: ,-,', . . $125.00
,......-.' .
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts $375.00
Reconnect Only $ 50.00
1. 3.
:J7SJ rna./'a..... Coo!)
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LEGAL DESCRIPTION
\'lD3~~ (lo~
JOB DESCRIPTION
J.!C,q-r P ~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
2.
Electrical Contractor
k y G;{e.d.IGtL
Address O. () , (b ox. :J- tfc; J 3
City
GUf~
bcf6 -~J..J~
Phone
Supervisor License Number 3 Lj<97S
Expiration Date / 0,// /(J c,/
Constr. Contr. Number 7 n r?"" c17
Expiration Date / ;;L i 7 0/ () V
/ I
Signature of Supervising Electrician
<-- ~ /jit/
, \
Owners Name G A.-4 (0 f-...r/J
Address d 7 S'3 (Y) 4...-/ a )
City S; j e L) Phone
OWNER INSTALLA nON
leA.rU.4P ~
It
Lool?
II
?Cf7- 5d7/
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof .
. eL!\JII":::" ..'f':. .....
Each Manuf<;lcCcH:Ig01e20.:rJ: O' '.>gOIl \,':.:". ':'
d .1' :rl.\'\....1~'oJ'" .' ''-'0 r..... '. ..
j\.-Mp .u ar'VWellll).g.Sem:or.e\0f ,"_1 S:0:.'
V", ,.-. adUp,I;:;V''''T.. \ ,,, (.' ~...!., . .
.F,.eed~!i\eS . -'-h050 \\.\ "d '" .,..;. ;_
/to\\u\J" ~..,~'{:-~~"'~ .\.j ,.f'-'I'\"....
$106.00
$ 19.00
$50.00
c.
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volts see "B" above.
D
fMrs 1=l~M\tp1g.tl{l!te~~RiItIP:lileE WOR K
~rH8~~ED U~DE.R THI.S PERMI! IS f\ID43.00
~~~ 6f{clSt. A'lfflNDONED FOR $ 3.00
A NY cfao61JAtfPEmYib.
E.
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
4.
'61)
t{5.
'~.lS
it/GO'
h d.(,1S
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T: )/Building FormslElectrical Permit Application 1-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00464
COM2003-00464
COM2003-00464
COM2003-00464
Payments:
Type of Payment
Check
6/6/2003
City of Springfi~ld_
Development Services Departmeh1:
Public Works Department \
Official Receipt.
Receipt #: 2200200000000000999
Date: 06/06/2003
Amount Paid
Item Total:
43.00
2.00
3.15
4.50
$52.65
Description
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By Received By
KS ELECTRIC & CONSULTANTS ddk
9:48:19AM
Check Number Confirm No
Amount Paid
How Received
In Person
Payment Total:
52.65
$52.65
Page I of I
cRcccipt.rpt
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2003-00464
ISSUED: 06/06/2003
APPLIED: 06/0612003
EXPIRES: 12/06/2003
VALUE:
225 Fifth Street, Springfield, OR
541-7i6-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2753 MAlA LP
ASSESSOR'S PARCEL NO.: 1703251406500
Springfield TYPE OF WORK: Heating System
Contractor Type
Electrical
Owner
Contractor
KS ELECTRIC
KAMPA GAYLORD G & ELLEN C
TYPE OF USE: New Residential
ATTENTION:Oregon iaw requites you m
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set TUfti
in OAR 952-001-0010 through OAR 952-00':
()()QO YOIl mav obtain copies of the rules b)
t"~lIin~ the center. (Note: the telepnone
I CONTRACTOR INFORMAJ.JQ.~'" for the Oregon Utility Notification
Ceo.!er is 1-800-332-2344).
License Expiration Date ';..;Phone
70889 12/30/2004 541-686-6236
PROJECT DESCRIPTION: Heat Pump
Owner: KAMPA GAYLORD G & ELLEN C
Address: PO BOX 313 SPRINGFIELD OR 97478
I BUILDING INFORMATION I
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPMENT INFORMATION.
REQUIRED PARKING
Overlay Dist: Total:
# Street TrMQiWE: . Handi~:meed:
Paved Dri'1Hl8~ERMIT SHALL EXPIRE IF Tij~~~J\
%ofLotd.~IZED UN.DER THIS PERMIT IS NOT /
COMMENCED O~ IS ABANDONED fOR
~Id\, ~ nQ 0:1,: rHU~~. /
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
Square Footae:e
Value
Date Calculated
Pae:e 1 of 2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2003-00464
ISSUED: 06/06/2003
APPLIED: 06/06/2003
EXPIRES: 12/06/2003
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
LFees Paid.
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
$4.50
$3.15
$43.00
$2.00
6/6/03
6/6/03
6/6/03
6/6/03
Receipt Number
2200200000000000999
2200200000000000999
2200200000000000999
2200200000000000999
Total Amount Paid
$52.65
I Plan Reviews I
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.
LReouired 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.
, I
Owner or Contractors Signature
Date
Pae:e 2 of 2