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Home My WebLink AboutPermit Electrical 2005-4-14 (2) . I.' . 'o~, ~o ' It; 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541g26~368'~/"'O~i.r':' ELEt;l.KlCAL PERMIT APPLICATION -<f. 'l',& ~ . "\ ^'~' I 1"71 U' -- V/~ ~~. -'0 "'oS' City Job Number LOiM "Z.-oO r- -00'1 '" Date/-/4 - 0 ') . ,o?~ ~ v"'& oS'vo . &0' ~ 9v.l ,,>>/~ 3. [:t9MeT-;Fik ti;j;;Sf;1jtp~;~):tQ~/", S~:~i1~,~,~'~, :," .:1 'v, ~~"/. '?, ;/"~ C' ~ &" '\. ,',' l'~ ,'l'"", o~ A. s~~!::;rlk~l~gl;;~i:M~I#~~~~'P.~~~.:tl> 1000 sq. ft. or less $10 . Each additional 500 sq. ft. or portion thereof 1. t::io, CATIONOE:JN.,'" 'sfi:).l,i,4.TI,@N:i"'~~S;J;" ~., ".Y ~'.',.. j,~+" .:ul:..: ':.l:>,~ '>!:'fL~;,~,!' ~". ,-,: .,' ~,,,,,,'<-,,_1"Y" " .;,;;;,~K,'-':~'< Y(,7 ')'~Al~'i f LEGAL DESCRIPTION ''70(. 3'2- L~ ~ o D /0 ( JOB DESCRIPTION Q.eLO c:.~ T(::- ZOV;4v'A f/ PA-l\IeL Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. f~~(jNi7RAqiQR,"':~IN$T.JlrJ'r:iTr10N;Q1Vti'~~,. 2. t<:~;'" '." ',.. ",;f""$;,.:. ..!o\M';.:--'v.,' . ,J,.'-'~'!""'l' '\:,.""",t,~--!.-,, ..F~I,~ ,fij , ' Electrical Contractor ~ r 1'\\ r 04-1' ~ Address <6<1QlJco ']::).au ~ ~ 0_ City ~ 1'1f !t\ 0_, Phone 105~-oqD..s:. L<:::\ hg .s I 0 J I I aOO'l I Constr. Contr. Number ~31 q I '2,D \~~~ Supervisor License Number Expiration Date Expiration Date Signature of Supervising Electrician ~'d .L'~ Owners Name clt ",,^,le-s.. 12,,)e?{)-<\- +So-- Address .-Jd..67 S- oA-( s.. 7' City ~ ~F 1\ Phone '7'17- 20\7- OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B. ~j~'~~i5~~'~~;~~~~~~t~~!~~~~i'!~ii6~~ 'A.it~;aii~ns:~r"~elo~~tj~~:' 'j b~ 200 Amps or less I $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 Amps/V!Ortl:NTlO $375.00 Reconnect OnJlol!ow rut N: Or"'r-_ . $ 50.00 .Notifin 1_ es ado .;3";'.1 law fi ! c. ~ft~fuP,~~~~'~~~)Ii$'~~'~~Ydu' ,q .<J o. You ~0010 e rUles fI Utility Installation, Alt~~"~,}1Jf*:~~to~9h OA~e Set fOrth 200 Amps of1M~ber for center. -{AI p/es$)~qJ9~ 952-001_ 201 Amps to 400 Ar&Jnt~h~ OreoonOU}h$ p8,gorU'es b!! 401 Amps to 600 Amps r IS 1 ~8Q(J , l"ty$lJjB9,:l1hontfJ a~~:>.~ A It/CallQ Over 600 Amps or 1000 Volts see "B" above:-4J. '1 ' D. i~B":irich:"Gij:'~~it;"~,,:,;<,,;.":,,"<" "'. ' "-,' ,~..,. .,1 ~''''''' .. ...~:..~. ,:h-.' ".,~.. .......'th'c:;."..." _," " "-J'"~ ~ ':"'.~.~ ._. __' .{:" " New Alteration or Extension Per,Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. tlMii~~J!~ii~~.~~~(~~ryit~i~~;.~e:~.~~i'in~J.u<l,ed) ~Ea()h '[lls.tana!~~n I PNOTI.r.r:.. $5 ump or Imgation 0.00 si~b'btfi~eSllii~iitiflgJALL EXPIRF 11= TJ.lr: $/50.00f AIITu[lRI7!:r-, I '~Inr.r:- I ~,t1t\ Limited'Energyi'Resiiienrii1l THIS PERMIT 1~25!00: Lr.[lM~E~I=~lrl;',p flD Ie'. "IBANDON[:D r'($C-~~""OOI Imlteu nergy,\!;.ommeFCla t: 1"'\.;-;,5. ANY 1 RQ [lAY p.~Rlnn . I Minimum ElectriC PermIt'lnspectlon Fee is $45.00 + Surcharges ~~~I\;.'t:' :,~.... ..k",'ll~:- -,,:~_jJ'h'- ,;.",~ :,.,.,.:. ~i '..Jf~ ,,1"1 " " ,"" ,,-, I 4. '\~t.~T.~~~~B~~'~~n!::~/. "::;:"~:': " ,',o' 7% State Surcharge 10% Administrative Fee, 6) l.( 'I ( 630_ 7 '3 '?!- TOTAL Shared prive(T:)/Building FormslElectrical Permit Applicalion I-03.doc $R!INGRIII1!.~.f ' _ ~.-...~. .,...'.;"O'h"""'!ll..,.... _, _ I .~-r_ _H' ...,...._"" ..' . _" __ '" ~ ; l . I ! 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: COM2005-00421 ISSUED: 04/14/2005 APPLIED: 04/14/2005 EXPIRES: 10/14/2005 VALUE: SITE ADDRESS: 4675 DAISY ST ASSESSOR'S PARCEL NO.: 1702324308101 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Relocate 200amp panel Owner: CHARLES ROBERTSON Address: 4675 DAISY SPRINGFIELD OR 97477 Contractor Type Electrical Phone Number: 541-747-2052 I CONTRACTOR INFORMATION I Contractor ROSE CORPORATION Phone 541-686-0905 # of Units: . Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 VN Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction License 54431 Expiration Date 09/30/2005 BUlL TION . w requires you to It ~?~?cWiw!es adopted by the Oregon&l~: l'f6iI~&fU}t@r. Those rules areSq3FfdJthFloor: lfil~001-001 0 through OAR 5Q;FO~d Floor: ag.. ir'fI)ernay obtain copies of the ~gll)s ~ement: Ran~iI1wij;e center. (Note: the tele~~dthParage/Carport E.ru;~tfor the Oregon Utility NotitfuhgbHther: Sprinkled<JlJJ.imjpg; 1-80D-33'.!tJE344). Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: . I PUBLIC IM.r~~y.EMENTS I K LL EY~lliE I~HE WaR THIS PERMIT SHA Sidewa !\Ipe~ NOT ZED UNDER THIS PtK IiI I\J AUT H 0 R \ DownsnoutslIlrains: COMMENCED OR IS ABMI~U\.."f~I-'" 'r'..... ANY 180 DAY PERIOD. I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pae:e 1 of 2 ., . _~A~~~J;I~!J?I' " ..~",., \~" I J, .1~' . . CITY OF SPRINGFIELD'- Building/Combination Permit PERMIT NO: COM2005-00421 ISSUED: 04/14/2005 APPLIED: 04/14/2005 EXPIRES: 10/14/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees...-Paid.l .. 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 4/14/05 4/14/05 4/14/05 Receipt Number 2200500000000000432 2200500000000000432 2200500000000000432 Total Amount Paid $73.71 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. I Re~ I~ecti.onsJ ": 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 ofthe 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 Date '" Paee 2 of2 225 Fifth Street Spr~ngfield, Oregon 97477 541-726-3759 Phone . Jlfy of Springfield Official Receipt ~elopment Services Department Public Works Department RECEIPT #: 2200500000000000432 Date: 04/14/2005 lO:23:02AM Job/Journal Number COM2005-00421 COM2005-00421 COM2005-00421 Description + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Payments: Type of Payment Paid By CreditCard ROSE CORP Item Total: Check Number Authorization Received By Batch Number Number How Received djb 014466 In Person Payment Total: Amount Due 4.41 6.30 63.00 $73.71 Amount Paid ' $73.71 $73.71 ." " :' 4/14/2005 Page 1 of 1