HomeMy WebLinkAboutPermit Electrical 2004-9-28
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225 I'll' IH STREET · SPRINGFIELD, OR 97477 .. PH:(541)726-3753 . FAX: (541)726-~8
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ELECTRlCAhPERMIT APPLICATION 0'0'.
City Job Number~fJ1 d!JD'-j - 01;;< 0/ Date 7/;;), :5);;) 07J ~ %<;>1~
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1. 'LQCAT.I6NOJJIfV8TAL-l1ATIQ~""."!f" 3. ';'rJlJMPLETEFEE}$t~i)UJ;E,Il
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LEGAL DESCRIPTION
1'703 -;;;;)7 3~ 0 d360
JOB DESCRIPTION
S;,Wu.d LI~5~JD __
Permits are non-transferable and expire if work is
not ,started within 180 days of issuance or if work is
Suspended for 180 days.
2.
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CONTRActQR IN$TALlA,TIONONLY
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Electrical Contractor ks .GI i!'" e?1-t.i ., Cm.ratf.
Address 0 (). 'Z C/)? ;) r y .3 .J
City ~J Phone foF 6 - 6;l J 6
;upervisor License Number 3 t/ q '7 S
Expiration Date / 0 // /6 ~
, (
Constr. Contr. Number 7 oJ= & 7
Expiration Date / ...2./ ..70/ /'.) y
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Owners Name V A I' t', 7 ~ ~, I' c-s tJ'\- v
Address ),.J II L:..&..Y1/M.. ~tI~
City ,\.,(&LC1 Phone .5~-V "-.P7:?~
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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:
Inspection Request: 726-3769
A. . '.~e~lt~~'~~~~l.=: S~ngle'~r.~~.ff~F~it
Service Included
1000 sq. ft. orJess
Each additiona1500 sq. ft. or
portion thereof $ 19.00
Each_lc;~~n faw requires you to
MorBftbw'rtH~8tff€cfbY the Oregon Uti~ 00
B.;;.r",.~mer. Those ~:_1i~g!ii[t;. .
200 Ao1tl~f)~I~ center. (Note: thEttele~~~oo ~ ~ _ OV
20 1 JtltfflJ~~l1orArnppregon Utfiny I.JOLlhCf~~o
401 Amps to ~J~ 1-800-3~)._ $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts $375.00
Reconnect Only $ 50.00
c.
Installation, Alteration or Relocation
200 ~lqr,.J~~ $ 50.00
201 ~\ls &:>'400 Amps $ 69.00
401 ~~~~HALL EXtJIHt It-I HiMtoW<
T ORIZ~~t~ r~~l . J? - IS NOT
}\tiipeff'\ .
New Alteration or Extension Per Panel
One Circuit $ 43.00
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
D.
E.
':7'_ :~.:::,' --0r::,:G';;~:-,:t\. : ,;.'r~;~2p,-- <,_i/\:~:~?::_:: ';:_ ,.': . iF.:::':~f- '<':.rv _7""<~.:.;~:'{":,' . ,~
. kCder'nQ't):mc;luded) .,,2E'achCfnstaHation~;
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Pump or inigation
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.
7% State Surcharge
10% Administrative Fee
'3 OD
o .
- L-t. Lfl
~ _ ,-<) 0
~13.7/
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 1-03.doc
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01201
ISSUED: 09/28/2004
APPLIED: 09/28/2004
EXPIRES: 03/28/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1511 LINDEN AVE
ASSESSOR'S PARCEL NO.: 1703273202300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Addition
Residential
PROJECT DESCRI~tr<iN'~'(s~~JR:es-gp'gr~1t~ requires you to
IfdllmD II1'.Jles adopted by the Oregon Utility
d\liCDlIllfill((;a!t1ur I \..Il::! Ilt::I, IIIU~t:: I Ult::~ a.1 t:: ,:)t::l iVI d I
Owner: 54C5LHAA~~IaA~1af1~JQ" throJ-l,Sh OAR952-7.001~
Address: \M~~fJ;P~ 'oBtfii?l'tot5~~f>tlh~IhJI%~B~
calling me CtHIlt::/. \1"Ult::.lllt:: It::lt::tJIIUIlt::
number for the Oregon ~(lJ@.NIlIRW~~wlNFORMATION I
, Center is 1-80Q-:;s 4=:-4::;jqq).
Contractor Type Contractor License
Applicant ASCEMO, LLC NOTICE:
Electrical KS ELECTRIC -' - TH/.~7~a~^AIT ru ^ I I n(~~12004 541-686-6236
BUILDING INFORM~TlID1NJl?EO UN'O'ER TH'ISr;E'~~~t WURK
l;UMMtNCEO OR IS IS NOT
# of Stories: ANY 180 DAY PERIOf\o~~rwPNED FOR
Height of Structure ~~ Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
Expiration Date
Phone
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary COl)struction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION .
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS'
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal!:e 1 of2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01201
ISSUED: 09/28/2004
APPLIED: 09/28/2004
EXPIRES: 03/28/2005
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 I
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
9/28/04
9/28/04
9/28/04
Receipt Number
2200400000000001215
2200400000000001215
2200400000000001215
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 Reouired Insoections I
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.
/)' ,./--~'-) , .
(, ~)AA~ J ( 15L<-J ~tD
O;;er or Contracfurs~ Signature \...)
9/~/0 (/'
, ! /' /
...'
Date
Pae:e 2 of2
.
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
"'ity of Springfield Official Receipt
evelopment Services Department
Public Works Department
RECEIPT #:
2200400000000001215
Date: 09/28/2004
10:14:25AM
Job/Journal Number
COM2004-01201
COM2004-0 120 1
COM2004-01201
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment
Check
Paid By
KS ELECTRIC & CONSULT
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
63.00
4.41
6.30
$73.71
Amount Paid
nJm
4442
In Person
Payment Total: ,
$73.71
$73.71
9/28/2004
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