HomeMy WebLinkAboutPermit Electrical 2005-11-21 (2)
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2~S FIFTH STREET · SPIUNGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (541)726.36~Pe f~ ~->b{ .J(L.J~
LLE,CTRlCAL PERMIT APPLICATION ll':\. I "5 Authorized Signature - -
CirvJoD'~umberCS- nl~~~ Date~-lJ...l
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~Ec.:'.L DESCRIPT10N ~
II n -:t 33 ['00 I ~ t57:J
.lOG DEScRIPTlm9
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Pamill uc n~ransferable and expire if work is
not sl3rlcd wirhin 180 days of issuance or if work is
Suspended for 180 days.
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Service Included
1000 sq. ft. or less,,~ r n \:::.' ronuires $'ro~~
Each add~ipr~~~'~0,sqHPo~90 the Oregon UtIlity
portion tl~6\f8!1J ru\e~ adoPte~:!;c. r'dl,?~ ::\re$sI~1b~r~__.__._...__._.
.t' "~i~n Center. I-. OAR 952-00 ,-
.~ach Man\'ll~a'G~o Home ~r_001 0 throUg'\ b {50
ModulaiirDwellLncgfs1~Pce 8Gtain copts 01 th~.~~\;; Y 50 .
Feeder 0090. '(ou may . NOlt:. ~:,e ~s\epYI~~e
. ,,:~ th. center. .( .,', d' Lcatlon
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Surrell Bros. Electric
401'59 Booth Kelly Road
Springfield, Oregon 97478
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200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts'
Recol1nectpn)y. '
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C. .,11
$ 63.00
$ 75.00
$125.00
$ 163.00
$375.00
$ 50.00
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::\;:'!:<;1!011 Dale \0\ Cl.,
)!g":':I'Jre or Supervising Electrician ,
f I[) \ JIIR) PI V\M,L" '--- ))
Each Additional Circuit or with
. ,C:....^ '" \_'/t '~'"" (J.~ 1. _"\ _ '" Service or Feeder Permit
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New Alteration or Extension Per Panel
One Circuit
$ 43.00
$ 3.00
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Phone
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
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Minimum Electric Permit Inspection Fee is $45.00 + Surchargcs
4. . I.~~ 60. t5V
<~ .50
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Shared Drive(T:)/BuiJding FormslElc:ctrical Permil Applicalioo I.()}.doc
$ 50.00
$ 50.00
$ 25.00
$ 45.00
'!'r;c :nsl31lalion is being made on property J own which
I'; no! Inlcnded for sale, lease or rent.
O.,;'!1~rs Signature:
7% Srate Surcharge
10% Administrative Fee
InspC'Clion Request: 726-J769
TOTAL
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. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01628
ISSUED: 11/22/2005
APPLIED:, 11/21/2005
EXPIRES: OS/22/2006
. VALUE:
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5335 Daisy 47
ASSESSOR'S PARCEL NO.: 1702330001300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Emergency Pedestal Change
Contractor Type
Contractor
I. C'ragon law requires you to
, ,o;;ied by the Oregon Utility
. '.-I:.;I1l~r. Ttlose rules are set forth
',.,. I"\('H'" .h.,...",nh n.o.~ Qt:;?-n01-
1,1 " '. ,.. -"" - -
. " - "ta'ln copies of the rules by
I CONTRACTOR INFORMATIOWl ..
V"'II,~ ".'" w".3r. (Note: the tel~~ho~e
numbcL' {(\r thF' Ore'Eon I.Jtilit~ll NQ~fl'1atloo..h
Icense. . xp'l.r~ .I()n ale Y one
. Center Is,1-8UU-3~~-~j44 .
Owner:
Address:
SANTIAGO ESTATES ASSOC LLC
11211 GOLD COUNTRY BLVD STE 10
GOLD RIVER CA 95670
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type .
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Baseme'nt:
Range Type: NOTICE. Sq Ft Garage/Carport
Energy Path: \ . Al~~I~~1 c=tHE WORK
. Sprinkled BUildi~~~u~~~~W'~~DERUfm~apt\WUT IS NOT
DEVELOPMENTINF - Hmlt OR IS ABANDONED "UK
. ANY PERIOD. REQUIRED PARKING
Front yard Setback:
Side I Seiback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
. Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
, Description
Type of Construction
$ Per Sq Ft '
, or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of 2
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Status:
Issued
225 Fifth Street, Springfield, OR
541.;.726-3753 Phone
541-726-3676 Fax
54i-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
'Manufactured Home Service
Total Amount Paid
.
Amount Paid
$5.00
$3.50
$50.00
$58.50
Total Value of Project
Fees Paid I
Date Paid
11/21/05
11/21/05
11/21/05
Plan Reviews I
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01628
ISSUED: 11/22/2005
APPLIED: 11/21/2005
EXPIRES: OS/22/2006
VALUE:
Receipt Number
2200500000000001604
2200500000000001604
2200500000000001604
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~ired Inspections'
MH 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 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
. 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 ~ontractors Signature
Page 2 of2
Date
.. 22;i..:Fifth Street
t.r '.4f' ).,.
. S,ringfield, Oregon 97477
541-726-3759 Phone
.
.y of Springfield Official Receipt
velopment Services Department
Public Works Department
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RECEIPT #:
2200500000000001604
Date: 11/21/2005
2:53:32PM
Job/Journal Number
COM2005-0 1628
, COM2005-01628
COM2005-0 1628
Description
Manufactured Home Service
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid ,By
CreditCard JASON BURRELL
Item Total:
Check Number Authorization
Received By Batch Number 'Number How Received
nJm 061268 Phone
Payment Total:
Amount Due
50.00
3.50
5.00
$58.50
Amount PaId
$58.50
$58.50
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11/21/2005
Page 1 of 1