HomeMy WebLinkAboutPermit Electrical 2005-8-8
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · F~~41)726-~JiJl9
ELECTRICAL PERMIT APPLICATION eo?? 7,0(\1
City Job Number COM ~ ~ - e \en ~ Date ~ -~ - o'S
1.
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LEGAL DESCRIPTION O~J\ \ {)
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JOB DESCRIPTION
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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.
E]ectrica] Contractor ~fi. ~/ /::(P//fJf..r~~',~\
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Address / ~O J4J..ttA bu-v .It~?e.,-~::;"\ \'0......
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Supervisor License Number'~,~<o/ 7S- S
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Expiration Date '':'It)~ 'j ....- () 7
City 0vVJ~
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Constr. Contr. Number ;JD-e~S7.-- c..
Expiration Date
7-- I -c) 6
Signature of Supervising E]ectrician
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OwnersName~"~L'\'f'tt\:.. C~~\l t.:z....
Address (,Oa.q O~\."'b U~
City?e~ts;qe~'b PhoneC'EAt) \L\c-t-ll O~
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
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3.
A.
Service Included
1000 sq. ft. or less
Each additional SOO sq. ft. or
portion thereof
Each Manufact'd Home or
Modu]ar Dwe]ling Service or
Feeder
$106.00
$ 19.00
$SO.OO
B.
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNo]ts
Reconnect Only
\
lo~.:OO
$ 63.00
$ 7S.00
$12S.00
$]63.00
$37S.00
$ SO.OO
C.
\'().~ 10 0 '(}e 91~r"j; S '0'\
Installatione~~~dffil<.~I,iZR6~~~~~e 010
200 ~~ps')br~~Ose ~~~ 0' >IS' . ,?'O~O t'O'$- SO.OO
4t}~1tnJl8.~~O' 0 <--,eS ,^e ,\10, ~0\C $ 69.00
6 ~ 0"". ~. ~
,,-<\ 1<.~p~~~~liCi o~e' ...;~~~~.~. $100.00
~' ~ . 0 R)\ ~'(j. ~ \)~... '~~
'O~:v ~ , ~ s &'<1 10 Volts se ~t:g.' above.
~Q
.~ ':.."Q; lter.atfon-o'fRy&nsion Per Panel
WJr1 ?>:.\" \ """ ~'
One ~c~i:pe 0e~
Each ^rd~htiona] Circuit or with
Service or Feeder Permit
$ 43.00
"=- < oc:>
""L
$ 3.00
E.
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residentia]
Limited Energy/Commercia]
$ 50.00
$ 50.00
$ 2S.00
$ 4S.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
(O~ ~ e;o
.4, <8':>
<d.~O
* 50, \3
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application I-D3.doc
Status
Issued
CITY OF SPRINGFIELD"
Building/Combination Permit
PERMIT NO: COM2005-01071
ISSUED: 08/08/2005
APPLIED: 08/08/2005
EXPIRES: 02/08/2006
VALUE: .
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6049 ORCHID LN
ASSESSOR'S PARCEL NO.: 1802033400162
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: Hot tub installation.
Owner: CHAVEZ JOHNETTE
Address: 6049 ORCHID CRT
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor ~
BOB FISHER ELECTRIC ~,Nc;r\t:. \j\jG~\\
License
96275
Expiration Date
01/25/2006
Phone
541-689-7973
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",.,s:.. \.\. \J"BtJILDIlNG'INFORMATION I
\(,~\~\ ~\~;c". ~~\\ S\;\t:\ '\\ \~\'-'\:\Q~\:.IJ \ ~
# of Units: ~~\\\S ~t.~\ \) \j~\)t. i\\)~~#'ofStories:
Primary Occupancy Group.:\\Cl\\\l~\.\) Cl'\\ \S \) Height of Structure
Secondary Occupancy &i-o,hp'\~\t.\~C _:{ ?\.,\\\Cl . Type of Heat:
Primary Construction Tf.~~\~~ \'O~ \)~, Water Type:
. ~\~,
Secondary Construction Type: Range Type:
# of Bedrooms: Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
n/a :0 \0 Occupant Load:
,. \10 ....%"
I DEVELOPMENT INFORMA\\'Eld~ct0 \)~~~\\'0
~ e ~ :(e Se OOV REQUIRED PARKING
. O\e9P '0'1 \'0 \).ws '0: ~ 9JS~- s 'Oi
oveR~~s!b9\eO '00se:( X\ O~ e :('0.\e e
~,\~'8-r,.ee!el\re~"\l.!qdi \'0:(o'0.~es 0\ \'0 ~e9'00~ 0(\
~eVe~Bf,i~~q~\ ~ CO'Q~. \'0e \e ~\\\c'().\~
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~O Ol>-~ "0'0. '(<\'0-'1 e0\e:(. (\00 \J r>...~_?-'?JC>.
\f\ _ 'I ,n C /'"'\(e",,.. ~;,)
I pUBLrri~Mitf~p~'l'OU~
t-~W-'; C Sidewalk Type:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Downspouts/Drains:
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 of 2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01071
ISSUED: 08/08/2005
APPLIED: 08/08/2005
EXPIRES: 02/08/2006
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.
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.90
$4.83
$6.00
$63.00
8/8/05
8/8/05
8/8/05
8/8/05
2200500000000001066
2200500000000001066
2200500000000001066
2200500000000001066
Total Amount Paid
$80.73
I Plan Reviews'
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.
Reouired Insnections I
Rough Electric: Prior to Cover
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
Date
Paee 2 of2
· 225 Fifth Street
Springfield, Oregon 97477
. 541-726-3759 Phone
e:4e~~... .
Wic. ..
City of Springfield Official Receipt .
velopment Services Department
Public Works Department
RECEIPT #:
2200500000000001066
Date: 08/08/2005
2:39:25PM
Job/Journal Number
COM200S-01071
COM200S-01071
COM200S-0 1071
GOM200S-01071
Description
Perm ServIFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard BOB FISHER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Jmp 0069S0 In Person
Payment Total:
Amount Due
63.00
6.00
4.83
6.90
$80.73
Amount Paid
$80.73
$80.73
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8/8/200S
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