HomeMy WebLinkAboutPermit Electrical 2005-9-9
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number COM ~~-o l~:z.~ Date
A.
()C)foCX::> Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
1.
qc;~ f./ff It
LEGAL DESCRIPTION
l7 O~ ~S 22-
JOB DESCRIPTION
tle.ctn~ {N- f-b.J- ~ 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 MLJ{,() IItl/.Lly ~ .
Address ;J;s:{ tl L4b.1 f(/KJ , ~
City ;;?A1.L Phone ~;"tJ.3f1
Expiration Date
1-f7v&5
IIJ,- J-tJ/
/ '/9 Jl3t
/
I~-/:;Y~
Supervisor License Number
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
C--;/IA ,,~~ ~
r ~ -.., ~ c:::::;7"
ownersName~ ~bee-,
Address qs~ M,tll st 0
City Sp~~etd Phone 74-\ -10(0 (
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
3.
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
, .. . '- ~ :';.", \~ /,:J/.,;':UUI,I;:I
200 AIJ1ps}irC less." "t'.J I U 0
"l!UJ"f\irn .
20 l' Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 4WI-~~~ION: Oreqon 13Vi '$;'69'.00 C .
401 Amps to ~I6WP.SJle~ adopted by UK$IOO:OO
O 600 A..!\.!!<;\';~I'lt'ti'Ai:nn ..G:PotP.~'Blh15ose ~u.J;;.:, .."" :.
ver llIi'HYOr '{'\;I\!/\yVunS'see' a ove, '_'-" .'
D.
. lJu III 1
New Alteration8cIl~~eMW't81'l.J.:eJf!lr.\~~ote: the ';:';'3!~, ;C,[~"
One Circuit rumber for the Ore~on Ut$i~3!GO)tl1lc~1(X:>
EachAdditiona ClrcuitEe~Nl:!r is 1-~O-332-2344). 1_ r"r\
Service or Feeder Permit ~ $ 3.00 '" 0","""-,,
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.
4'fo 00
3./:&
4.'0
S(.~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application I-D3.doc
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: COM2005-01228
ISSUED: 09/08/2005
APPLIED: 09/08/2005
EXPIRES: 03/09/2006
VALUE:
Springfield TYPE OF WORK: Heating System
SITE ADDRESS: 953 MILL ST
. ASSESSOR'S PARCEL NO.: 1703352200600
Residential
PROJECT DESCRIPTION: Replace heat pump
TYPE OF USE: Repair
Phone Number: 541-741-1061
Owner: JACK BARBEE
Address: 953 MILL ST
SPRINGFIELD OR 97477
I . , ,.' I '. ~..'. 11"<. \, ~__I,_ ~L=.'.,' -.. 1'---: ~ , .
I r~lu :JC,' _' O.
: Ii i l " i~~ II ,- 'j LIi: 0L;' i ~ I I;) , ,-
I CONTRACTORINFORMArION '"i \3 ;\3,i\:\;OO;'kD H);:"1
ANY -\ (jet 01-\"'( PERIOD. . .
Contractor LIcense EXpIratIOn Date
MAG ELECTRIC INC 149834 12/13/2005
ASSOCIATED HEATING & AIR CONDITIO 106275 08/31/2006
Contractor Type
Electrical
Mechanical
# of Units: -
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Phone
541-461-0387
541-683-2590
BUILDING INFORMATION I
# of Stories: Lot Size:
R-3 Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
VN Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
:.T:!:~ IT'C"'" nYO~"n l~w rpnl lirA!; "au to
I DEVELOPMENT INFO,RMAr1Jl@N:i~opted by the Oregon Utility
Notification Center. Those ruleRE~ARKING
O I D. t 'In OAR 952-001-0010 thrOUghiR 952-001-
ver ay IS: . ota): b
# Street Trees Rq8P. You may obtain copleslna{~les dY
Paved Drive Rqd:::alling the center. (Note: thE(; m.EfPa~~~S
% of Lot Coveraget'mber for the Oregon Utility NoIDicatlon
Center is 1-800-332-2344).
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
Downspouts/Drains:
Paee 1 of3
.-7~J~ .........'.c.... i;..
1It;:..'C . I
'-fj;
. -~..-",....-......,...--... ,.,.. .....
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Heat Pump
Minimum/Adjustment Mechanical
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Total Amount Paid
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01228
ISSUED: 09/08/2005
APPLIED: 09/08/2005
EXPIRES: 03/09/2006
VALUE:
I Valuation Description'
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
~
Amount Paid Date Paid Receipt Number
$10.00 9/8/05 1200500000000001323
$4.50 9/8/05 1200500000000001323
$3.15 9/8/05 1200500000000001323
$12.00 9/8/05 1200500000000001323
$33.00 9/8/05 1200500000000001323
$4.90 9/9/05 3200500000000000543
$3.43 9/9/05 3200500000000000543
$43.00 9/9/05 3200500000000000543
$6.00 9/9/05 3200500000000000543
$119.98
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.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Pal!e 2 of 3
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2005-01228
ISSUED: 09/08/2005
APPLIED: 09/08/2005
EXPIRES: 03/09/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 OCCUP AN CY 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
Pal!:e 3 of3
225 FUth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
velopment Services Department
. . Public Works Department
RECEIPT #:
3200500000000000543
Date: 09/09/2005
12:07:01PM
Paid By
CROW V ALLEY ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 009202 In Person
Payment Total:
Amount Due
43.00
6.00
3.43
4.90
$57.33
Job/Journal Number
COM2005-0 1228
COM2005-01228
COM2005-0 1228
COM2005-01228
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment
CreditCard
Amount Paid
'.
$57.33
$57.33
;'1.
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9/9/2005
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