HomeMy WebLinkAboutPermit Electrical 2005-1-4
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225 FIFTH STREET - SPRINGFIELD, OR 97477- PH:(541)726-3753 - FAX: (541) ~:3-6~8.-?6>~ '
ELEC;TRICAL PERMIT APPLICATION '\ u c <0,O~"/:O~1)
City Job Numb~li-n5- &::::0) ~ Date - , - 0 --' "~! ~O':'or~
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LEGAL DESCRIPTION
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JOB DESCRIPTION
~it6
Permits are non-transferable and ex re if work is
not started within 180 days of issuance or if work is
Suspended for 180 days~
2,
'Electrical ContractorG (j- S 'C'('~I c...-, J:l7G-.
p() 59X /If~d
City Err/#Ji Phon, 71J/-dd30
Address
Supervisor License Number
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3 <3/-1 q
9 -J- OB
Expiration Date
Constr. Contr. Number
Expiration Date
5=:~?Mk
I'
ownersNam~ Vl'lP /
Address ',.$ _ C;S ~ l~, - '&z.\{Ju.r E.
City~ Phon;?<..fl - ~
O\VNER INSTALLATION
The installation is being made on property I own which
is rwtintended for sale, lease or rent
Ov.rners Signature:
Inspection Request: 726-3769
3.
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1000 sq. ft, or less $10, ~
Eac~ additional 500 sq. ft. or ~........ ~
portion thereof ' , $ 19. QlJi
mTTENTION: Oregon law reqUires you to ' "
Each flP,W'\'itig~ffi1r%:.d by the Oregon U. tility.
Mofjv 'if :OwHtmg,.S'ervrce~QJ;. ~
Feeti'M?tlflcatIOn venter. I nose rules are se\.llIJl.l'f.\\ll1l "
. 1.
Co
New Altera ion or Extension Per Panel
One 'Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 3.00
Pump or irrigation
Sign/Outline Lighting
Limited EnergyIResidential '
Limited EnergyiCommercial
$ 50.00
$ 50,00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
4,
7% State Surcharge
10% AdministrativeF ee
&600
Lf.Y-1
W' 3'0
~r5. 71
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 1-03,doc
11 225 Fifth Street
. Springfield, Oregon 97477
541-726-3759 Phone
r:fv of Springfield Official Receipt
/elopment Services Department
Public Works Department
RECEIPT #:
2200500000000000010
Date: 01104/2005
2:32:21PM
Job/Journal Number
COM2005-00012
COM2005-00012
COM2005-000 12
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard 'MELISSA GEHRKE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm 300453 ,Fax
Payment Total:
Amount Due
63.06
4.41
6.30
$73.71
Amount Paid
$73.71
$73.71
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1/4/2005
Page 1 of 1
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-00012
ISSUED: 01/04/2005
APPLIED: 01/0412005
EXPIRES: 07/04/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1336 MODOC ST
ASSESSOR'S PARCEL NO.: 1703253314900
Springfield TYPE OF WORK: Electrical Work Only
Contractor Type
Electrical
Contractor
C & SELECTRIC
TYPE OF USE: Addition Residential
ATTENTION: Oregon !aw reqL'ires 'jou to
follow rules adOi-'led by the Oreqon Utilitv
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules bv
callina the center. (Note: the telephone
I CONTRACTOR INFO~1f!P.':Nr Ihe Oregon Utility Notification
Center is 1-800-332-2344).
License Expiration Date Phone
3849 09/01/2008 541-741-2236
PROJECT DESCRIPTION: Service Change
Owner: COLE DONALD E & ELAINE B
Address: PO BOX 70142 EUGENE OR 97401
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 Hea,t:' '.' :,',; . Sq Ft 2nd Floor:
r. ...,,~ ,I L -4J"'"'G
Water Type: HI . ;.~ ' , ' Sq Ft Basement:
Range Type! IS PERlvl/T SHALL EXFSqlFtI:Gat~ge!~~tP'~rt
Energy PatIj,:~:~?rRIZED UNDER THISq~FJfQmfr:s !\JUT
Sprinkled Builditlg::NCED On/aS ABARccunant I:..oad:
1\~I\.l -in" "Au ,,;.;...'.__, 'UU~LU I un
. .... ......\J U'lI '.. ~ I UUU.
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
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
Total Value of Project
Pae:e 1 of 2
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2005-00012
ISSUED: 01104/2005
APPLIED: 01104/2005
EXPIRES: 07/04/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$4.41
$63.00
1/4/05
1/4/05
114/05
2200500000000000010
2200500000000000010
2200500000000000010
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.
~.-U'_ -' f\& b.u\L;
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Owner or Contractors Signature
Date
Pa2e 2 of2