HomeMy WebLinkAboutPermit Electrical 2004-10-19
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72@r3689 "'o,t.<9 ~ o~
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ELECTRIC~'ERJjIIIT APPLICATION ~"Il ~ --,," 0'(>..'09.0,..
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City Job Numb r .'.. - 0 I z.t L Date l b.U-:!-{ 2 CD Lf- o~'><9O' o~~ 6'<1' ~'{o
1. rlL09ATION'OF mSTAiLA170Ni', 3.':CO~Ii>iETE!FiE SCHEDU~ '>"'~P~~{~l'f~,;j)\,;:.~~tEi
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LEGAL DESCRIPTION A. ',:\:,~~,t\~~si~eriHal":S,i~~le oLM~lti- . :t3~~~~'~~,f:i~
tl 0 ,S ~. ~ L1,l., 1;32' ()2> Service Included G-1l'(9o%;.
JOB DESCRIPTION~ 1000 sq. ft. or less i9
(' ~ \:6: . Each additional 500 sq. ft. or \,
....,::ortJJ\1 4.t\J(JttlU-fY' (A)'JY15 portionther~fTEf\jTiON:Ot8qC)f'I~\f,"~ :;$
P 't f bl d . if k' E h M fOltl~v:~rUI8~ aciOfjtet' . ,./ .~ I '" " .'
erml s are on-trans era e an expire IS ac an\lfa~ ".u. ome;Qr ~"". ",.':
not started within 180 days of issuance orif work is Modular Ow~,~fiR51 gR-i\;@t)\ter. Those": I~::. "50"'-'/ "
Suspended for 180 days. Feeder In OAR' 952-001-001 O-tfrf-t; _L "..~, c,,:OQ., .
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...,..,.. , O~O..;yo~maypbtain cOf.)ie~{)f the:'(tilmi'bN'A";f:,~l';l
B. .,~;er\i~~s ~~jJlin!Jt/lle~~tio>>...t~~trn.tioos orRelo~l~i?,?,:\(\.:
^' .,W",^",.... t1Umbedor the 6re~~; LJtili~~~~e~:~~:L<"'~= ."."
200 Amps or less Center is 1-8~;1 ~3~ ~.lf(f
201 Amps to 400 Amps $ '!Is.oo
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts $375.00
Reconnect Only $ 50.00
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'CQNTRACTOifINSTALIATIONOiVLY..
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Electrical Contractor D.. v E' rS J ( e A f:1 ~ (' \-rlll\ "<:S
Address ~, F;D)<'" L( ~S '-\ ~
City ~.
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Phone
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Supervisor License Number .?,) 'lS 9 3 L [;. A-
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c. 'Ti{fuporary'Sen;ces or Feec!ers
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Constr. Contr. Number I Y 4[.., '[S
Expiration Date <.0 I ~
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Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69,00
40 I Amps to 600 Amps $100.00
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m~/Al&Ja!lPir <p'~l5BsPo{lj~~IFOR
One Circuit . $ 43.00
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
Expiration Date J 0 I ( Il"lS
Owners Narr:O'IJrll'J) ~ t{)a.1J 0.-
AddressgL~ 1YlP~
City ~tZ..-
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E. lVliscella~eo~~ (~erYice/fee~~~}lOt included):~,~~~ ~~.~.!~~.a..~~!t~
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Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
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$ 50.00
$ 50.00
$ 25.00
$ 45,00
d~'()V
Phone
OWNER INSTALLATION
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The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
.L'sbl1TOTAL OJ/ABOVE
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building Fonns/Electrical Pennit Application l-Q3.doc
-~4IiI
Status
Issued
CITY OF ~Y.tOl~l:if11ELO .
Building/Combination Permit
PERMIT NO: COM2004-01282
ISSUED: 10/18/2004
APPLIED: 10/18/2004
EXPIRES: 04/18/2005
VALUE:' .. ~J, ~.,-'.-
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Spr.ingfield.' - 'FYPE-OF-WORK:' I EleCfricarWork Only
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.,~~,;.l1YPEt)F USK:::: "-AlidititiIPil~; Residential
PROJECT DESCRIPTION: Low Voltage/Security & Vacuum Syst~m '::y.:.1 :" :'Ti1nn \ :f,":V '\~'~;,'i";2,'liC'-.
...... '1" -. : -I ,--:," '"" r J~l ~~~iA).
SITE ADDRESS: 823 Mint Meadow Way
ASSESSOR'S PARCEL NO.: 1703234313800
Owner: DEWALD DOUGLAS C & BETTY A
Address: 2515 WILLONA DR EUGENE OR 97408
Contractor Type
Electrical
I CONTRACTO~~ATION I
Contractor THIS PERMJfce~LL EmiimaJfiitllDNGRKPhone
DIVERSIFIED ELECTRONICS INCAUTHORIZH,.<<m~DER THIS pt/~~qofB NOT 541-484-9078
BUILDING I~RMWriQN R IS ABANDONED FOR
ERIOD.
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION.
Front yard 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 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
Paee 1 of2
CITY OF SPRINGFIELD.
Bu i1dinglC ombinatio nPermit
Status:
Issued
PERMIT NO: COM~004-01282
ISSUED: 10/18/2004
APPLIED: 10/18/2004
EXPIRES: 04/18/2005
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
Amount Paid
Date Paid
Receipt Number
Total Amount
$0.00
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.
Reauired Insoections .
Low Voltage: Prior to cover.
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 perm it 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
2 of 2
.
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-0 1282
COM2004-0 1282
COM2004-0 1282
COM2004-0 1282
Payments:
Type of Payment
CreditCard
10/18/2004
r 'of Springfield Official Receipt
L felopment Services Department
Public Works Department
RECEIPT #:
3200400000000000294
Date: 10/18/2004
Description
Low Voltage - Residential
M inimuml Adjustment Electrical
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
ALLEN WOOSTER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm
005942 In Person
Payment Total:
Page I of I
12:16:12PM
Amount Due
25,00
20.00
3.15
4.50
$52.65
Amount Paid
$52,65
$52.65