HomeMy WebLinkAboutPermit Electrical 2004-3-23
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225 FIFTH STREET. SPRINGFIELD, OR 97477 0 PH:(541)726-3753 0 FAX: (541)726-3689 .
, 't ubmitted has the followmg
ELECTRIC~P..'E~fuf~. 'Ll ON The followmg proJec as s. ' .
zoning, and does not require speCific land use
City Job Number _.a\\ . _ Date ' approval., l'lD _ ~
3. CONIPLETE FEE St;;;~ULE BE'LOV/ 3...023- of
Date . ~~
Authorized Signature
A. NcwResidential- Single or Multi-Family per dwelling unit.
1.
LOCAI10N OF INSl'ALLA110N
b(()O Tl-\u RS-\6 ~ Kb 4>
LEGAL DESCRIPTION
\.f)~~~ \
['[}\(f)
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
JOB DESCRIPTION
WIRINCl }::"6R. VFD
$ 19,00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50,00
2. CONTRACTOR INSTALLATION ONLl' B. ~6tit(}i or Feeders - Installation, Alterations or Relocation:
On \aW requ\ras UtUtW
Electrical Contractor ~E-Nl\ON:Or~~,d-b~~Jha or~~l' ~IlOVt less $ 63.00
----;\\~W f,U\a6 a:~.lhose ruleS 2Ng's'2PO~ 400 Amps $ 75.00
Address "l~t\cat'oO ~Ol)10 \hrO~~h ~1\h~~\eSd600 Amps $ 125.00
\0 OA.R 95~,/ obta\O cOP'~~e ~~\'1I1q)~ftJ 1000 Amps $163.00
City 0()9Ci\0l~ . lie center. ,\'1o\a. ~iW R'()liilO~~~lPS/Volts $375.00
ce,\\\f\9 \ , the oragoO Uti ?~a,!,nect Only $ 50.00
nut'\bedor . 1_~nn- ~"l?-'
f",,.t'"""~!" .r:-
Supervisor License Number 402:<) s C. Temporary Services or Feeders
~
ExIt:ation Date \ () - l- ZDD 4
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Constr. ContI'. Number (\1 A
~iration Date
Over 600 Amps or 1000 Volts see "B" above,
Signature of Supervising Electriciqn D. Branch Circuits
// U ~. .. If . ~ ~..ft .e.. . lR~M.\\\fie\MQ~r Extension Per Panel
r-./~ D-~~~\l-,~\-\r..-llt~? i~~\k&~~O' I
i"-'SP.t\-\ ~t:D UNDER 1\-\\5 \i~ilGBnal Circuit or with (.
\ . " ~'.~1~ . n~ \5. ~B~N rvlce or Feeder Pennit
Owners Name vvlUAft'oA.LA . ' t.D)~t\\OO.
Address ZOO 5... M ;LL. S ':I1800f>.'( pt E. Miscellaneous (Service/feeder not included) -Each Installation
City -S f'g)~ p~ Phone 731;,. ~1641 Pump or ilTigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45,00
$ 43.00
43.00
3 . t)CJ
$ 3.00
OWNER INSTALLATION
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:
4. SUBTOTAL OF ABOVE
7% State Surcharge
10% Administrative Fee
cqb<lOD
3..22-
Lf,06
-If53~82
Inspection Request: 726-3769
TOTAL
~Wl.
Shared Drive(T)/Building FonTIs/Elcctrical Pcnnit Application I-03,doc
Status
Issued
CITY OF SPRING~lELJ) -
Building/Combination Permit
PERMIT NO: COM2004-00319
ISSUED: 03/2212004
APPLIED: 03/22/2004
EXPIRES: 09/22/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
'\'"
SITE ADDRESS: 6100 THURSTON RD Springfield TYPE OF WORK: Electrical Work Only
ASSESSOR'S PARCEL NO.: 1702342100400
- _ __ \NOl\'trYPE OF USE: Addition Public
PROJECT DESCRIPTION:. - Wirini,!Or VFD 'tY-?\l\t. \t \~~ \<2> ~O\ '
'. ,~C\1\C ~\'(~ c.\-\~\.\.\\ -n w: pf.l\W\ u fOr,
Owner: WILLAMALANt8~ \) \)~\)~c:.~~~~\)OWC.
Address: 200 S MILL ST S ~ yq '7
rC\tlflMC" n~~\Q . .-
u\JJ eO \)1'\( \ . - -
~~'{ "\ _ I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
I BUILDING INFORMATION I
~~~
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
# of Stories:
Height of Structure
Type of Heat: \0
Water Type: S iO\) '~\\'1
Range !~D.~~e 0(\ U\'\ \O~
~~~ ~~~ e Se\ ,d)'
N.,O~e?~o 'Q'i \~~\}\es ~~g~~\e~ '-
~\,a '''''..lC L- -'lQ - - f -
..A''e \ Or _ ~
~\ \ ~\}\
'O\\O~ ~\O(\ ,\.00. \(\ CO e'. \"e ~o\~\C
~o\\\\C~ g~'2."()~'i ~~~~~\\\\\'1 ,\fJ.b.~'
~ O~ '<(o\) <<' c~ee~l1-'!,~a:
'\ n,090. '\~~ \"e \~e~a..,Qti~"Rqd:
v 0-\\\\' ,o~, ' ~
~\}~'Oet ("":. ..% of Lot Coverage:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
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
Pa2e 1 of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00319
ISSUED: 03/22/2004
APPLIED: 03/2212004
EXPIRES: 09/22/2004
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
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$4.60
$3.22
$43.00
$3.00
3/22/04
3/22/04
3/22/04
3/22/04
Receipt Number
1200400000000000361
1200400000000000361
1200400000000000361
1200400000000000361
Total Amount Paid
$53.82
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.
L Reouired Insoections .
1 Rough Electric: Prior to Cover
2 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
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00319
COM2004-00319
COM2004-00319
COM2004-00319
Payments:
Type of Payment
Check
Receipt #: 1200400000000000361
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
WILLAMALANE
Received By
llh
Check Number
Batch Number Authorization Number
50653
City of Springfidd Official ReceipJ
Development Services Department
Public Works Departmen!
Date: 03/22/2004
2:46:22PM
Amount Paid
Item Total:
43.00
3.00
3.22
4.60
$53.82
How Received
In Person
Payment Total:
Amount Paid
$53,82
$53.82