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Home My WebLink AboutPermit Electrical 2003-9-18 , .1 ~(OO T1-\"'-R'STo (\) 'RD.. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAX: (541)726-3689 EL. ECTRICAL PERMIT APPLICATION q. . ~ f \lowing project as submitted h~S thl e fdO\l~:ing ..a~ ":> I (j e 0 uir~eclflC an u City Job Number (T fhtVLO(ao 3 - 00 ~-::::> Date - 1:) - () zing. and does not req approval. '0. 3. C01l1PLEJ'E F"E#~E1JUL1!.' BE'L011/~' ct ( -()? Date - , ' ./\uthoriz,ed Signature A. New ReslOentJaI - Single or Multi-Family per dweIIing unit. 1. LOCAII0N OF INSTALLA110N LEGAL DESCRIPTION I 'l , (') J- ' ~1I . J.. I JOB DESCRIPTION 0-0 c.t o-D 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 <JJIR,~ N<.R l. ,ATE~ ) Ke:AIMF:tS) "5)'5)- $ 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 INST,,4LLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: Electrical Contractor fU/A City Phone 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/V olts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Address ~ 1-,:' i ,-' , Supervisor License Number 40 Z[f>fhJ.S,:.:" ;., '-'~"" ,1:e~1}>l?"rary Services or Feeders 1"C:!:ji~. .,(t -'~':~,t.';!u:;i:.:(: bYth I <:lQL:/r6S YOu It; Expiration Date I D - I - 01 ;1 ;;/, -. (,~.; ,." ~(~~~\:,-( :I.~~~l~~i~~l:~er<i~~:nt~r Relocation \IO~f) ".., . '.,'1 i200)Amps.orlessQ2i r~' ' - ,. , , ~ I ./ n j } ~.' ...., ,'....,". ' . I 1') 1 J .. } j..\ lJ ,,_ . v! : ;.:,:h', ",,,' ":") 201:-:Arp.p.s N .400 Amlls::: n t..J' ~,--:,"'-.~~ (1\' . '--,- ,,'l; ,""......,..." W//;'Jor"~ ;';,".-",' ~:. , ... ,"1-0:\sAPl,p-~ ,.~Ql.600 ~liips . t....' ; 'L-' .~",;"'G'Y'"".""" ,1 g~...~" l,.. 4::'.: ~."""l'10~"'~ - ::'-'~.;,," ~,'JOver!600~,Innsor 1000 Volts see "B" above, . -'L i< :;n,,'?'"Ir, "J~ v.Ji'Il8,3.iion Signature of Supervising ElectricianN OTl . D. c, Brar{ch1(l)!'clllts. , )1 ./ .-;7 ~~!Pr-~~ New Alteration or Extension Per Panel ~ JIJJ,nLI;/J... V. ~4m/~~IT SHALL EXRmE<lfrqtfiltE WO~K I . unlLtU UNDER THlgapItAMf'~'q~aN '1fuit or with. COMMENCED OR IS A8Arum1C~f .~.der '~nnit 3 Owners Name W i U.JA^"ALA.l\6,ev~.'\!frrFl/OD. /IJeu UH Address ~6 $, f\J\',U ~ .:;-r . E. Miscellaneous (Service/feeder not included) -Each Installation Constr. ContI'. Number $ 50.00 $ 69.00 $100.00 Expiration Date $ 43.00 43, a:? '1 > DO. $ 3.00 City 'SR< ,....-x::. ~ 16c..J:j Phone 73h-cr0t7t!/ Pump or in'igation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50,00 $ 50,00 $ 25.00 $ 45.00 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 7% State Surcharge 10% Administrative Fee $5 2 ~oo 3,b1 5..20 "bD...S4 Owners Signature: 4. SUBTOT~4L OF ABOlTE Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building FOllns/Electrical Pellnit Application I.03.doc ~_S:;G:.~.~.LO ~".'..'f..'..... WlL'~.'''c ' '.ug' , -~. .,. ~~.,' .,--.. ..-....: -' " . Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line \ CITY OF SPIL8GFIELD . Building/Combination Permit PERMIT NO: COM2003-00923 ISSUED: 09/18/2003 APPLIED: 09/18/2003 EXPIRES: 03/19/2004 VALUE: SITE ADDRESS: 6100 THURSTON RD ASSESSOR'S PARCEL NO.: 1702342100400 Springfield TYPE OF Electrical Work Only PROJECT DESCRIPTION: wiring for water treatment system TYPE OF USE: Addition Public Owner: WILLAMALANE PARK & Address: 200 S MILL ST SPRINGFIELD OR 97477 Contractor Type Electrical # of Buildings: Primary Occupancy Group: Secondary Occupancy P'rimary Construction Type Secondary Construction # of Bedrooms: SETBACKS Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: Description I CONTRACTOR INFORMATION' Contractor OWNER License BUILDING INFORMATION I # of Stories: Height of Type of Heat: Water Type: Range Type: ATTENTION:Or~~pMIHUlrE;::, you 10 follow rules adopted DY the-Oregon Utility r J - "f' '; ,...~:s':'" ,.,.,....,to.. Thnco rlIIQ~ ~rA set forth ~ull \vc.d. .. - . _ _ _ _ I in OAR 952.1lmY-llDlXtlhllU~WIINiI'\!Jrd.ID\"'PION . 0090. You may obtam caples OT Ultt IUltli;) uy calling the cent@jv'N~f:})m~ te'~~ho~e number for the Of~~tt4tJ.l\~ NotificatIon Center iSBa~Qih~~e~)' % of Lot Coverage: IPUBLIL l1\1PROVEMENTSI Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: NOTICE: THIS PERMIT SHALL EXPIRE IF THE wdMrnspoutsIDrains AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ^~IV 1 on n^v DCOlnn I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project 1 of 2 Value Date Calculated CITYOFSPRINGf11ELD - Building/Combination Permit Status: Issued PERMIT NO: COM2003-00923 ISSUED: 09/1812003 APPLIED: 09/18/2003 EXPIRES: 03/19/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees paidJ Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $5.20 $3.64 $43.00 $9.00 9/18/03 9/18/03 9/18/03 9/18/03 Receipt Number 1200200000000002162 1200200000000002162 1200200000000002162 1200200000000002162 Total Amount $60.84 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 Reauired Insoections I 1 Final Electric: When all electrical work is complete. 2 Rough Electric: 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 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 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00923 COM2003-00923 COM2003-00923 COM2003-00923 Payments: Type of Payment Check Reccipt#: 1200200000000002162 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Received By lkw Check Number Batch Number Authorization Number Paid By WlLLAMALANE 48027 City of Springfield Official Receipt Development Services Department Public Works Department Date: 09/18/2003 10:47:50AM Amount Paid Item Total: 43.00 9.00 3.64 5.20 $60.84 How Received In Person Payment Total: Amount Paid $60.84 $60.84