HomeMy WebLinkAboutPermit Electrical 2004-8-24
u2/06/0~ FRI 09:11 FA! 5~17263689
CITY OF SPRINGFIELD
~001 ~
~ . ~ 10 I) : ..
225 ~'IFTH STREET"'. SPRINGFIELD, O~ 9747~ . PH:(541)726-37S3 . FAX: (541)7N_"'I) M A J ~ 16
ELECTIUCM PERMIT APPliCATION ~~~~I)rJ~~r%c "1f2;
City Job NumlkO;n,;7o-vy -DID YI Date x--r <;' ~C> <t, 0 J:~ ~ 0&81)0;"881;6
<:t/(?" <Oni rs9u 1rJ111&
: ," ,.~'~.."~ '. 'r"~"-, ;:-.: :,_.a _~.:-~- ...::'.:0'-: '.!"r~,.(==\j r,... -,-,, :!o~r.: ~.'" ",,';."_-,_'_~ ..A........'I'I~..."f." . - -/J.9....... '",,,~.. {r.e.~ O',lJl1,S,.,.,-
1. ,'LOCATIONOl!:JNSTAi::;I;{t;rror;,,~,',_7.".'.:'"; 3. '~CO.l\lfP,B.:."..t;..r,="~, . " B w.,:;...,,-:, ""'6' "!e '.
870/".... ';;~ l: """9,'-;';~'" '0= ,.- -:... ...~>-~.""'~ .,', :',~:o .." ;i;~I'" E. ~'~ ":'~';~~~~"'I)O
A.. ~&~~i;;;;dii[t;1i:"id.~S".ri~r~~~ii:r#o':'~ ,.'"~:o. ">ii: "
r!~:~:!SOr 30 d;g E::~~~~:"J.,.'"~c'~'~mo- "~,..
j f f, ( Each additional 500 sq. it. or ....
f< (It.4{.c __ lee nca.1 f7a n-e. portion thereof $ 19.00
Permits are non-transferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder
. '. - .... ~ I ... ~ '--.-.-. ,-~ .~_. ~ ,t;- - .,;:r......'.,~"._" ~ -,.i;1:::~;;:!,":~Ijii:;.;-.-.;:-:~:r=.:~:>;.,\~~~i:"!"-I;:';;\~:::-..;"~:"~'iE,~':~~~~:I.;.,:,?r":"~';:C:1:"':-"'~";;~/~:'"":'C
-'~: ~:: . -. ..
2. ~.'.~,~'.C.'.'.'.",P,,',;_".-.1'Tl>".:.:,-.'.'.' .....:".'...CW.'.. ...,..'....O.'i.'-....'.i{;]N.o-. ..:,'~,'...:.._=.,..ST..c. '..',...,.'.'AL....,',..,,',.,:.. '.:.,l:;.,:...o.,.!.~_'.'..'rr.,_
,-,',O..','.'N,'.'.,;.'. ,O,."o"""iXFr'., :..:,:.....~..y,.....::.,'.;..,' B. ':1:siiP."~,l":'..(JPjFW1e(S'~1iiStiIl:wo "'~li,",i-iitij)tlSor.R.lobition: .
,~~'I"~~ . ','" __..c. _ _ ,.,. ~~.._ ~~:.i:;;~~5~:.i&~~;i':."f.~"i,~,~~~:L:;:ti';&~;":~;:.,~:::~2.;::i~~;\.)"~J,;:'.i:...-i;'';;':(';'~:..,:I,:; .:.', :',
~ El~~:~~~~a:~~:''"j-.;:'' j{;v~~'- ~;~:t .. 200 Amps or less S 63.00
~ [ 201 Amps to 400 Amps $75.00
Addl-ess 4f3> Sj,~( ~ Soh NOT. ICE: ~O~~f5\~~IM~ WORK $125.00
~ THIS PtRMIT ~b 1frf\SI\lO.!lWil-pslS NOT $163,00
::::.: City <;Fl~1? Pho<le ,47-0~VYHORIZED ~e'it<:.JQg~~~\9'FOR $375,00
COMMENCED R<!CdiI!1&'t'5fUy $ 50.00
~ ANY 180 DAY ~:E.'~~~~~~"""':""-"-)""~~'''''':;'!';'''''-'''i.,i.f!::'''''?''f;{,Y';''"~=:;:'!,,!:;-.,
~ Supervisor License Number 300b > . c. ~~.~.QE~~peJ:y.l~~;~f:~eet.[~~/;~.~J;~~t~~~~:;1~~'f~:;'2':~~:;:'~;':",
t-- Expiration Date
/0- J-CJ4--
if.
;.
COllStr. Conn'. Numb.r
oN ~ \(
b - f-o.5
~ Expirntio<l Date
t "~-~6!"'''"'
!f Xx:L_.., ~ j?
:b- 1 - -~ u
~ Owners Name ~OVJri..c<---- .:5!DJJG
\j\ Addr"-,, / / OS / sT 01
)>
~ City ~
} .
~
~
"
'"
Phone
,
OWNER It'lSTALLATlON
lI.
"'.
Th. installation is being made on property I own which
is nee intended for sale, lease or rent.
~
~
:,
t:;
~,
,
?'
Owners Signature:
Inspection Request: 726-3769
I
550.00
so
Installation, Alteration or Relocation
. 200 Amps or Jess
201 Amps to 400 Amps
401 Amps to 600 Amp.
Over 600 Amp. or 1000 Volts see "B" above.
D. IJ!~~:~~riJci1~~:~1~~~~~i~~~~~~~~:lft~~1~:ii~~~};~~~~:~~~.'.~2~.r .:":'~
$ 50.00
$ 69.00
$ 100.00
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or FeederP=i1 .. $ 3.00
"...... ,". ~.,:...~ ' ~'l~~.~,.,..,,'''o....,..,'' ""'. ..
~~i\\\jl "',"':0" ''''!tli~.'::'.!.:!l!.''. u"di.1i):~:ll2~~~~)~~aii?'l
-.'";teQ """---e'5e\ GtJ.l1-.........,...,... ..-
f~p'6lps ~d~ TnOse f\J~~~~ 9S2-O~1i 50,00
NOS1\lii1~l~\\'IfO~9 ot the f\Jle:> w! 50.00
In ~ . 1&~R~~~e \elepnon~ 25.00
orM'.t\j~U"~:~"1...lli.~~tili\'l NOU\\Cilo" S 45.00
,..a\\\ngttre'r.P~0re9~;:' ~I.
MinimjJfilJHS1'(t:lf:~~~I"~e'ls 545.00 + Surchar~.s
4. i~P$lpllr~~;r.~~~~~if~jI~0~~~~[~~\ . Si, ~ ;:
7% State: Sur<:harge ~
10% Administrative Fe.
$ 43,00
,.- .:::2-
i ( ,-'?O"""
TOTAL . :.5T?' )
Sh..'U'tC1 Drivc:(T:)lBuildic.g FormstE1cc:ni~~ Permit A~ic:llion l:!1J..dct"
02/06/04 FRI 08:09 (TX/RX NO 63291
-i ',:~
.
.
CITY OF SPRINGFIELD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2004-01041
ISSUED: 08/20/2004
APPLIED: 0812012004
EXPIRES: 02/2012005
VALUE:
225 Fifth Slreet, Springficld, OR
541-726,.17S.1Phonc
541-726-.1676 Fax
541-726-.17(1) IlIspcction Line
SITE ADDRESS: 3701 DUKE ST
ASSESSOR'S PARCEL NO.: 1802061309218
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: Replace electrical panel
Owner: STONE ROBERT & RHONDA
Addrcss: II liS 1ST ST SPRINGFIELD OR 97477
Contrarllll' Type
Elcctrkal
l,no\l
, CONTRAC10R-I~mRMATlON I
"01\CE:. Slit>,ll t.'". Ef\~il Iv"
contr~t\\~ ?E\\UI\~ \\\'o\\)E\\ ili\S ~O~E\) rJ1Qcense
L H MO \~\lil13E'&-~1,C:U IS t>,'Ot>,~ 01838
'~\:.r)' '3 - ;~
CaUl,,, " ,BURtDJN6'INFORMATlONI
lI$i '\~u -
# of Stories:
Hcight of Structure
Type of Heat:
Watcr Type:
Range Type:
Energy Path:
Sprinkled Building:
Expiration Date
06/08/2005
Phone
541-747-0811
# or Unil,:
Primar~' Occupancy Group:
Sccondnry Occupancy Group:
Primary CflllSlrtlctiol1 Type
Sccond;lr~' CfJl1struction Type:
# or Bedrooms:
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
Frontyarcl Scth:ICk:
Side I Selhaek:
Sidc 2 Selhaek:
RcarY:1I'l1 Selhaek:
Solar S('lhacks:
I DEVELOPMENT INFORMATION I
WQUlRED PARKING
Overlay Dist: {8O.u\te'!> ~'JiDlhI:
# Street Trees Rqd: at' \e'" OIeQ,ofl J[~apped:
Paved Drive Rqd~: ~. Ot~ 0 '0'1 ~9 ~eS e1e S~'\ict:
% of Lot~ : a.Oo~\e ~ose lU ~ Op...~ lillU\9S '0'1
'" "" lU eS (\\01. ~tOl.lg ~ \~0 (\8
'n\\~.i::^n~ , ",,\0 ...::-iesO...,\.,~~~;.5'
I PUBLIC IMP!t()ytOO:5NtrS ~ 0'0\'<>\(\ ~o\e" \~\'l ~0~\\r;4'
\..- ~Ov' e(\~" ",~.\\\ "t,A).
090. ~e c ~IK "
o ~X\(\~ ~ \~e . -0
c-O: :oe1 \01 'elQl>\,f(spoutsmrains:
(\ulll eel'-
Street Improvl'l1Ients:
Storm Sl'\\'('r A "ailable:
Spcciallnstrll(:tion:
Notes:
I Valuation Descriotion I
Jlcscrilllinn
Typc of Construction
$ Pcr Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Page 1 of2
Se-~INf.l{t.'~
- . - >>,-,,-'- ..'
l,Jj
II
.
.
CITY OF SrKuiGFIELD
Building/Combination Permit
Status
IsslIed
PERMIT NO: COM2004-01041
ISSUED: 08120/2004
APPLIED: 0812012004
EXPIRES: 02/20/2005
VALUE:
225 Fifth SII'Cl'I, Springfield, OR
541-726-.17;;.1l'hone
541-726-.167(, Fax
541-726-.176') I n'pection Line
I Fees Paid I
Fcc Description
+ 100ft, ,\dmillistrativc Fcc
+ 70/0 51:lte Surchargc
Manufat'fllrcd Homc Service
Amount Paid
Date Paid
Receipt Number
$5.00
$3.50
$50.00
8/20/04
8/20/04
8/20/04
2200400000000001075
2200400000000001075
2200400000000001075
Tofal Amount Paid
$58.50
I Plan Reviews I
To Requcst :In inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be m:ldc the same working day, inspections requested after 7:00 a.m. will be made the following work
clay.
I Reouired Tnmections I
~ III Service: Approval required prior to utility company energizing service.
Ill' sigualnre. I 'late and agree, that 1 bave carefully examined the completed application and do hereby certify that all
iuformatinn ''''I'eou is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinance, of the City of Springfield and Ihe Laws of the Stale of Oregon pertaining to the work described berein, and
that NO OCCUPANCY will be made of any structure wilhout permission of the Community Services Division, Building Safety.
I furth,'r l'l'rlif~' tha' ouly conlraclors and employees who are in compliance with ORS 701.005 will be used on this project.
I furthl'r aJ,!rCl' In cnsurc that all required inspections are requested at the proper time, that each address is readable from the
,'reet, """ the permil card is localed at the front oflhe properly, and Ihe approved set of plans will remain on the site at all
times durin!! fOllstrllction.
Owner or CUlltractors Signature
Date
Paee 2 of2
225 Fifth S t reel
Springfield, Oregon 97477
541-726-3759 Phone
.'
.
""~AIN'!>_Fl"~.,.' _'.'~P" ~,
Ilk'
, ,
'~ '.~ ;
, ,
-..' .-- ..~
aty of Springfield Official Receipt
.evelopment Services Department
Public Works Department
RECEIPT #:
2200400000000001075
Date: 08/20/2004
1:37:11PM
Job/Journal :"lIll1hrr
COM2004-0 I 041
COM2004-0 I 041
COM2004-0 I 041
Description
Manufactured Home Service
+ 7% State Surcharge
+ 10% Administrative Fee
Cheek
Paid By
L.I'I. MORRIS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
50.00
3.50
5.00
$58.50
Payments:
Type of PaYIl1('1l1
Amount Paid
njm
112118
In Person
Payment Total:
$58.50
$58.50
8/20!2004
Page I of I