HomeMy WebLinkAboutPermit Electrical 2004-8-27
1'.
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAX: (541)7~~~89
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ELECTRICAL PERMIT APPLICATION I ~'or;".Q o!z:,,,
City Job Number CO~ z.o 64 - 0::> 0'70 Date ~jfc?7'~~"0' ~'oro/",
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LEGAL DESCRIPTION
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JOB DESCRIPTION
A-DG
'7
C l /2..U_A ,1s
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
(:) "32.00
Permits are non-transferable and expire if work is
/- not started within 180 days of issuance or if work is
Suspended for 180 days.
2. 011 aE \i:j~*
m .~ ..t ,~..' .l'T 1HIS PER S PERMIT IS NOTJ -
Electrical Contractor ~J ( ~ r'f' \'L\AIV tU~iJTHOfWllferWd[3Ei&sIHI R1
I .\' COMMEWJ~~d~~~ONED FO
Address ~n-0\ (~ Q~ e,/ C~'9 ANY 16eOID~E~\oo.Amps
(\ ~ + 601 Amps to 1000 Amps
City \"b I Phone 7J.~ -) l(K,ll Over 1000 Amps/Volts
V Reconnect Only
$ 63.00
$ 75.00
~125.00
$163.00
$375.00
$ 50.00
Supervisor License Number ~:) ,)
Expiration Dare --tt/..d-il1J.
Constr. Contr. Number g7 SD b
Expiration Date /11 04
c.
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Address
City
Owners Signature:
4.
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Inspection Request: 726-3769
7% State Surcharge ~((') kV / ~ /'
10% Administrative Fee ~'\> (j' f~~";'
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Shared Drive(T:)/Building Fonns/Electrical Petmit Application I-D3.doc
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TOTAL
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00878
ISSUED: 07/14/2004
APPLIED: 07/14/2004
EXPIRES: 01/14/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6354 C ST
ASSESSOR'S PARCEL NO.: 1702342403200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
PROJECT DESCRIPTION: Panel changeout. Heat pump on permit COM2004- 01022
Alteration
Residential
Owner: KELTON ZACHARY J & JANICE L
Address: 6354 C ST SPRINGFIELD OR 97478
Phone Number: 541-683-7128
Contractor Type
Electrical
I CONTRACTORINFO~
N01\CE: II E'1.PI\-\t If NOl
ContraclffilS ?r.\\lA\1 S~r.\\. 1\-\\S PERM\\ ~~nse
MY ELEC!m<4~~~~l\ \'i t.p.i\NOONEDtfJb\
, COMME~G~FORMATION I
p..tW ~ 6
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Expiration Date
11/20/2004
Phone
541-729-1454
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
R-3
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage: , W requlres yoU to
ATTENT10N; Oreg~nb~ the Oregon Uti\\ty
"QW I.!\V .~\.:..; :...f"'rtQifh e ru\es CliO ~....\ ~s~
.. . ~NmS os hOAR952~OO1.
\n OAR 952-0 .. ? th~~~es by
0090. You may obtain ~~e.\ft\E}J11o~e.
calling the center. ( UtiliJf.fofif'i fci\\~
number for ther o1re-80go~32..2344).
Center .s
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description'
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee 1 of2
~S.H.PR.'N~...r;;"'IlIiLD'... iii.... .......'..............'.
WIr'.~ ;
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Status
Issued
CITY OF SPRI~li~lELD'
Building/Combination Permit
PERMIT NO: COM2004-00878
ISSUED: 07/14/2004
APPLIED: 07/14/2004
EXPIRES: 01114/2005
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
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$6.30
$4.41
$63.00
$2.10
$1.47
$21.00
7/14/04
7/14/04
7/14/04
8/27/04
8/27/04
8/27/04
Receipt Number
2200400000000000926
2200400000000000926
2200400000000000926
2200400000000001102
2200400000000001102
2200400000000001102
Total Amount Paid
$98.28
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
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
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.
Owner or Contractors Signature
Date
Pa2:e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
r;ty of Springfield Official Receipt
. velopment Services Department
Public Works Department
RECEIPT #:
2200400000000001102
Date: 08/27/2004
lO:47:48AM
Job/Journal Number
COM2004-00878
COM2004-00878
COM2004-00878
Description
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard EDWARD GUIDRY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 967369 In Person
Payment Total:
Amount Due
21.00
1.47
2.10
$24.57
Amount Paid
$24.57
$24.57
8/27/2004
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