HomeMy WebLinkAboutPermit Electrical 2004-12-27
.,,_", -;':, "~t"'';.'~~'~~l''!.'';'' _;t \.'~~ ,'.~ ":. ",0$__,,";,. . '~.." "', ..' . :t'....\' .t~~J:...:t<lf>:.'.;,..'..-~....."';..?;.'.:..~
'~;',j~').;; :~il:;;;f.q i;~':'~'.:..,ffi;)},~@'!Im~~,Gi)E}~~rr \IffiRlliEHm';'!l@'R.iw@@N/";,'" " ;' ":""<< (~' "if.,;\2.\~l
~~t~:~~~\~~:~~tJIl\~1'~~~~~4~~'M:~f~$1r~f~~:r~~;~.,...di.~1 "Z}~~'~\;Y(1:~~~it . ~ :~f*~~jk(~~( f~, f~~(~:( .:~ tl " .: ~; ~. (!\~~lk ~:>.-!.;(.~~t
_ A
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541}726-3753 . FAX: (541)726-3689~ 'b.,1:,~
ELECTRICAL PERMIT APPLICATION . ~ ::oo:~ '%~
~ 1> ~~~
City Job Number CoV\;\ 'ZIzO l{ - I S- 7 '7 Date %. 0- ~
o 0-0 ""
~ ~.
City Ql fl, tAlE
1000 sq. ft. or less
rl / Each additional 500 sq. ft. or ou \0
'1 b c/ /2.LV\..:-U portion thereof ....., teC\U\l'eS ~ ut~
, no" ,~~. n, ego" rth
t.rl\~~!tl~~e-Jr ate set \0 "\.
"'~:~8glti~~~o~?t 952-00
to\\OVl ~e~~(l\ef. \htOUgh 0 the {uh;: h,!
~\f\ca; () . ~ \
,",0 pP.
" ~(). c8"t8 . U\\\\\'I
Electrical Contractor rilt. EJUc.. ~llinjt!. Sf.el.1~~~~~@tegon_332_2344).
nurt\'o~~i\\e~ tw~-~~~s
Address /.2() IntJ/\/12.iJ6 ~. 401 ~ps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
LEGAL DESCRIPTION
/70] 3S / <-I
JOB DESCRIPTION
;+
20 <:) St:Cl.AIlc...<.:-
I 2 s, G c:::,
A.
1.
t 2-- SO
C sf-
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.
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Phone :3 '-Iii - 3 b (P I
'-...,.'.";...
.....,<.............<ii/It
~-:L3r(1
Supervisor License Number ~ T ..::> v
Expiration Date { () II / ~O 0 :t-
I
Constr. Contr. Number 9 C? :J. CJ D
Expiration Date .311 t-l () ~
Sigriature of Supervising Electrician
$ 3.00
18
~/--'yt:t;;::I
Owners Name LrJ-rVc:...e- .~ D S t::--r
Address :So .s 2 st- # C]
E.
City
SYIr-~
Phone
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
OWNER INSTALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent
7% State Surcharge
10% Administrative Fee
<6-1
~f,7
8'/0
?C/?Z
Owners Signature:
4.
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding FormsIEIcctrical Permit Application I ~3.doe
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2004-01577
ISSUED: 12/27/2004
APPLIED: 12/27/2004
EXPIRES: 06/27/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1230 C ST
ASSESSOR'S PARCEL NO.: 1703351412300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Service change and 6 circuits
Owner: LANCE POSEY
Address: 305 E ST #9 SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor
EUGENE ELECTRIC SERVICE INC
License
90200
Expiration Date
03/17/2005
Phone
541-344-3561
I BUILDING INFORMATION I
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nla
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:
~OltCE: DorxPffi~t~~N~9NORK
1\-11S PERM\1 S\-l~~~ 1\-\lS PERMI1 IS N01
AIJT\-IORIZED U~~ IS ABANDONED fOR '
COMMEN~~? ncO\(\n
Notes:
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: COM2004-01577
ISSUED: 12/27/2004
APPLIED: 12/27/2004
EXPIRES: 06/27/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
L Fees paidJ
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$8.10
$5.67
$18.00
$63.00
12/27/04
12/27/04
12/27/04
12/27/04
Receipt Number
1200400000000001788
1200400000000001788
1200400000000001788
1200400000000001788
Total Amount Paid
$94.17
I Plan Review~
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 ,
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
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 ofthe 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 ofthe 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
;
r"~ty of Springfield Official Receipt
. ~velopment Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97477
!If'
541-726-3759 Phone
RECEIPT #:
1200400000000001788
Date: 12/27/2004
11:18:07AM
Job/Journal Number
COM2004-01577
COM2004-0l577
COM2004-0l577
COM2004-0l577
Description ,
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard RUSS ROBBINS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 027654 In Person
Payment Total:
Amount Due
63.00
18,00
5.67
8.10
$94.77
Amount Paid
$94,77
$94.77
I:
I'
"
12/27/2004
Page I of I