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Home My WebLink AboutPermit Electrical 2004-7-14 .< I I' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72~-3~.? ELECTRICAL PERMIT APPLICATION "'00 ~"'" ") ;9 City Job Number CO't{\ "2-ct:::4-~e~(e Date 0'\ ~ ll\- -0 <\- ~&o ~. ,'. . . :--~.........9?", 1. '3. SCH.~DUEE!!' Co ~s-4- C ~ LEGAL DESCRIPTION Ll () L S~ "2-0.:.- ~ '3>200 JOB DESCRIPTION P"",Q.\ ~,,~~ 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. -/ EJ"trie,J Contr,etm- I'I\Y, tl Ad<h", 3 :l-~ \ b {( i \ ey llMl Q "R 'f- City C1\hf1~. utPhonc _<~~\ I . \f 0 - ~~~\'(-.v~~~ ~~ ~\)~ ~\.\. ~~~~\. Supervisor ~~€ ~~5e~~\0~~~~ ~~~ ~~ \S. Expiratio~~1e _ , ~\) tr'0\ ~~ ~,<". Constr. con~~\) a 1 S- 0 b ~~ J. Expiration Date I) JO!>ll Signature of Supervising Electrician ~~UJ~ / Owners Name -z.... I\c.. 8.... ~( K:E--L,,\o-f-\- Address (0 'S S (\.- L Sr\, City S~ Q-ltZ~f' ~L.D Phone b8 ~ -'1 l2.3 OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 A. 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder " $ 19.00 $50.00 B. 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 63.00 0~, 00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. $ 43.00 $ 3.00 E. Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. 6 ~ , ()~ ~L &.-- \. Co .30 ~ '1 3, at l 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application I-D3.doc Status Issued CITY OF SPRINGFIELD' 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 SITE ADDRESS: 6354 C ST ASSESSOR'S PARCEL NO.: 1702342403200 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Panel changeout. Owner: KELTON ZACHARY J & JANICE L Address: 6354 C ST SPRINGFIELD OR 97478 Phone Number: 541-683-7128 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor MY ELECTRICIAN INC. License 87506 Expiration Date 1112012004 Phone 541-729-1454 BUILDING INFORMATION I Street Improvements: # of Units: # of Stories: Primary Occupancy Group: R-3 H~ht of Structure Secondary Occupancy Group: ~~~ of Heat: Primary Construction Type VN '\~~ c.WMer Type: Secondary Construction Type: '8:-~.:* ~'\~' ~ge Type: # of Bedrooms: ~fS.~ ~~~ S;.~ \tDergy Path: t\-\..\.. -<~S <\\:)~ Sprinkled Building: ",V;r (o." ,,~\.I ~,\\tV\~~~'0~\,)\S t:r-V' I DEVELOPMENT INFORMAuUN . ~ ,,0 ~v ~S ~ ~"ly;. G\) \:)~ ~\J\)' IO,\O.\~~-\..~REQUIRED PARKING '\'0 ~\) ~\\.,\,... 'X~ ~\<..0 ~ v ,0"" .' Front yard Setbll~lE:s\ ~Y)"" \)~ Overlay Dist: <..0fS. 0C!J0 ro0' R)~"'<fC)tal: Side 1 Setback: \.,\)~ \CO'0 # Street Trees Rqd: \'?J.~ 00" ~0 ~~'l; s'Ulmdicapped: Side 2 Setback: ~~-4.. Paved Drive Rqd: 0~O~ 'O~ ~ <..~0ro O"?-~ 0 (.s.0~mpact: Rearyard Setback: ' % of Lot Cove~~~ ~\.00 ~Oro0 ~rf'o' ~ e'Q,(:/:i ~# Solar Setbacks: . ~\O '?J.~}J e<". ~ ~O ~\0~ 0'\.e\1 ~,\\r;j) t<t':.~' 1'1"0; ,t\~ ~,,~...O'" ."'~ NO I PUBLIC IJ~J.~~~\.~\\ ~O'\.~~~~:rC>~~V '" ~ ~" ~~. :\e~~" o~,~~7; ~<tb~' ~ . ~~. v~ " ~;Type: ~ ~~~~; K'e V ~~~. .~~) \O~~.' (:~wnspouts/Drains: ~'(l~\~~~\ . -(\.\~) ~~~J ~'<J)' Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a Storm Sewer Available: Special Instruction: 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 Pa\?e 1 of2 Status Issued .<! CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00878 ISSUED: 07/14/2004 APPLIED: 07/14/2004 EXPIRES: 01114/2005 VALUE: ;j 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 Amount Paid Date Paid Receipt Number $6.30 $4.41 $63.00 7/14/04 7/14/04 7/14/04 2200400000000000926 2200400000000000926 2200400000000000926 Total Amount Paid $73.71 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 , Rough Electric: Prior to Cover 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 ti~wt~ r Own.. or Contractor, Si~~ Date Paee 2 of2 if:,:. 225 Fifth Street . 'Springfield, Oregon 97477 . 541-726-3759 Phone r;ty of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 2200400000000000926 Date: 07/14/2004 1:43:55PM Job/Journal Number COM2004-00878 COM2004-00878 COM2004-00878 Description Perm Serv/Fdr 200 amps or less + 7%State Surcharge + 10% Administrative Fee Payments: Type of Payment CreditCard Paid By EDWARD N GUIDRY Item Total: Check Number Authorization Received By Batch Number Number How Received Jmp 000440 024182 In Person Payment Total: Amount Due 63.00 4.41 6.30 $73.71 Amount Paid $73.71 $73.71 '!~ :{1. ~~ 7/14/2004 Page I of I