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Home My WebLink AboutPermit Electrical 2005-6-17 3. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541~~-~1i89 . ':\o~"t~ ELBCTRICALPERMIT APPLICATION . c~':~'(}~, .<,~ . I / ...- ,"\,;,'<>:(\\ CIty .Tob Number eolNt z.oo~-oo 7 S -, Date b - 7 -O~ ,- JO 'to .' Owners Signature: ;; ." :c. , 4 -tHIS PcKIVllT SHALL EX?iPlIF fJ,'u iHOi<12EJ UI~IJER THiS PERr\1tbiol~tJ~P~urcharge . I '" '~"Ci_1J U' . P b" '~IJUNErl i=m~ COI\II,ICh L K I~ \ hi '10o/ci'A.dministrative Fee f\.IN "\ ee; Of-\Y PERIOD. Inspection Request: 726-3769 TOT AL 1. LEGAL DESCRIPTION 17033boO oobOO JOB DESCRIPTION A ~~ lcJoAwtf SE(l"lL~ Perm its are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contractor ~ {I.) Va {(lie ,tp j;u L.- Address yJ 0 v:1 tJ! D2 /.5 03 , City ~;fiL Phon6<1l-6R0 i1 ~05 Supervisor License Number ~,j;) f?;;; 5 Expiration Date I 0 ,- 0/- ~ of-,lfPf Constr. Contr. Number :C; / 0 cf!? Expiration Date ~ ~,;; 7 -0 _S .,/ Owners Name Address City Phone OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. ,~ r ..j .. E A. 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 $ 19.00 $50.00 B. 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only I $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 b) c. . follow rul~s adcwted b.Y the Oregon Utility InstallahfflJt!tillaffbYioeg~~F.lor~Bg~ rules are set forth 200 AmpltPoJAiR 952-001-0010 through OARf0~Q-001- 20 1 Ampi{)~Oy''(}Olmay obtain cODies of ttle9r:O'8s bv 401 Amps t<calU~Itfoo center. (Note: the tlll~l:001e Over 600 ~gfl~ ~ijo $~g~@~0lf4~~tye~otification D. [;~!ir"!S#il~{0'li'it New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Pump or in-igation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges "3 Lf'lf b30 73 '7 f Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc _8~.1 IdA. ..... Ia. .: Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00757 , ISSUED: 06/17/2005 APPLIED: 06/17/2005 . EXPIRES: 12/17/2005 VALUE: SITE ADDRESS: 1701 SA ST ASSESSOR'S PARCEL NO.: 1703360000600 Springfield TYPE OF Electrical Work Only TYPE OF USE: Addition Commercial PROJECT DESCRIPTION: Add 100 amp service Owner: SPRINGFIELD UTll,ITY BOARD Address: 223 A ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor NEW WAY ELECTRIC INC License 51088 Expiration Date 06/27/2005 Phone 541-686-2365 I BUll,DING INFORMATIONI # of Units: # of Stories: Primary Occupancy Grout9cTTENTION: Oregon IMtigttlWfes you to Secondary Occupancy follow rules adopted by11YP:e@f~:Utility Yrimary Construction TtP~ification Center. ThmW,Uje~!u~:set forth Secondary Construction in OAR 952-001-001 0 thr5@~(J~R~52-001- # of Bedrooms: 0090. You may obtain c~~fIM~Fules by calling the center. (NG~~\,~~glephone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Storm Sewer Available: Special Instruction: ffTr"r,r"r;::.. IPUBLICIMPROVEMENTSI u\jU u 6~~. THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR A1~Y 180 DAY PERIOD. Sidewalk Type: DownspoutslDrains Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRING111ELD ' Building/Combination Permit PERMIT NO: COM2005-00757 ISSUED: 06/17/2005 APPLIED: 06/17/2005 EXPIRES: 12/17/2005 VALUE: Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6.30 $4.41 $63.00 6/17/05 6/17/05 6/17/05 Receipt Number 1200500000000000864 1200500000000000864 1200500000000000864 Total Amount $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. 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 wiD 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 COM2005-00757 COM2005-00757 COM2005-0'0757 Payments: Type of Payment CreditCard , -, " 6/17/2005 City of Springfield Official Receipt ~velopment Services Department, Public Works Department RECEIPT #: , 1200500000000000864 Date: 06/17/2005 3:20:43PM Description + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Amount Due 4.41 6.30 63.00 $73~ 71 Paid By NEW WAY ELECTRIC Item Total: Check Number Au Utorization Received By Batch Number Number How Received djb 007640 In Person Payment Total: $73.71 $73.71 Amount Paid I of 1