HomeMy WebLinkAboutPermit Electrical 2005-6-17
3.
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 ยท FAX: (541~~-~1i89
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ELBCTRICALPERMIT APPLICATION . c~':~'(}~, .<,~
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CIty .Tob Number eolNt z.oo~-oo 7 S -, Date b - 7 -O~ ,- JO 'to
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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
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73 '7 f
Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc
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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