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Home My WebLink AboutPermit Electrical 2004-8-30 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Q O/'Y\. &0() if -DI () I , Date ~ .-- ~ - 0 f pow~~rJJrl:t:;:;:m;:::::f~Mfif!//1~Z:;t;:;z~ LEGAL DESCRIPTION A.~~si<iel1tial--:SiIY..re?~.J\'lulti-Famil)' per dwelling unit. %~O~ _ 0 00 n 0 [) DO 00 n () 0 Service Included <> "'0;: .;;:Iz;,;" . 'l'/. ' 0';9", JOB DESCRIPTION , 1000 sq. ft. or le$~ @ ~ '9. '0, $106.00 If) ./ , .L f , ' j Each additional 50~q. . oro'?,." t.\S'? lvc>,- "'l!lOtl'fTG' f;<'l:5f/1fPi $P4<1lt1..(./Mt1'!ttt,7'lp1f,{tvu rhereof <->@O'u;.. ~ 0,- -\<S>t; $ 19.00 -fge~ nfd!frf&k!::!i3Jll?;fff:prr~ if work is Each Manufact'd Home~~ _ '8 0;.@ ~~ not started within 18-0-~"~f issuance or if work is Modular Dwelling Service ~ ~(\h~ ~,o 00 Suspended for 180 days. Feeder ~'O ~~'- 41'- ? B. ~~1:~~'~~;~t~0 ti~~~t~JdOri: l[!5r:,rJ\icalContractor L.R. Brabham, Inc. 200 Amps or less 00 1(/)' 201 Amps to 400 Amps '\. 5. 0 Address 68 West "Q" Street 401 Amps to 600 Amps '\.$125.00 601 Amps to 1000 Amps $163.00 City Spfld. 97477 Phone 747-6638 Over 1000 AmpsNolts $375.00 Reconnect Only ~ $ 50.00 I lJ{j ,00 Supervisor License Number 4944S c. Expiration Date /DII/tJtf / , Constr. Contr. Number 8699 Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps Over 600 D. $ 50.00 $ 69.00 $100.00 Expiration Date I'J../ / % I () C(- / Signature of Supervising Electrician /L ~~L' t-/ /' '7 /) ,- , Owners Name U R /" . 4 5j)l~ Address O?~ S t4{).s~ ' ( E. 1VliscltraT/iNiF/~M:'?5i/feeder not included) -Each Installation . ~ / ?J1C: 3 h"ow rules a'd egon tawrequfres , City 7h Phone 1;J,1() I ZJ PumporWrig~~cen oPtedbYtheorA90{~~1P .. .~. Sign/Outline ~~~ _~~ Those rules ~r9tNlll1 OWNER INST ALLA nON Limited En&.g~~~rm~~ through OAR ~~ :!OT1CE' .. 'InJ.J) .mcop,esofth · The installation is ,be~' ~in~ ~n Qr'.)p~.l,QWn w~1.1,.. Llmlte~ EnergJ~<J.tlH~~a~N t e f$J~" ,. "~1, '1;'.I'J ~R L ti\t"lt'\t: Ir I Ht: W~ 1.1,,0 i.J(;;, for th . ( 0 e; me~/i3h ' IS not lDtended f01: ~a,l,,, \~a_ ~ 0 1 :l:in; . mum Electrk..PerI11j~Qr~~I{}t,,~i.s ::l.8wcmJorcharaes 11_'r\IZtJ U ~D:R THIS PERMIT IS Genter is 1.80 'lY, otification '" Owners Signaturej ,,~L"J~tD O~ IS ABANDONED FOR 4. SUBTOTAL OFABOVEo~a2"'2344j. I~~, ~O I r 100 DAY PERIOD. /},OO 7% State Surcharge / ! 0,00 _jJ), D2 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Forms/Electrical Pennit Application I-03.doc I" I"' II: f ~ f, ~ CITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: COM2004-01011 ISSUED: 08/30/2004 APPLIED: 08/16/2004 EXPIRES: 02/28/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726:"3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 202 S A St ASSESSOR'S PARCEL NO.: 0000000000000 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Public PROJECT DESCRIPTION: Install service cabinet on traffic signal pole. Service @NE Corner of South A & Pioneer Parkway West. Owner: CITY OF SPRINGFIELD Address: 225 FIFTH STREET SPRINGFIELD OR 97477 Phone Number: 541-726-3753 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor LR BRABHAM License 8699 I BUILDING INFORMATION I Expiration Date 12/18/2004 Phone 541-747-6638 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a REQUIRED PARKING Frontyard Setback: Overlay Dist: Total: Side 1 Setback: # Street Trees Rqd: ' Handicapped: Side 2 Setback: Paved Drive RqdATTENTION: Oregon law re~~~p'U. ~o Rearyard Setback: % of Lot Covera~5!1ow rules adopted by the Oregon Utility Solar Setbacks: _ . .1l\P." Notification <?~nt~~. ,Th~S~ rule~:~e ::~_~~ '. ~: '- tJ?\~'t. W .~~I f.~~nlc IMPROVEM~N~si~~~~;y' ;~~Tnl~~~:: of the rules by Stree&l:dd>O~t~~.Ij(s:S\\~\", :\\\\S ?t.O~'t.O rO? calling thESitie~lirk {f~p~:.t.he tel~~hO~8 , 1'r\\S \' .~\;~\\ \J\~u I\Q~~O . number for...the Oregon Utl!tty Notification Storm Sew, er.~yadable:OQ \S l"U , ' C DOWllSDOiit!;II)J'alDSh44) f,\ \ \ \~ ('CD " eOler IS "I-OUU=-0v'.-O::v . SpeciaIIInstriuctioh:l~ OCO\OO. . O..)\'1\I'I'\..-' . ~'{ r~" Notes: f\~'{ '\ \',\J \) I DEVELOPME1'l1 ll~FORMATION I 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 Pal!e 1 of 2 /1 f W Status . Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726~3676 Fax 541-726-3769 Inspection Line L Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps o'iless + 10% Administrative Fee + 7% State Surcharge Service Reconnect Amount Paid Date Paid $6.30 $4.41 $63.00 $10.00 $7.00 $100.00 8/16/04 8/16/04 . 8i16/04 8/30/04 8/30/04 8/30/04 Total Amount Paid $190.71 I Plan Reviews I CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01011 ISSUED: 08/30/2004 APPLIED: 08/16/2004 EXPIRES: 02/28/2005 VALUE: Receipt Number 3200400000000000209 3200400000000000209 3200400000000000209 1200400000000001286 1200400000000001286 1200400000000001286 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. L Reouired Insoections , Electric Service: Approval required prior to utility company energizing service. 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 times during construction. Owner or Contractors Signature Pae:e 2 of 2 Date .225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-0 10 I I COM2004-01011 COM2004-01011 Payments: Type of Payment Check 8/30/2004 r<:ty of Springfield Offis:ial Receipt ,velopment Services Department Public Works Department RECEIPT #: .1200400000000001286 Description Service Reconnect + 7% State Surcharge + 10% Administrative Fee Paid By L.R. BRABHAM Received By lkw Page I of I Date: 08/30/2004 Item Total: Check Number Authorization Batch Number Number How Received 31059 In Person Payment Total: 2:46:46PM Amount Due 100.00 7.00 10.00 $117.00 Amount Paid $117.00 $117.00