HomeMy WebLinkAboutPermit Electrical 2004-8-16
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: '(541)726-36@2 c;.)~
ELECTRICAl:.. PERMIT APPLICATION ~o~
City Job Numbe'-.JJy' 2..o~y - U I 0 i I Date '6} ILR J 7--LJ7) 4- tQo-~.
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LEGAL DE~ A. se~v::~::::::::al..c Sing,l:or Multi-FlUnily p
JOB DESC~lf~l'i. 1000 sq. ft. or less
~501J ~w~~ea6tA1b1 rm Y;ttL;UL~ ~~~~0~d~~~~~~1500 sq. ft. or
5t.q 'yi~ FtTU:..- . (A/'
Pefmits are non-transferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or ~" ; ~ ...;i~',:;:; YcUs5b 00
Suspended for 180 days. Feed1>.tt1ENTION: Oreqo,I;\~::~~~ -~'''''''1')n utility'
~S'.r:SL~~Srf!~INSTALL.i1TlON OZYLY B ~~~1:~iI~il~~F~~~~"o'~"on:
f l. :l~ectrical Contractor U. !JMhMfrm JIve- 200i9JrlJt~t~~~.: ~bt~~n ~'opies of/he r~\ef&1 ~3, ()tJ
/-17' J 11/JL! I"~ II "",_, . 201 ~R~'\f~9q~~~uwer. (Note: the tel~~~9E~a
Address lJ?J VVtJ ;;;:;>f1L- 401 AJr~ tBgp~~Oregon Utility I~otl 'ffi5.00
601 A~P~O l~grlWI~!ii 1_800-33~~i'~'t4). $163.00
City S vfLb . 97tf77Phone 1i7- 663J Over 1000 AmpsNolts $375.00
I Reconnect Only $ 50.00
Supervisor License Number 4e; t/- r.f Sl
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OWNER INST ALLA nON
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Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600
D.
New Alteratit)n--or bt~J!s.. ior p;~Jj~ltie1d ;'VO nq ~ } ~.r'1
Ol!j UjNLI(]~ \-10\.' 1'1 1 'n [J'
One Cif1.n.N ~r . ;~'. _. . u c~'-> =:$!~~.PPyvr\J
Each A fl1iJA~~rr-11ltu~~$iHil tb1im O:F;~O~J n\f
Service r-1't&"d;lIBJrnih3ti1dX3 lTv'IIS Illj\~~{j:~ S;"ll
E.i>~II~~~ii~h~()lls(S~r~,ice/f~ed~;h~t.. ~i~lude~1tttJi~stalla tion
$ 50.00
$ 69.00
$100.00
Expiration Date
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
"
."
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45,00
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
7% State Surcharge
10% Administrative Fee
t1J 3,
Lf,'If
6,,30
______78. 71
Owners Signature:
4. SUBTOTAL OFABOVE
Inspection Request: 726-3769
TOTAL
Shared DIive(T:)!Building Fonns/Elecl1ical Pennit Application I-03.doc
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Status
Issued
CITY OF SPRINGFIELD -
, Building/Combination Permit
PERMIT NO: COM2004-01011
ISSUED: 08/16/2004
APPLIED: 08/16/2004
EXPIRES: 02/16/2005
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
BUILDING INFORMATION.
Expiration Date
12/1812004
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
NOTICE:
Frontyard Setbactl:HIS PERMIT SHALL EXPIRE IPm~W?jftK
S!del Setback: AUTHORIZED UNDER THIS PEt!t~~1f.1!-~~J\~ Rqd:
, Side 2 Setback: COMMENCED OR IS ABANDO 'PaVed Dr'iW Rqd:
Rearyard Setbac~NY 180 DAY ~fOO Coverage:
Solar Setbacks: PERIOD.
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
G
Street Improvements:
Storm Sewer Available:
Special Instruction:
ATl IJ;>UBLIC IMPROVEMENTS I .
E, . . . -. C '- ,'. ,~,'_" .w", I vl..jUlI tlb you I!.l
fO!'.?W ~ules adopted by the Oregon Uti~l~ewalk Type:
~otlflcatlon Center. Those rules are set ~9~nspouts/Drains:
In OAR 952-001-0010 through OAR 952-00':
0090. You may obtain copies of the rules l
calling the center. (Note: the telephone
number for thA OrAnrm Iltifih, I\I,.,~;+;~~.,__
Notes:
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: COM2004-01011
ISSUED: 08/16/2004
APPLIED: 08/16/2004
EXPIRES: 02/16/2005
VALUE:
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
8/16/04
8/16/04
8/16/04
3200400000000000209
3200400000000000209
3200400000000000209
Total Amount Paid
$73.71
I. Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested befo're 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 I
Electric Service: Approval required prior to utility company energizing service.
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 locatedat the front of the property, and the approved set of plans will remain on the site at all
times during construction.,
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Owner or ContraaUr~ Signature
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Date
Paee 2 of 2