HomeMy WebLinkAboutPermit Electrical 2006-12-15
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job NumberL.om LiJri.g - 0 \ ~ \ .,
3.
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
B.
200 Amps or less j
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
C.
LEGAL DESCRIPTION:
\/03 3<P II 0' 60D
JOB DESCRIPTION:
~:::~: no2~~'~~PI" Ifwo,k b
not started within 180 days of issuance or if work is
Suspended for 180 days.
$106.00
$ 19,00
$50.00
2.
$ 63.00 ~,-3
$ 75.00
$125,00
$163.00
$375.00
$ 50.00
Electrical Contractor
Address c: tr. f. E!~ctriz !r:C.
l~.C~. .~_:O.(I 1~.=2
C;;<"'''~ r .'i nn ':)7477
City I.. ~J "~._,-,,_4, .., <J t'hOlle'
Supervisor License Number 4~ LfS
to/ I JOB
,
85t.fCf
q/l/OR
" -
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Expiration Date
$ 50.00
$ 69.00
$100.00
Constr. Contr. Number
Expiration Date
Over 600 Amps or 1000 Volts see "B" above.
D.
Signature of Supervising
~a^-'~ ~''''\!lid. ... lid::> _ ..l,\)
fli \cl\\,\_n"'--::"'~ o~t ,OregoniJ"I,ly
tollow i u\eS 3~C,t~1'Jd '.I ,,~. re set fortI'
pwoeJ:s,N&n~~O D ol;~M101
,'!ot\IIL;C1.' 1~10~OU\:l\l' T 1. .,-
\f't..~~v:-. i~nri:.<fle rules ~ E.
nn90'~~f:~YttAj~3.' -- ~ thetelepnone' " .
C1~, _~r, \Nrptf6~hy--N:etifi':'!:Iti~ Pump or lITIgatIOn $ 50,00
;111mb t()rtheOregon_~~~1_23446/5 -- ()qq 5 S~g~Outline Lighti~g , $ 50,00
OWNER l~iMJ~:h()~ ' Limited Energy/ResidentIal $ 25.00
The installation is being made on property I own which Limited Energy/Commercial $ 45.00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45 00 + Surcharges
. ~
(/73.
...6.0_'1
::T. i~
~'60
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
4.
Owers ~igpature:
[UU i mil"
8% State Surcharge
10% Administrative Fee
5% Technology Fee
TI113 FERlvil-i 3ftALL EXFlhE IF TilE WORK
AUTHORiZED UNDER THIS PERMIT IS NOT
COMMENCEO OR IS ABANDONED FOR
InA~~t~g cffJW~sp E 'FHb1f69
TOTAL Ji .I I. Ljf
Shared Drive(T:)/Building Fonus/Electrical Permit Application 8-06,doc
'I:j~'"""t,;",."
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01617
ISSUED: 12/15/2006
APPLIED: 12/15/2006
EXPIRES: 06/15/2007
VALUE:
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2535 J ST
ASSESSOR'S PARCEL NO.: 1703361101800 -
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Weather Head (Wind Damage)
Owner: V ANIS LISA M
Address: 2535 J ST
SPRINGFIELD OR 97477
Phone Number: 541-515-0995
I CONTRACTOR INFORMATION.
Contractor Type
Electrical
Contractor
C & SELECTRIC
License
3849
BUILDING INFORMATION I
Expiration Date
09/01/2008
Phone
541-741-2236
# 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
I DEVELOPMENT INFORMATION.
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I '
Street Improvements:
Sidewalk Type:
Downspouts/Drains:
An t;:N IIUi~;vlt:yulllav" le41..l11t:~ yvU. ~iJ
follow rules adopted by the Oregon Utility
.. . ' C ter Those rules are set fortI
THIS PFRMIT ~I-I~ I ~ cY.PI~E If TIlt '''01RI( Notification en...., ~ '1' "J"'~c Q!:\?-OD1
AU VVl.' H~oO:::-UUI-VV v...1 \;lo~'
THORIZED UNDER THIS PERMIT IS NOfaluation Descri ti ~" . You may obtain copies of the rules ~
COMMENCED OR IS ABANDONED FOR calling the center. (Note: the tel~~ho~e
~~XrMt~oR A Y P EfJQAf Construction $ Per Sq Ft SquBa.rdeJIfWli9~1or the. 01~g~!:l3U3t2i1it2Y3N~~~~~;:~~ated
or multiplier or ll'Arriounventens -Stm- - I.:A/.
Storm Sewer Available:
Special Instruction:
~JtIICE:
Pa2e 1 of 2
Status:
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01617
ISSUED: 12/15/2006
APPLIED: 12/15/2006
EXPIRES: 06/15/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$3.15
$5.04
$63.00
12/15/06
12/15/06
12/15/06
12/15/06
2200600000000001712
2200600000000001712
2200600000000001712
2200600000000001712
Total Amount Paid
$77.49
I Plan Reviews,
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 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 ofthe 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
Date
Page 2 of2
225 Fifth Street
Sprjngfierd, Oregon 97477
541-726-3759 Phone
C., . of Springfield Official Receipt
l ,dopment Services Department
Public Works Department
Job/Journal Number
COM2006-016I7
COM2006-0 1617
COM2006-0 1617
COM2006-0 1617
Payments:
Type of Paym,ent
CreditCard
cReceint 1
RECEIPT #:
2200600000000001712
Date: 12/15/2006
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
C & SELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm
396144 In Person
Payment Total:
Page I of I
2:14:48PM
Amount Due
63.00
3,15
5.04
6.30
$77.49
Amount Paid
$77.49
$77.49
12/15/2006