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Home My WebLink AboutPermit Electrical 2004-7-26 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Tob Number LOVO'\ZoOy-001Z:~ Date 7/7-~,;{;lt 1. 2-b s L/ ~ LEGAL DESCRIPTION \ 70 3 ~S"-t l/ 01300 JOB DESCRIPTION 200 ~ Sfl-VL 'C/'M^'C"c Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. 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 $106.00 $ 19.00 $50,00 B. Electrical Contractor ~U) {llJj J c!&,~ j;u ~ 200 Amps or leSSli\1E WOR~ 7 N01\CE: )E~}{~$ \1 \5 ~01 Address yJ 0 v1 01 co2 /503 l\\lS p~RtA\" _ _e [laiD fOR f ..w1~~R\lE~ ~NllPS City f 11 ql/rd!- Phon6~/-6R~2;(~~~C \jt~Q\W1ps/Volts ~ f\~'i 1aQ 0 dmnect Only Supervisor License Number ~3;; J?>:] 5 Expiration Date / 0- 0 / ~ () l' Constr. Contr. Number ,.c; / 0 g R Expiration Date ~ ~/:} 7 -O.s Signatu~: 7uPTis~~~cian //;/ ~k/ f20k (,,)EI tL ZbJ L{ T ~\- ~?rl\ ,/ Owners Name Address City Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 I $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 63 c. Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45,00 4. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 7% State Surcharge 10% Administrative Fee TOTAL h3 '{'II b30 73?L Shared Drive(T: )/Building FormslElectrical Permit Application 1-03 .doc CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00925 ISSUED: 07/26/2004 APPLIED: 07/26/2004 EXPIRES: 01/26/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2634 J ST ASSESSOR'S PARCEL NO.: 1703254401300 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: 200AMP SERVICE CHANGE TYPE OF USE: Residential Owner: WEIR ROSE M Address: 2634 J ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type' Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: New Phone Number: 541-741-1578 Expiration Date 06/27/2005 Phone 541-686-2365 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occ~waJit Load: ; ~, . .' "....~.c' __" I DEVELOPMENT INFORMATION I , :" , ~UlREDPARKING Overlay Dist: ~~~~ # Street Trees Rqd: A,q~~ p~e.,.\i aDPed: Paved Dri;:e ~()\t. ~~:ia6~ ~~~ . % OfLot~~~~~uP_~ 'c\\~~A,~~~~~~O ~~:. '-v..W-"" p. !"UQ ~.t IPUBLICIMPRO~t.1~t\~~~ 009' ",e . ~\\~ \~ '\ ~utf\'OfJ. c,e~~spoutS/Drains: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Total Value of Project Pal!:e 1 of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00925 ISSUED: 07/26/2004 APPLIED: 07/26/2004 EXPIRES: 01126/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid-l 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 7/26/04 7/26/04 7/26/04 1200400000000001138 1200400000000001138 1200400000000001138 Total Amount Paid $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. l 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 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 Paee 2 of2 225 Fifth Street ~, . . Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00925 COM2004-00925 COM2004-00925 Payments: Type of Payment CreditCard '7/26/2004 rity of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 1200400000000001138 Date: 07/26/2004 11:24:59AM Description Perm ServIFdr 200 amps or less + 7% State Surcliarge + 10% Administrative Fee Amount Due 63.00 4.41 6.30 $73.71 Paid By NEWW A Y ELECTRIC Item Total: Check Number Authorization Batch Number Number How Received Amount Paid Received By djb 000452 076250 In Person Payment Total: $73.71 $73.71 Page 1 of 1