HomeMy WebLinkAboutPermit Electrical 2004-5-28
I ' oject as submitted has the following
as not require specific land use
approva , , .,......~
225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 L--lA"-
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ELECTRIC;1LPERMIT APPLICATION C; 1'2'616,/
City Job Numb~m 'J. t1:) 4- ... f)eJ! _ 3~ate CC:) 1-::-> !r/? 15D<L" pate. ,'I · ~
c.q. \Q I ~ ~ 4- '/Authonzed Signature !:?f--
1. 3.
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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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.
Electrical Contractor ~T ~ (
Address (9'10 {) 2~ $T.
City ~fL I ~ R ~Phone 74-7 -226
I
Supervisor License Number 24'3:,.--5
Expiration Date I D - ( - 0 c}
Constr. Contr. Number I L /1 L
Expiration Date S --~LL. -0:5.. ~}2i
Si'~nature of Supervising Electri~
/ilrPh~~
Owners Name ~/ I ~
Address ~3& :c 6"-
City cGp 12.) Phone
OVVNERINSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A.
\;\L '_j -:';-:-,1.': <:1.'-.t,: ,Y;ji;)
Service Inc~1ffl;\)fN rule~ ad()pt~d uy tile O,egon ULi,lY
1000 sq, ft:NmltiSlation Center. Those rulesa$eQfufNorth
Each additiJ:lr@L4.1'Q<Bm!-~at-001 0 through OAR 952-001-
portion the0090. You may obtain r.nrip.s of t~elPtRgs 1J,l'
Each Manufa~iAQrUefb~enter. (Note: the telephone .
Modular D~Ym@8ek.iMoo Oregon Utility Nq~~qmion
Feeder Center is 1-800-<lO;;:-2544). .
B.
f.R:JmIE:or less $ 63.00
f~\~~Efi~t1ff>%f1WEt EXPIRE IF THE woo1(.OO
~CljTfflYfflitrP~~rJ~~ THIS PERMIT IS Nt}r5.OO
el(}rv'NWEN~e~08~~BANDONE~ ~OO $163.00
'Rrw ,~ l'\lW'~<P{fVD. $375.00
Reconnect ~nly .' $ 50.00
<5<:) . 0<'>
c.
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volts see "B" above.
D.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3,00
E.
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
7% State Surcharge
10% Administrative Fee
c50 . rP
J.50
es . cr-o
(jf, I)~~ 00
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application 1-03,doc
Status
Issued
CITY OF SPRINGFIELD C
Building/Combination Permit
PERMIT NO: COM2004-00633
ISSUED: OS/28/2004
APPLIED: OS/28/2004
EXPIRES: 11/28/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2536 I ST
ASSESSOR'S PARCEL NO.: 1703361101900
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESC,RIP~I<A~:. ~e-.c.M~J.fJ requires you to
~~Tlvl\l, uregu urn
, , I ~.. -;-I,\,',to1"1 h)l thp. Oreoon 11 Y
f\lQ'l\\""'~V,I""'~-,--~I' ttann
Owner: WQfl),-pcStW~ .N'hose rules are se .
Address: 2536-6S'R 9~1!~'-OO-w..DlrOO{J1914~ 952-001
Il1!Il ,1-\" .. "J -;-I-.+..,in ('''rip.~ of the rules by "OTIf'~.
\!)U;:IV, I Y... ',' .... -- . t leohone ~;. ~ =-:
calling,the. center. (Note", . - . OR INFO~TtiNIt SHALL EXPIRE IF THE WORK
tllumber'for the Oregon Utili UNDER THIS PERMIT IS NOT
Contractor T;pe .' ~a\fl~iic\"9P0-332-2344). COJANQJGED OB~pi~OOW F(j){ftone
Electrical ALERT ELECTRIC INC ANl'2TOO DAY PERIOO/22/2005 541-747-2213
BUILDING INFORMATION'
# 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 Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 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:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
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
Pae:e 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00633
ISSUED: OS/28/2004
APPLIED: OS/28/2004
EXPIRES: 11/28/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid.
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
$5.00
$3.50
$50.00
5/28/04
5/28/04
5/28/04
Receipt Number
3200400000000000084
3200400000000000084
3200400000000000084
Total Amount Paid
$58.50
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.
I Reouired Insoections I
1 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.
~~ ~~ ) 6\ 'f::h!>/37
Owner or Contractors Si~1ature ~ 6. --r- 'LLL~
s J ~8' J 0 q
~r
Date
Pae;e 2 of 2
225 F~ft)I Street
S'pringfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00633
COM2004-00633
COM2004-00633
Payments:
Type of Payment
CreditCard
5/28/2004
~
RECEIPT #:
3200400000000000084
Description
Service Reconnect
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
STEVE/ALERT ELECTRIC
Received By
nJm
Page 1 of 1
_O.y of Springfield Official Receipt
velopment Services Department
Public Works Department
Date: OS/28/2004
Item Total:
Check Number Authorization
Batch Number Number How Received
00398 028679 In Person
Payment Total:
9:21:55AM
Amount Due
50.00
3.50
5,00
$58.50
Amount Paid
$58.50
$58.50