HomeMy WebLinkAboutPermit Electrical 2004-8-6
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PII:(541)726-3753 . FAX: (541)':'6-3689' OOs'%
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ELECTRICAL PERMIT APPLICATION "% ~""'^ "01 ~"''''''
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City Job Number~ Zo:::::'l ~oO 9 D) Date 0 'f 10'1 sO" 9",~ ~i!:
U},.... ~ \90-
I. 'LOCA.Tii/rloIUNSTALuiiON .~~r .;~ 3.'coM~iEliFEi SCHED;;~'tlE """~sC}::",~ .'
4Cj} 2 Fyn~k\'fn' tihld ..~" '-'""", '. .... ~ .~>~"~~~~
LEGAL DESCRIPTION A. '..N~,,: !tJs!~~nti.al- Singh~or J\,lulti.Famil) 'dh 'unit."
I '60 -:> 0:' (l( 0 ZOO ( Service Included
200 Amps or less $ 63.00
20 I Amps to 400 Amps $ 75.00
40 I Amps to 600 Amps _ $ I 25 .00
NOTIC~OI Amps to 1000 MIP'F THE Wefl*-- $163.00
4 ~5- CA~~ PE~.J.l;rISbb\~I.t~~1Ii\S- RMIT IS NUT $375.00
AUTHO~li)1h1t<lD:lid1yTHIS PE $ 50.00
COMMEtiC,EQ OH IS t\B~~DqNED!O~." .... ___,. _ ,,_, ~.~.
ANY 1180 lJMhi19A4i@~i'n'kes or,F~eders ',,;."':;_~I." > i,',i.' :'~';'t~~:o:
JOB DESCRIPTION
I ()IIC' ( 11' +""""
Permits are non.transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
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. CONTRACTORINSTALLATlON ONLY
2. ......'l'}..ri'i::,1:.~:'..:.:-....'.:~......, .~-':\ .'~, .<....l-.~. ~ . 'L'
Electrical Contractor ,Rll,'ldfYS . []ec+r,'c. InC
City
ICJS Mac/,.<)Qr)
~):len(
Address
Phone
u
Supervisor License Number 3:J.Cj 0 - S
Expiration Date lOr I - 04
Constr, Contr. Number 4 'Jq I 0
Expiration Date
Z:Z:;;;:'~;dOO
Owners Name ~~a>_14) / IJ J," \ d 1:'\ h
Address .4; 70 (2 OK 71.( Z. ~ .
City
~ -c..--rt' ~ . Phone
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OWNER INST ALLA TION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$ 19,00
$50.00
Y" ,.., l" .., ",,"
B.'~Ser,vices or Feeders':' Installation',.A!t~.~ations or. Relocaiion:,
\ . .' 'r" : ..., . _ .'. _", . "~ ,'".. . ..,.,. '. .
Installation, Alteration or Relocation
200 Amps or less
20 I 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.
::'.......",... .,' ',"" . ._.....~;.'.~~. ~'1 .";: .\~..
D, Branch CircUits" .l': ). ,.; ,1. ,,:
..
'r'.:", ...
New Alteration or Extension Per P,mel 4 3
One Circuit _~~ 43,00 ---
-~~~~~--~ilV 10- _____
i61i"~fijIQs~fttfibYU.~re Jfi'OO .1...:.3
N'IW~Genter. ThQSl.t ,. ntoA~~~. .., ..
EinO(j~~~~(ll)1iilnle1ai1m.'"'rl~~lfr'UliWEncII Install~tioIl'
YoU maY C)btain .~. ,I,.., of
pg~;'~r t~l~ (Note: u.tJ~P~..50.00
Si~;rfdr~~on UtIIl"iJ;~o.oo
Limtled E~~-23l..o)o $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fe, is $45.00 + Surcharges
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4. . SUBTOTAL OF ABOYE'-'
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'-fl.'
blO
7(37
.'
- ,.
.;'~ ....
7% Slate Surchnrge
IOtJ.Io Administrative Fee
TOTAL
Shared Drive(T:)/Building Fonns/Eleclricnl Pcrmit Applicalion I.03.doc
. CITY OF ~rK11~uJ:'1ELU.
Building/Combination Permit
PERMIT NO: COM2004-00965
ISSUED: 08/04/2004
APPLIED: 08/04/2004
EXPIRES: 02/04/2005
VALUE:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4912 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1803031402001
Eugene
TYPE OF WORK: Electrical Work Only
Total:
Handicapped:
Compact:
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I PUBLIC IMPROVEM~.N:.TS~ ~\>.\.\. \.l'~\~ ?\~~~~\) {'\)\'\
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':0'\'1'0 \;\C,'t.IJ&\v{!.~~tsmrains:
IX '0\h\h'l:: IJ~ '?"'"
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TYPE OF USE:
PROJECT DESCRIPTION: Add 7 circuits
Owner: WILDISH IND DEV CORP
Address: PO BOX 7428 EUGENE OR 97401
I CONTRACTOR INF~TION I
Ui~e'O '-\l\\\\\'f
Contractor _~e,-:l ~a~\a~O(\ !I. \o\\U.icense
BUILDERS EL.E~~~e e. a~a :~".()~~296
.-6~\V\'~qy)i\hED~@NiOR~'l'IO~ I
'" ,- ft~e'O ,I I "'(I ". I II
f' ~()"ll \~ C/)(\'" :\()\I'" 'as 0' .' ~a9'(\u':' (\
# of Units: ~~c~~O(\ ~o:\~o cSRlrj...~e \0 !I.\\\Ca.\\O'
Primary Occupancy Group: ~O O~ gr;,~ ~~ 0'15 e~\V(~lt'P't't~~
Secondary Occupancy Group: ~..cl\.'{~ iii C "~J;r.~'2.tt~A
Primary Construction Type \)\I~~\\(\~ ~ I ~e ~{inl:r~pe:
Secondary Construction Type: - ..n'Oet \0 I\"et ~ange Type:
# of Bedrooms: \\U"-- ce Energy Path:
Sprinkled Building:
Contractor Type
Electrical
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:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Total Value of Project
Pal!elof2
Addition
Commercial
Expiration Date
12/ 10/2007
Phone
541-485-0922
n/a
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Value
Date Calculated
.
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00965
ISSUED: 08/04/2004
APPLIED: 08/04/2004
EXPIRES: 02/04/2005
VALUE:
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I F....~. P~W
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Rec"ipt Number
$6.10
$4.27
$43.00
$18.00
8/4/04
8/4/04
8/4/04
8/4/04
1200400000000001186
1200400000000001186
1200400000000001186
1200400000000001186
Total Amount Paid
$71.37
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 R..onir..d \lw1..ctions I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I bave carefully examined the completed application and do hereby certify tbat all
information hereon Is true and correct, and I further certify that any and all work performed sholl be done in accordance witb
tbe Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described berein, 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 ead, 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 tbe site at all
times during construction.
Owner or Contractors Signature
Date
Page 2 of2
[I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00965
COM2004-00965
COM2004.00965
COM2004-00965
Payments:
Type of Payment
CreditCard
8/4/2004
.
RECEIPT #:
G~
~
Jiii)' of Springfield Official Receipt
.elopment Services Department
Public Works Department
1200400000000001186
DescrIption
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
BUILDERS ELECTRIC
Received By
djb
Page 1 of 1
Date: 08104/2004
Item Total:
Check Number Authorization
Batch Number Number How Received
000462
020798 In Person
Payment Total:
2:19:04PM
Amount Due
43,00
18,00
4,27
6.10
$71.37
Amount Paid
$71.37
$71.37