HomeMy WebLinkAboutPermit Electrical 2005-4-1
. SP~INGFIELD
. .
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)~~9 ~
ELECTRICAL PERMIT APPUCATION q",,,,~~ <::.ill,'
City Job Number ~ "Z.OO r - en:::> "3 7 L( Qi!te (,. .r~_~
I. ~iii,v.;..i'.'.~"IU"","Ha'.;.\lil't4WrON""'" 3. aOOMP.k.~.~J,illr. ~~ . . ~I.u~~~
~I":"" . r'liiiiiK . -. -- r L />. GO' ~""'~:G0'1
:lOS4- GolL'''''1'U- '" Rd. . ,., ,. , .s>,... .""& . q~~. .
LEGAL DESCRIPTION A. '~eWlI~iJ.i'deDlIlil~~~~~J'}ti ,.. ~ ' d~~
i 7 () J 2 Zl.( L () ( 7 GQ Service Ineluded ""'- ~Q '. I';:;""" '';'",
JOB DESCRIPTION 1000 sq. ft. or less ".l..4-1 .00 ~ "-
Each additional 500 sq. ft. or "-
portion ~ereof . ._'-
cv4rl r~A~~ WI'IH krntPf'" 'If)-f~~I~.
Permits are Don-transferable and expire if work is Each Manufuct'd Home or
Dot started within 180 days of issuance or if work is Modular Dwelling Serv~ VOU.~ $50.00
Suspended for 180 days. Feeder. .~Of\IQ'II ontJ\J;~/..
2 j&:;....Jl~~,~.~Jl'.~L~r;il:4.WOM'ONbYp ,,'1111.' ,. . .1~,;.h~!!tio~~iO~jRel:.c\.lf~:..
. 1,1" ,. ..J'd'" ,-. .__.,J. "1- ,.. to'\OW . 'cen . h' ~:.:R., iiii I ,,,I.l>..I.
Electrical Contrnctor JV-~Tt. FlnIT;", Notifl~lt_~ oalieW tht~~i~S 0' the !\lIeS ~'I $ 63.00
\n Of;: IPJWIll'Yto~lJOl9:~\)\e' the telepllU'.'~ $ 75.00
Address 5'25 !-h-1.....'Jc;."r \.i... 0090.':1 ~@;~A\\1'~UtiliW Not\1ll,;<L" $125.00
ca.\~~~fW'il.'ttillW~'Sa2-2344)' $163.00
Phone .519 4 \ SD "U'Ever<!;Ql!Q.0lri,p~~' $375.00
Reconnect Only $ 50.00
City LuiJ.......
Supervisor License Number ~\ 'O~ $
C. ~TemP..i!!:YYl.~~
.....-
Expiration Date
tn/liD,
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
Constr. Contr. Number I (JI---I ~8
Expiration Date f.,.,/?/ii5.
Signature of Supervising Electrician
, . , ,
, .
.. .
. ."" , .~ ~ ~
New AlteratioD or Extension Per Panel
~~._~ ,_f\.,,,-,<,cl One Circuit '><
I ~. Each Additional Circuit or with
.cr- /' I" ~ . Service or Feeder Permit
OwnersNarne ._.... C ~ ~
Address '79 \ At f:-,.A~\c.... ~mrw.:: E. ~lIl1DeGns.~semeeJfiille~notin~niJeil:~Ei.IiI~tioD
G . I HIt) PERMIT SHALL f::XPIHI: It- I Hf:: VVUH -
City $'f ( ~f!1 Phone .^.'.;~'! !.2RtZED ~~n:'P~?'i iWRtti?ncRMIT IS NOT $ 50.00
J 0-.-( COMMENCED ~~~Bu~ig'ilHBh~~tD FOR $ 50.00
OWNER INSTALLATION ANY 180 DAY ~igWro~~ergylResidential $ 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.
$ 43.00
I
$ 3.00
Owners Signature:
Minimum Electric Permit Inspection Fee is 545.00 + Surcharges
4.1I'S~A'llaFroroVE_ l( r-
Iii _. B_'~../II,'I~...,.I
3(l
y')o
")Z~
7% State Surcharlle
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)IBuilding FonnsIElectrical Permit Application 1..{l3.doc
.
. CITY OF ~"KJl~GFIELD
Building/Combination Permit
PERMIT NO: COM2005-00374
ISSUED: 03/31/2005
APPLIED: 03/31/2005
EXPIRES: 09/30/2005
VALUE:
Status
Issued
US Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2854 GAME FARM RD
ASSESSOR'S PARCEL NO.: 1703224201700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Add I circuit
Owner: LARENE HAAS
Address: 795 N DUSK DR
ST GEORGE UT 84770
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
STEPHEN JOSEPH HOWARD
License
106738
Expiration Date
06/0212005
Phone
541-5794150
VN
I BUILDING INFORMATION I .
. IjOUlO
\ oN reqUIreS 'rt>/
,.._,~,ofSt~r!.es:go~h~ he oregon UtI \ rttot Size:
. - Height !l!~\!rueturet rules are set 10 !I Ft 1st Floor:
Type'ot~~.!!~: 1\10Se \1 Op..R 952-00 !I Ft 2nd Floor:
Waterr!y,p.!',:)10 t\1roUg S 0\ the ruleS ~ Ft Basement:
,Range,J~P\~btaln cople he telep\1O~esq Ft Garage/Carport
c') Energy P,!'t~\ter. lNote. t. Not\\\catJo~ Ft Other:
, cZ Spriitkled'B~~!!lFn Utl\lW"$II., Occupant Load:
_ (.....r tne ~ _" 11.,=,?2.'.;;J ...,
..... .~._ .....!J'.
I DEVELOPM"",., "..u....;;IATION I
REQUIRED PARKING
# of Units:
Primary Occupancy Group:
Sceondary Occupancy Group:
Primary Construction Type
Sceondary Construction Type:
# of Bedrooms:
R-3
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Selbaeks:
Overlay Dist:
# Street Trees Rqd: .;::.': ..
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
,.PUBLlC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Spccial Instruction:
Sidewalk Type:
D. _"e \tJtf}~\\ .
't'\CC' "n\Rt ,!lwnspou ..",rams:
"Q, \.. S\1f\ll t^! Mil IS NU I
\\1\S Pot~~~; \1NDtR \\1~~~~~ED ~Ot\
{>.\1\\1 II OR \S f\B"
....(\~~lII\ENC.ED _rn,(\1\
Notes:
I o.\\I~ \ uv - I
Valu'lition Descriotion
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
.
. CITY OF ~rKll~GFIELD
Building/Combination Permit
PERMIT NO: COM2005-00374
ISSUED: 03(3112005
APPLIED: 03/3112005
EXPIRES: 09/30/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
~
Fce Description
+ 100.10 Administrative Fee
+ 7% State Surcharge
Add, Altcr, Extend Cire
Minimum/Adjustment Electrical
Amount Paid Date Paid Receipt Number
$4.50 3/31/05 1200500000000000399
$3.15 3131/05 1200500000000000399
$43.00 3/31/05 1200500000000000399
$2.00 3131/05 1200500000000000399
Total Amount Paid
$52.65
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 Rrlluired wsnrrtin.ILLI
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hcreon 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 agrce 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
Pae:e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2005-00374
COM2005-00374
COM2005-00374
COM2005-00374
Payments:
Type of Payment
Cash
3/31/2005
.
RECEIPT #:
MI""~"~~..'~"!!!-..D."-'.-..-'-"'.'....""....
J .. .... -- -"... j
,
,..-~ .'
"c- lfIIJf:' -,
.'.."-' ..
Cih' of Springfield Official Receipt
.elopment Services Department
Public Works Department
1200500000000000399
Date: 03/31/2005
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Paid By
KNIGHT ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb In Person
Payment Total:
Page 1 ofl
2:10:44PM
Amount Due
3.15
4.50
43.00
2.00
$52.65
Amount Paid
$52.65
$52.65