HomeMy WebLinkAboutPermit Electrical 2004-9-7
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)7i6-J689
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ELECTRICAL PERMIT APPLICATION ~.b '/)/~,901/0~
City.TobNumberc..oJ-t.1~l{ ~Ol' 06 Date ;f"ot.-~//)O'~.b,..o'
06) :rl;'c
2. B.
Electrical Contractor G () S f.!e('k/(!..,.tMe-. 200 Amps or less
() 12 /1 ) 201 Amps to 400 Amps
Address 1() c:v ;( 'I qd 401 Amp,seto 600 Amps
~\!
;p ~ .6~~1~S~\I?M'l1000 Amps
City _ y/ . Phone 7 tt/ - dd3~ ~eC\~~~ bb~~b\~. . sNolts
0(\ ~ e O~e~~ ctnlY'
'. o~eg 0. 'Oi \\\ ~~,es gr:::,- . _ \y~
::::t::: ::::o,e Numbe, ~:~~F~r~~~~.h~'fi:;:"tion 0' Rdo,"';on
3 ~~~~ "'~~ (\\a.'i fI\e~' ~O{\ ~'O\~~~br less
~'\~~.'.(~; \~e ~~,~ O~ei\)\)~~AmpS to 400 Amps
9 - ) - ~\\ e~ \O~ flW\ \S \ 401 Amps to 600 Amps
i'i (Je Over 600 Amps or 1000 Volts see "B" above.
D.
1.
LEGAL DESCRIPTION
17()-~ ZSZ~
JOB DESCRIPTION
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fr~()~.cte:- S {lvL R::'c'ot'iL
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Constr. Contr. Number
Expiration Date
~):::;;;Elk
I
Owners Namd,<lfL..l&S
Address (? 0 &:-;<
City ~ b~A. e L,
97L[O&
OWNER INST ALLA TION
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Phone 4gLf -b<<)75-
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3.
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
I $ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
~,-3
$ 50.00
$ 69.00
$100.00
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
'fr IA.-S-t-Service or Feeder Permit
$ 43.00
$ 3.00
E.
P.u~p,~i; irri~~~'-'- 'ti-~\S ?t.\\~~ o;:.\J~ $ 50.00
'~~iW~A~rtie~tfig\\ \~~\\~\)\)~\. $ 50.00
'\, rS 't~d\B~~r"&WRMi~?nt~1 $ 25.00
~,\~\ ., ~ !\ct"v'" - '.l.~\J\)'
'L~e'~dch~he~~IfJf:'~\nercia1 $ 45.00
Minim~tl~St~iC Permit Inspection Fee is $45.00 + Surcharges
4.
b>
l{l(1
I -c~
0..)
7'37/
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FormslElectrical Permit Application I-03.doc
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01106
ISSUED: 09/08/2004
APPLIED: 09/07/2004
EXPIRES: 03/08/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1308 R ST APT A
ASSESSOR'S PARCEL NO.: 1703252301202
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Reroute service feeder
Owner:
Address:
CHARLES N SHEPARD LIV TRUST . es 'lOU to
PO BOX 8516 COBURG OR 97408 . oregon \aW reC\u~gon \Jt\\iW
. _1(t...\T\Ol't j ~I the or. _~t tnrth
"'\_f- aOo\-,w -E":ee ru\es c;l.\v :;?-OO~-
10 ~1C(!)R'I~Q~APl()N-J1 s b'l
Not\ 50 00 ~uu I v . eS 01 tI \0 . ~ e .
p..R 9e.~ . coP\ hOn~
Contractor \n 0 ~ u may obtaln{Note: fAictmrs.~ ticfi;xpiration Date
C & S ELECTRIt0090., ~ the center. ~ ~n \ \t~~~otl'lca 09/0112008
~D1IN&L.mFQ~~eNltt'tI'
\,ie' ,~.... .f
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled BuiJding:
Phone
541-741-2236
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Vlhr
n/a
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I
REQ~~~D PARKING
Overlay Dist: \~~?~<;J\
# Street Trees Rqd: \~X:.. \~ ~~1ticapped:
Paved Drive Rqd: \.. ~i-'Y 'Y~~ ~~t:
% of Lot Covera,t't:. ~ S\\~~~~ \\\\~~\)<;J~
~O~r ~\:.~~~\\ '0~\) \S ~~~
I PUBUC IMPROvE~J;~\.'\) {~'?-\'\)\)'
\\" \)~
C;\) '\ COf.J Sidewalk Type:
~'\
~ Downspouts/Drains:
Street Improvements:
Storm Sewer A vaiJable:
Special Instruction:
Notes:
I Valuation Description 1
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Page 1 of2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01106
ISSUED: 09/08/2004
APPLIED: 09/07/2004
EXPIRES: 03/08/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
9/8/04
9/8/04
9/8/04
Receipt Number
1200400000000001318
1200400000000001318
1200400000000001318
Total Amount Paid
$73.71
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 ,
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
Page 2 of2
225 Fifth Street
Sprip.gfield, Oregon 97477
,541-726-3759 Phone
ii:~
r<.ty of Springfield Official Receipt
~velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001318
Date: 09/08/2004
8:23:38AM
Job/Journal Number
COM2004-01106
COM2004-01106
COM2004-0 1106
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Perm Serv/Fdr 200 amps or less
Payments:
Type of Payment Paid By
CreditCard MELLISSA GEHRKE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 008183 In Person
Payment Total:
Amount Due
4.41
6.30
63.00
$73.71
Amount Paid
$73.71
$73.71
9/8/2004
Page 1 of 1