HomeMy WebLinkAboutPermit Electrical 2007-8-14
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION c>
City Job Number Co I;(.A 'Z"Oo 7 -- c:> I' , p Date
2. ;, C()NTRAST()RjNSTAL,LATIONONLYY
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Electrical Contractor rW4A t::,ltc;fvtvL
, - 0
'~, 0 ( ~D~ 2-& L{
City Wl4- \ -k VV 1\ 14 Phone ) i4 - 0'10C:
JJJ. ~",.~. ~>
Supervisor License Number ~ ~ r
l ~ I{ () II (:) Installation, A\te"(\\t~~~cation
I I 200!~\~ ~~\~~
Constr, Contr. Number 7 ~ 17 \" ~~'f:. ~~\A ~~~~O\\
I ~\) ?t.\\\f\~ u~~ ~~(l)~~s
Expiration Date ! (') I I 0,1 { (!) ~"\~~O\\\tt.~ ~\\ R~mps o~.1000 Volts see "B" above,
Signature of Supervising Electrician t\~Q~~t.~~~ 9~9~ ,~!~~uit~s.
J/J /d g II l' l\\,\i \fQ'U New Alt,eration or Extension Per Panel
/~ ~iflA/l One Circuit
l Each Additional Circuit or with
""'"77 II ~ J I I - Service or Feeder Permit
Owners Name f"'" ~ (""h., I rus tt&.
Add,,,, ?''' '( ( ( ~.() e ~.fz<1t. E.M;",!la~'~.' (S~\~;"'f~:\~~~~~nstatl~un.
City ~ t:( Phone Pump or irrigat~'t\'. Ote~ed '0"1 \~eJ~t~ ~~<2,(Q. 0\-
Sign/O~~JU\~adO? \~Ose \ ~ OJ).~ ~~~s '0'1
Limited\IDV~~~&'e%~~tO' '\ 0 \~tO~s O~ W~~t\e
~~\'C'C-\\': ~ OO~:'\J ,ce~ ~'tev' :-~~~ vf.
Limite~~e~m~~i~\a\(\ W\e', \~: ~~~a; \ .
MinimUln~I~Ol9:f.~'j(~\~~\~tl~~f~~~UrChargeS ,-r'
4. SUBTOT~~~~~\&''\'?>OO~' ,:) v
8% State surci~~ C9t\{et'~,,--.. . Lr-tO
'10% Administrative Fee 5 Sf:>
5% Technology Fee Z,7/-
b7~
l.~Oc:ATIONOFINSTALLATIQN: ---- -. 3.
rJ3~-~~tA.~~~ "~i4'n/E
LEGAL DESCRIPTION:
17C> 3.3.1( 0 C> ~O
JOB DESCRIPTION: C-~ ~r- 4J~>
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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.
Address
Expiration Date
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
".,,~;\. ...~
COMPLETE FEESCII:;EDULE BELO~ '
'''~' "-r:.:"" ": "'1"'""'::-~:'" "~::::::~:~~/Y'--,' ' 4(-" ~-:~:-;:.. .~'...:-: ,'< ~. ';- ',":: -"
A. New Residentia.r:... Si,ngle o'r Multi-Family perd"~eIlillg ~nit.
, . :.,<..:.... ' ,'..,'..;. ... ....." ..;_" "." ,~ ,;: :,"",:""':vi~.~ -;~'::_:,.,,,1.._.:,'',, _,^>, ".......: ,,',", ....'..,.:;..w':." """ 'A__....~~_~ ",~.:'" ~~".._--
, Service Included
lOOO sq. ft. or less
Each additional 500 sq. ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$117.00
$ 21. 00
$55.00
, " ._. ,,~ -- : '::-~ 't~f-~' ,'- ,
B. , 5,eryicesor feeders- InstalI~tion,Alterations or R~location:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to lOOO Amps
Over lOOO AmpsNolts
Reconnect Only
$ 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
\(
. .~; .
C.TeInporary-Servjce,sor Feeders,
~"B"'" , ,'..~. _ _ .-~, ._, " .,\,,,... ,."" .~ ...',
$ 55.00
$ 76.00
$110.00
. ..,,- ,. .. .- ~
$ 48.00
$ 4.00
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 7-07,doc
Status' Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01198
ISSUED: 08/14/2007
APPLIED: 08/14/2007
EXPIRES: 02/14/2008
VALUE:
SITE ADDRESS: 835 ANDERSON LN
ASSESSOR'S PARCEL NO.: 1703331100600
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Service reconnect
Owner: TROTTER BETTY
Address: 2941 E,DGEWATER DR
EUGENE OR 97401
I CONTRACTOR INFORMATION.
Contractor Type
Electrical
Contractor
GLEN A CAMPBELL
License
73995
Expiration Date
OS/24/2008
Phone
541- 7 44-0705
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
# of Stories:'
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
R-3
n/a
REQUIRED PARKING
Overlay Dist: TO_!i~" ~~~\\1~
# Street Trees Rqd: ~~Mr: ~V.
Paved Drive Rqd: ~e90t\ \e."'\~o.i~9$e\~,\.
% of Lot Coverage: }\-r..\O~" ~o~\eo :~se tU\e O~ ~~\es \1t
~-r..\~ tu\eS ~ t\\et. '1 .~tOuO'(\ 0\ ~e ~Ot\e
. JI ,,'~ ../. r.e t, ^"<'\ ~ ~ft ~2 ._ft
I PUBLIC IMPROVEMENT~\II!\,\\C~9~Z.()()~ o~\&\f\~~o\e"!'; ~o\,<<,arJ..-
... O~'p. u ((\9:~e" \: \)\\\\\.!...AA).
Street Improvements: 11 \f\ 09().S'1ae~ IO"ego~ ",-fJ.?/fir '
, f. 'J'l()~l' Q ~g \~ \!O()~
Storm Sewer A vailable: ~t \r ,\\ s ~Q\ C~~Wb~~\$18rllins:
Special Instr't.ct~If'. ~\.\. t'/-.?\ ?t~~\' \ f\U C
\~on N\\\ s\\ ~ \\\\s ~U rO~
Notes: \\-\\s ?t~\lt\) \)~\)t: ~\)~~UQ~
1\\ \\\-\O~ ;':J-{' O~ \s_
o O~"-l\t.\'1 e. ~ ?t.wv\)' "
C~~\{ '\ ~Q \)~ I Valuation Description I
I DEVELOPMENT INFORMATION.
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
-{.i-
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2007-01198
ISSUED: 08/14/2007
APPLIED: 08/14/2007
EXPIRES: 02/14/2008
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
Fees Paid J
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Service Reconnect
Amount Paid
Date Paid
Receipt Number
$5.50
$2.75
$4.40
$55.00
8/14/07
8/14/07
8/14/07
8/14/07
1200700000000001037
1200700000000001037
1200700000000001037
1200700000000001037
Total Amount Paid
$67.65
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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
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 of 2
225 Fifth'Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01198
COM2007-01198
COM2007-01198
COM2007-01198
Payments:
Type of Payment
Check
cReceint 1
RECEIPT #:
Description
Service Reconnect
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
GLEN CAMPBELL
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200700000000001037
Date: 08/14/2007
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
4087
In Person
Payment Total:
Page 1 of 1
12:00:04PM
Amount Due
55.00
2.75
4.40
5.50
$67.65
Amount Paid
$67.65
$67.65
8/14/2007