HomeMy WebLinkAboutPermit Electrical 2007-8-20
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number LOVV'. ZO-O 7 - 0 Vl. 7- 7
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Phone 4f)'-\.-'1~(i~,,,_. "" O~r1000AmvsNolts
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lN~tl'ilc:~t:ti)n CO~r., "fholSf?Allewara ~t19xth
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C~t~:o itlA1fi~9Qr~~~~~).
401 Amps to 600 Amps
f\r:'
~.\;, ~~Qii"". 4. SUBTOTALOF~YIL
nns PERM!T ~~~tt ~tJRE~f THE wORK.d
f;UTHORiZEO lf~In'~f~~iT IS Nor
COMMENCED Oii~IAU~~~~El1 fOR
ArtV 180 DAY PERIOD.
TOTAL
1. LOCATION OF INSTALLATION:
/DJ '(
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LEGAL DESCRIPTION:
/70]J52 "2
D8000
JOB DESCRIPTION:
lEt Uru:." e)t/57 ~'" ~ 5 ~ V L
,
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.
CONTRACTOR. INSTALLATION ONLY
Electrical Contractor
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\Z. \e.c,,^( l:(\L.
Address
2 '() -z.. I. \
G'..lC" GW <"),.\-<-- SJ r .
City \Z.uc\ ~ 01\ '(;'.
Supervisor License Number
Expiration Date
j", I , 10'7
Constr. Contr. Number
1101..\8<'::::/
Expiration Date
<::, 12-< IZ}.:;,c9
Signature of Supervising Electrician
U~
Owners Name ~ (/n.I
fJJ~~--
TM~l sf-
Phone 91l- 9lf/j
Address
11 ~{
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City
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Date ?( - cd-{) - 01
3. COMPLETE FEE SCHEDULE BELOW
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 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
B. Services or Feeders - Installation, Alterations or Relocation:
(
70
$ 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
$ 55.00
$ 76.00
$110.00
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 48.00
$ 4.00
z.g
7
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation $ 55.00
Sign/Outline Lighting $ 55.00
Limited Energy/Residential $ 28.00
Limited Energy/Commercial $ 50.00
Minimum Electric Permit Inspection Fee is $50.00 + Surcharges
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Shared Drive(T:)/Building Forms/Electrical Pennit Application 7-0i.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1034 MILL ST
ASSESSOR'S PARCEL NO.: 1703352208000
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2007-01229
ISSUED: 08/2012007
APPLIED: 08/20/2007
EXPIRES: 02/20/2008
VALUE:
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Service change and 7 circuits
Phone Number:
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
N\.tir;~,.;.t.l~. ..g;.:',,~.!;. Th:..:Ht:iltE: ::": 13:\ 1:~~,
M~~'~'~)i$~f~lr~~~~O~y
calling the center. (Not~: !the telephone. .
Contractor number for the Oregon Utfta,INStificafldiiHratIon Date
TRITON ELECTRIC INC Center is 1-800-3~m4). 05125/2009
BUILDING INFORMATION I
Owner:
Address:
ALAN PETEROON
1195 JANUS ST
SPRINGFIELD OR 97477
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
541-912-9415
Phone
541-484-9800
VB
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
NOTiCE: Side~{W'HE WORK
TH\S PERM\T SH~~~m60Pt!mJInnlS NOT
~~~~:~~~D U~R \S ABANDONED FOR
ANY 180 DAY PER\OD.
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa!!e 1 of 2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 F.ax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Total Amount Paid
Total Value of Project
Fees Paid'
Amount Paid
Date Paid
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2007-01229
ISSUED: 08/20/2007
APPLIED: 08/20/2007
EXPIRES: 02/20/2008
VALUE:
Receipt Number
2200700000000001322
2200700000000001322
220070Q000000001322
2200700000000001322
2200700000000001322
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.
$9.80
$4.90
$7.84
$28.00
$70.00
8/20/07
8/20/07
8/20/07
8/20/07
8120/07
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
$120.54
I Plan Reviews I
Reouired Insoections .
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
Pa!!e 2 of 2
Date
225 Fifth &treet
, '
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-01229
COM2007-01229
COM2007-01229
COM2007-01229
COM2007-01229
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200700000000001322
Date: 08/20/2007
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
BARRY LISTER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 015463 In Person
Payment Total:
Page I of 1
2:14:40PM
Amount Due
70.00
28.00
4.90
7.84
9.80
$120.54
Amount Paid
$120.54
$120.54
8/20/2007