HomeMy WebLinkAboutPermit Electrical 2004-7-22
225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (541)726~6~
'5.
ELECTRICAL PERMIT APPLICATION o'l~
e
City Job Number CaW Wo\..( ~CXJ 7 / L/ Date
CONTRACTOR INSTALLATION ONLY B. SfeQ~_~~'s - Installation, Alterations or Relocation:
2. _ ~_ Oleg<>nUt';o(t\ ~' _ , ,
Electrical Contractor fuJdf'{S - t1J~~88G&~t -00\- OR. $ 63.00 ~t-ft
~ ~ ~~~~~rn~ $ 75.00
Address JCJC:=) Mac"-SOiI ~~.oo'\O~~~\t~b~~~ $125.00
"'~~~~ti~~et~~~ $163.00
Phone ~ ~. off\!\~~~!Volts $375.00
-=-..-h8f.ot\\,\eOf ~~y $ 50.00
........._ , 1 \$ '\
Supervisor License Number 3'J.q 0 ,- S ~ C. Temporary Services or Feeders
Expiration Date 10,. J - 04
1. LOCATION OF INSTALLA110N
~~ ~ I-l~pf' n ~~-(
LEGAL DESCRIPTION
17033YZZ 0027-(
JOB DESCRIPTION
re'C'lW\I')e(~ SeV\/ I" Lf'~
- ....... .
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
City
f'UJ en e
Constr. Contf. Number 4 'dq lr)
Expiration Date .1')- I O. - 0-7
Signa e of Supervising Electrician
/c ~/A-J.L
Owners Name G- p jIl-"\. C5S I {Lv-. ~,-\-
Address l \ Z u \.\..) P ~ \L. L,t(
City 5A-.~ ~ b~. c).Phone
/ --
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
3.
A. New Residential- Single or Multi-Family pe
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
'-
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
~ 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.
D. Branch Circuits Q~'"
New Alteration or ~~f~f~~Ql
"O~~trs\\~\.l J>>\S ?~~~~\l $ 43.00
i~\~~~~~~~~~~ $ 3.00
~~ ~t.~Ct.O t-~\a\).
&Q~\~llJI~'i~~'(SerVice/feeder not included)-Each Installation
~~'i
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
r. (' -
) l (;(
3.>0
5"00
S" 8 yD
7% State Surcharge
10% Administrative Fee
TOTAL
Shared DIive(T:)IBuilding Fonns/Electrical Pelmit Application I-03,doc
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Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00914
ISSUED: 07/22/2004
APPLIED: 07/22/2004
EXPIRES: 01122/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-'726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 885 ASPEN ST
ASSESSOR'S PARCEL NO.: 1703342200221
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Reconnect service
Owner:
Address:
A GOMES FUNDED RECOV ABLE TR
1120WPARKLN SANTA ANA CA 92706 , OUW
'iJ"~ 'f ,\\~~J
, \.~ ~ ~f\ \)\.11
\O~..O~(f"'~~i$~1ION I
~~~ adO ose WI ~~ gt) ,.' ,. .
con~~ce'rll6f. ~1"\~'0\19" ~ \"e (\1\e, ,Si?'tense
BU1.T. m'i\o~ @Eon\e50. I ?"O~96
"\~:n 9. , l:: i'C,.t' . ~~Ie ~\ r...~.~~
\t\O~ 'lou.f(\&.~~~~"IONI
009\1' e - ~
ce.\\\oQ ~ \\,\e 0{e9 n.fJ...?{l..z' " . -
n6t,ot ~Qe9wnes: .
f\\1f3 ceO\6t '''i:feight of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
. Expiration Date
12/1 0/2007
Phone
541-485-0922
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: '
VN
Lot Size:
Sq Ft ht Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION'
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
~\\"
I PUBLI~EME~~1JE)!.~\~t. ~t l\'\t\~ N01
l Q \ \ vI" \c. 0 -1\1
.,.\-\\5 ~t.~ I \"'\Ot~ 1\-\ -:;Jilt ~ k,.~:
\ ORUt.OU\~ B~NOJ U
~Ul\-\ ~CtO OR \5 P\ nn'ownspouts/Drains:
COW\W\to Ot-.'l ~t~\OD.
~~'l ~ 8
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pae:e 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00914
ISSUED: 07/22/2004
APPLIED: 07/22/2004
EXPIRES: 01122/2005
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
Service Reconnect
Amount Paid
Date Paid
$5.00
$3.50
$50.00
7/22/04
7/22/04
7/22/04
Receipt Number
2200400000000000961
2200400000000000961
2200400000000000961
Total Amount Paid
$58.50
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 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
Pae;e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00914
COM2004-00914
COM2004-00914
Payments:
Type of Payment
CreditCard
7/22/2004
RECEIPT #:
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
KELLY OBRIEN
ii::4ij
r.ty of Springfield Official Receipt
lelopment Services Department
Public Works Department
2200400000000000961
Date: 07/22/2004
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 000450 047521 In Person
Payment Total:
Page 1 of 1
11:33:28AM
Amount Due
3.50
5.00
50.00
$58.50
Amount Paid
$58.50
$58.50