HomeMy WebLinkAboutPermit Electrical 2004-6-24
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION The following project as
C Z -.,..-,U 77 ~ Date b =.~ (llndAfo Qjnot require specific land use
City Job Number (j(.\./\C~ ( - 0 C - ).~;-'C) \
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A-S7t'rL Date cf)J
Auth()rized SignQtlJre
A. Ne~'Residentia.I__Singleor Multi-Family per dwelling unit.
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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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.
2.
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
SPRINOFIE:LiO
$106.00
$ 19.00
$50.00
B.
Electrical Contractor C ~p wi.( ~. ~~L 200 Amps or less
() () -1 ~ 20 I Amps to 400 Amps
Address f" . Oo'f. z.u, :t~OT!C~~ 401 Amps to 600 A~s
.,. lH1~(~ERMlT S1\All ExaJ~Y,lM~~~"WPS
City LAJ\1-.lJtw J ~ LLt Phone .f4J't~~~DER Thtl$e?f&~ill ~o"Ils
COMMENCED OR IS ABNdOOWi~I1
."2'- /~Y,:+80 DAY PER100c'.
Supervisor License Number -:;>\I? <..e 4" ::>-
Expiration Date ( 0 11/) Id 0
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Constr. Contr. Number 2.()~Lci cz c:..
Expiration Date J O/{ () / () '"
Signature of Supervising E{eCtriJan
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Owners Name i12~N (C
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Address
City
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
I
.
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
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4.
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600
D.
$ 50.00
$ 69.00
$100.00
$ 43.00
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
~u
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
AI .~~~~~~ut..ycu!o $ 3.00
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Owners Signature:
'7 :>0
7% State Surcharge ~
~ ':'vA. 0\0 ::~:inistratiVeFee ;;'~
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Inspection Request: 726-3769
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. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00775
ISSUED: 06/24/2004
APPLIED: 06/24/2004
EXPIRES: 12/24/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
54] -726-3753 Phone
54]-726-3676 Fax
541 -726-3769 I nspection Line
SITE ADDRESS: 4460 ASTER ST
ASSESSOR'S PARCEL NO.: 1702323106100
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Alteration
, Residential
PROJECT DESCRIPTlON: Service head change location
Owner: ERCK FRANK A
Address: 44/10 ASTER ST SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Electrica I
Contractor
GLEN A CAMPBELL
License
73995
Expiration Date
OS/24/2006
Phone
541-744-0705
BUILDING INFORMATION.
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
# 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
I DEVELOPMENT INFORMATION.
Front yard Sethack:
Side 1 Set hack:
Side 2 Scthack:
Rear~'ard Scthack:
Solar Setha,cks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
, Handicapped:
, Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:.
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
Pal!e 1 of 2
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54J -726-3769 Inspection Line
Fee Description
+ ] 0'1<. Administrative Fee
+ 7% State Surcharge
Service Reconnect
Total Amount Paid
.
I Fees Paid I
Amount Paid.
$5.00
$3.50
$50.00
$58.50
I Plan Reviews I
Date Paid
6/24/04
6/24/04
6/24/04
,
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00775
ISSUED: 06/24/2004
APPLIED: 06/24/2004
EXPIRES: 12/24/2004
VALUE:
Receipt Number
1200400000000000976
1200400000000000976
1200400000000000976
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.
L Reouired Insnections I
Electric Service: Approval required prior to utility company energizing service.
By signatllre, 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 OCCU P ANCY 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.
] further agrec 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.
Owncr or Contractors Signature
Pal!e 2 of 2
Date
225 Fift)! Street
Springfield, Oregon 97477
541-726-3759 Phone
.
Job/Joilrnal Numbcr
<;:OM2004-00n5
COM2004-00n5
COM2004-00n5
Payments:
Type of Paymcnt
Check
6/24/2004
RECEIPT #:
Dcscription
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
GLEN CAMPBELL
'~ty of Springfield Official Receipt
~ evelopment Services Department'
Public Works Department
1200400000000000976
Date: 06/24/2004
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
3493
In Person
Payment Total:
Page 1 of 1
2:56:06PM
Amount Due
3.50
5.00
50.00
$58.50
Amount Paid
$58.50
$58.50