HomeMy WebLinkAboutPermit Electrical 2003-1-26
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CITY OF ~.UNGFIELD, OREGON ". .J
225 FrFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ~ J.nJ3 - 000 47 Date \ !2.L:,{ 6:2.,
1. 'LOCAl'ION OF INSTALLAl'ION
,- .
3, : COMPLETE FEE SCHEDULE BELOW
?-,103 p-~-~- r~- --
LEGAL DESCRIPTION
\ 0v\rp O~6( p~~
JOB DESCRIPTION
17, 03' 3'1. 1*. OC,5/;r--
l._._ ____
I' -,- -
A. I New Residential- Single or Multi-Family per dwelling unit.
I.. ~ ~ _ _
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufac!' d Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
Address
2. : cONTi4cTORINSTALLAiION Om-Y~ B. . Se-r~'-i~;~r Feed~;;-- i~s;~llation, Alterations or-R~;;;ca~i~u:
"- ---- ---- ------ 1'\ r-~.::TIITiOj~:0rl:lgo" lall'; reqUlresyou to -- - - -- ---- - --- -- - , - ---
Electrical Contractor follow rules adopted by llQ!l ~.~mIE1l\lity $ 63.00
l\Iotification Center. ThoSilOIJ~2ll't9~Q~"s $ 75.00
III OAR 952-001-0010thrOlOJtA!Di\f!Q)!iQ!l~s $125.00
UUl:iU. You may obtain corutnSAlf,f,!;1tllrtdOOJAmps $163.00
Phone calling !he center. (Not(!)Je1EJ bolr-~prrool~ $375.00
"u" ,ut:, 'UI tile vregon lRtdH/,)I&!Cllithiiytion $ 50.00
r""tP., is 1-Ron-332-2
- -
C
io , ration or Relocatio~. ./
200 Amp~ )<- $ 50.00
0400 Amps $ 69.00
40 I Amps to 600 Amps $100.00
City
Supervisor License Number
Expimtion Date
Constr. Contr. Number
~~;~~~'M' ID.1v~;;~hA~:~~~~~OQQ Voltss~e ~'~.~ abo,,~. --- -- --
.f2\?HJM~~~~i ~'1ftJ~~:T. ~/.-:^~;i; ;anel
.. au DAY ~ fi rlA ffhll
Owners Name ~ \~:+_ ~~S p or FeederJ~ Fl
Address 2<O?'~ Vd). L W~ E'l~!sCella~.':,,-u~ (Ser~~e/~e~der;o!T~~~i;d)~~~Ch inst~lIa~io~.
City ~ J. Ph~ne {4-1-5'6~
Expimtion Date
Signature of Supervising Electrician
-- -1
$ 43.00
$ 3.00
~ Signature:
,( ," ...."..,
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergyIResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
r--- ---- ---- ---------
4. I SUBTOTAL OF ABOVE
OWNER INSTALLATION
111e installation is being made on property I own which
is not intended for sale, lease or rent.
726-3769 )
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding Fonns/Electrical Pennit Application 1~03.doc
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CITY OF SPRINGFIELD
Building/Combination Permit
Status: Pending
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2003-00047
ISSUED:
APPLIED:
EXPIRFB:
VALUE:
01128/2003
07/28/2003
SITE ADDRESS: 863 Prescott Ln
ASSESSOR'S PARCEL NO.: 1703341409512
Springfield TYPE OF
Single Family Residence
TYPE OF USE:
New
Residentiol
PROJECT DESCRIPTION: Temporory Power Only
Owner: NOAKES JEFFREY L & SUSAN R
Address: 2833 VILLA WAY SPRINGFIELD OR 97477
I CONTRACfOR INFORMATION'
Contractor Type
Owner
Contractor
NOAKES JEFFREY L & SUSAN R
BUILDING INFORMATION I
License
Expiration Date Phone
# of Buildings:
Primory Occuponcy Group:
Secondary Occupancy
P'rimory Construction Type
Secondary Construction
# of Bedrooms:
# of Stories:
Height of
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Bosement:
Sq Ft Goroge/Corport:
Sq Ft Other:
Impervious Surfoce Area:
SETBACKS
I DEVELOPMEN 1 mruJ<.1vIATION,
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyord Setback:
Solar Setbacks:
Overloy Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Totol:
Hondicopped:
Compoct:
IPUBLIC IMPROVEMENTS'
Street
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains
Notes:
I Valuation Descriotion I
Descrilltion
Type of Construction
$ Per Sq Ft
Square Foota!!e
Value
Date Calculoted
Total Value of Project
1 of 2
.
.
CITY OF SPR1l'~\.Jt<IELD .
Building/Combination Permit
Status: Pending
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2003-00047
ISSUED:
APPLIED:
EXPIRES:
VALUE:
01128/2003
07/28/2003
l..Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
Amount Paid
Date
$5.00
$3.50
$50.00
1/28/03
1/28/03
1/28/03
Receipt Number
2200200000000000422
2200200000000000422
2200200000000000422
Total Amount
$58.50
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 Tnsnedions ,
1 Temporary Electric: Approval required prior to Utility Company energizing pole.
By signature, I state and agree, that I have carefuDy examined the completed application and do hereby certil)- 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 certil)- that only contractors and employees who are in compliance with ORS 701.005 wiD 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
2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Jnb/Jnurnal Number
COM2003-00047
COM2003-00047
COM2003-00047
Payments:
TWe of Payment
Check
Paid By
Description
Receipt #: 2200200000000000422
Date: 01/28/2003
Temp Power 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
JEFF CREATIVE
CONSTRUCTION
Roc eived By
Check Number Confirm No
3954
lkw
Page I ofl
1/2912003
2:41:42PM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
50.00
3.50
5.00
Line Item Total:
$58.50
How Received
Amount Paid
In Person
58.50
Payment Total:
.
$58.50
cReceiptrpt