HomeMy WebLinkAboutPermit Electrical 2005-2-21
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
CityJobNumber CoM 2' 005 -01356
o 1 & 2 Family Dwelling or Accessory ~ New Construction
o Multi-Family 0 Addition/Alteration/Replacement
o CommerciaVIndustrial 0 Tenant Improvement
Job Address 342-0 b/{L-[;V t/t''C...//J t../J
Lot Block Subdivision
Project Name 1(:'"U/fi...12 bt: ;:7/) H.~)S Pit Ii /.... ..
Description ofWorkJlocation on premiseslspecial conditions
Phone 20(0,3.'::;; '1.. 5303 Fax
o Contra.u~ju. {s}
Contractor's Name
~ ~ /f
G I ....r-; t I.!j Ie' , ~ 1ft Ii of"t' /1.,' t.. I i (. In 'J : .-f').
enera ! LA. 4.!'l!' 't:,,,- ~__cl't,<fi.j. t fI," tt:JI' '-'"
Plumbing /,.J.A ll..n J;lf;fL pllie ( Ju'iJ n )- U)J
Mechanical NlW~t)f':':'.~( h1I"ChCil'7)r 1'1 J
Electrical A'/cr :"":',h~"!~, . ""
o Commercial/Industrial Projects 0 Residential Projects
!'Ias site review application been submitted? Heat Source: Primary G 1#5
[2S1 Yes 0 No 0 NIA Water Heater 6-1'..; Range
If so, Name of Planner /-/A//Jfi pfJ !.t!LY Do you require any of the following for this project?
Journal Number Ctt7v (jfJ ~ a 1c1/A mJrll{.., Over-width or Second Driveway 0 Yes ':S No
DJ<C" '2(105 '.0::;'(') ~?() 1 l""'ll.l.'t,. ! WICiO Temporary Power 0 Yes 1ZI No
Notice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon
under provisions of ORS 70 I and may be required to be licensed in the jurisdiction where work is being performed.
1 For Qt1ice Use Only
I PLAN CHECK FEE I
o Property Owner
NameP e:>,k:-e ~ 'C. Ct, t..JT H
Mailing Address ~2.3 I.i(Jh?tL.t\,K1m"i.h~ UNrV
State f':1i!....... Zip '17477
Fax G ~l t '6.C'SO
Owner Representative ~!-I h> !vt- Of A {,.;::.:6
City ~/jff')bf'("?O
h '-"/J - ..... ......7
Pone """'.l>-;; "- 'i'>'~ !
- f,oP.~ ~ -r-'_
Phone '.s~ Zp:; /-,
A /; J Z;n::.?J
Fax f:'~'" jf):::;,......
o Applicant
Name :::>Il tP"i!,5~ ,4:.,~, f!. {::-:i1J [I!!r
Mailing Address
City State
Phone Fax
Zip
o Architect/Designer/Engineer
Name /lA/'sI/C:;;.~ ....c:...: f.".La.-A/
*'
Zip ~IDI
Address 1'51..-:;~~ .-.e;-:.".:f',f::1~' Arh~ "8t:
I
City ~,?, i!.A!_ State tI".,.q
Contact Person G i.AY P'Ult... &I OR
I RCPT#
Date 2-2/'0.5
D
o
Demolition
Other
Bldg No. Suite No.
Tax Map/Tax Lot I '1 0 s.1.-z' 0000 90"'2;.
... , '" J ,-;" J)f} -'.~ ~ (,. I' l"')\
l.r:~t...'-n2.,rv CJ(/(..- y P..~I'II[// .t~.t..,"r
c.&:;:::" ZS t (;,1 ;:;-/1 C. t:..1) 6~' 2., ,
~ & 2 F;......~:ly Dwelling
SQFt
X $/SQ Ft
Value
New Dwelling Area
Garage/Carport Area
Other Structure Area
Total Value
CommercialjIndustrial/Multi-Fantily
SQ Ft X $/SQ Ft
= Value
Existing Building Area
New Building Area 2t~9;;,~
wr:..'!>'i'"" ::~..l"'<:::'A v. VIi/ tie
t >>...:i.</,; eJfti...I{)~ t~htt(
Total Value
5'~ 7' tY.
J c.) .:'1L 937
-,
t 1/1.~"l7~~?r;; )
,4 ..1' ~. (J 1'\1'.')\
t ~:"4;;'; - t/l:...t...... .l
I~?b?e 5'77
/i
Existing
New
P J ,~t _.J~ ~,)...:.;' ~::
-.,.. C',; ~.,
_ :-"; f ...-
if~L~
Occupancy Group( s)
Const. Type( s)
Number of Stories
r;.
I!!~T"':~"
CCB#
Expiration Date Phone #
1;,k,,'P/o-'j '5c'z" 12.." ~(t/O
.(; j)'[)!fJ~ <;e3_.2.Sr.. Ill/!
4I/';t./Ot, ..../.
tfI1~~
Ci'on07#
O/!?C.1C.-; '? <)
Secondary
Energy Path
I
PERMIT
BUILDING
I DATE
I
APPLICATION
I BY I
Shared Drive(T:)/Building FonnsIBuilding Penni! Application 1O..Q2.doc