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Home My WebLink AboutPermit Electrical 2007-8-30 ZON INITIALS !'~ r-^\. DATE -G' SOURCE ('i\)j -. ~.t'J".) -'J 225 FIFTH STREET. SPRINGFIELD, OR 97477 - PH:(541)726-3753 - FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COoAo'\. ~~ 07 -- 0 ( ""307 1. LOCATION OF INSTALLATION: 3. 32s 7::)' -Ie'.. ~ ~- (2l :' of- ~ , . \ ' ) LEGAL. DESCRIPTION: I 80 Z. O. b fL(_ .1 {DO( A. New Residential- Single or Multi-Family per dwelling unit. <.!_ i ' .~ er(/ , " le;-l.I';L~E'. l Mr.:L~...t- .{ _~ -. ~'t.~- Service Included JOB DESCRIPTION: 1000 sq. ft. or less $117.00 _ . .h- "'- ~.I ~ r_ _A ,A "'--- -r- Each additiona1500 sq. ft, or .s: t:<LV\ c....e:-: M/J ~ J ~ ~-........... -, portion thereof $ 21.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Electrical Contractor City ~~~ Supervisor License Number Expiration Date /0.- J - 6/ 1t,(73~- q-7-.Q~ Constr. Contr, Number Expiration Date Signature 4f Supervising Electrician :ytJ/~ oJ/Name! ~~ (.Jf\\l~ Address ,?oM} TA~.PM- "2-~ City s~~~ Phone OWNER INSTALLATION 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 Each Manufact'd Home or Modular Dwelling Service or Feeder $55.00 B. Services or Feeders - Installation, Alterations or Relocation: New Alteration or Extension Per Panel One Circuit $ 48.00 Each Additional Circuit or with \Q~'1t Service or Feeder Permit * ~ ~\)\ x:~ '\ 'l\ \'0 \" E. Miscellaneous (service/\e~~;:'~~i~ach Installation c.\~\~".. -fl.1\S ~~~~~ (" '{'~ _,#( -y.\' v'~ \\\ \\"\\J\~ PumI?'~lI kflgatiQ'!i, ,':" \\\.:~,)\" t \l,)~:'l'" Sign/Outline'I..:igbtjing! . ~ .r.. Limited~et~ylR~i~~~i8{lt.\\<j \). : ' ~,:,\\,',>'-'-' -- "', <~\'\ Limited ~l1etW/G<;imm~rcial $ 50.00 Minimum Elect~'Pe~~it Inspection Fee is $50.00 + Surch~rges S~ If'lO O)=' z?r f~7~ Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits 4. SUBTOTAL OF ABOVE 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL I $ 70.00 $ 83.00 $138,00 $180.00 $413.00 $ 55,00 sr CONTRACTOR INSTALLATION ONLY 2. _ C) _J [. Cv\ c (~LL~ C- 200 Amps or less """'" r;' _ 20 1 Arg~~'i!()J~~&~" \ Address 38'5Y J6-~~- ed. ,OW401~!pt4>~~,~~:, p::(\t:t:" ,"~!fmJ,~"t8~ d~,Attip's Phone 7F - {o.~~~~~~\lf$ ,\<~;~\~;;r~d{~s\/:;'T ~700 5 ~;:~~~I~r~~;::~eM'rs \\Utf'O ce(\1.et Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 55.00 $ 76,00 $110.00 $ 55.00 $ 55.00 $ 28.00 Shared Drive(T: )/Building Forms/Electrical Permit Application 7 -07 ,doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01307 ISSUED: 08/30/2007 APPLIED: 08/30/2007 EXPIRES: 02/29/2008 VALUE: Springfield TYPE OF WORK: Electrical Work Only SITE ADDRESS: . 3875 JASPER RD ASSESSOR'S PARCEL NO.: 1802061411001 TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Service mast reconnect Contractor License Expiration Date Phone JEM ELECTRIC 1~.~I:~~~~~~g~ ~~~~~j!~~:~;_ 09/07/2008 541-729-1074 N -- - - - _n_ --- . Ii) e setforth In roug 952-001. 0090. '/It)uftS.~afn copies of the rules by Lot Size: call1nlJ~eelDtBli;u4Note: the telephone Sq Ft 1st Floor: raumbIIr~ UBtlQragon Utility Notification Sq Ft 2nd Floor: ~~~-800-332.2344). Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: Owner: RICHARD WILLIS Address: 3875 JASPER RD SPRINGFIELD OR 97478 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Construction Phone Number: 541- I CONTRACTOR INFORMATION I R-3 VB I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I NlJm: Sidewalk Type: THIS PERMIT SHALL EXPIBIiJlislbmW-GAKs: ':UTHORIZED UNDER THIS PERMIT IS NOT i..OMMENCED OR IS ABANDONED fOR \NY 180 DAY PERIOD. ~ I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01307 ISSUED: 08/30/2007 APPLIED: 08/30/2007 EXPIRES: 02/29/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.50 $2.75 $4.40 $55.00 8/30/07 8/30/07 8/30/07 8/30/07 1200700000000001122 1200700000000001122 1200700000000001122 1200700000000001122 Total Amount Paid $67.65 I Plan Reviews I 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. L Reauired InsDections I Temporary Electric: Approval required prior to Utility Company energizing pole. 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 Pa2e 2 of2 225 Ji'ifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01307 COM2007-01307 COM2007-01307 COM2007-01307 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Service Reconnect + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JEM ELECTRIC City of Springfield Official Receipt Development Services Department Public Works Department 1200700000000001122 Date: 08/30/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 232551 In Person Payment Total: Page I of I 8:49:41AM Amount Due 55.00 2.75 4.40 5.50 $67.65 Amount Paid $67,65 $67.65 8/30/2007