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Home My WebLink AboutPermit Electrical 2004-12-9 . ~ ~ ~'- ~",' o~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541) 26-368~....o ~ o~" ELECTRICAL PERMIT APPLICATION . u<9 t-<9/ ~.,O' :'O....~ City Job NumbVlJY\")t\DLf ,. ()\Cjo5}ate I'd/ Cf\ I 04_ 'Yv/, rt') ~"J.' (\l&?&C'/~& - ,1)0...,. ;'''J. O/'r. & '{ 'J......'. "''''t - ~-"~~,"j "l~';:'~-'~_ ..'<"" ~~ ry-~''t: '~,-,' f"'.' ''::''',.~ , ^ : .,-~" ,_~":'", )~} -"~ _ ._'f" - - ~ < 3. k,;g.RM~-fK4~~~d~g!I~e'~~1' <9tvr. .~:::'~. t'\.:v;"t :::(7~~i~'7; ~'":7r~~'.c~T~~::'.~~~:,~."l~J"f:~:r;/~J'r:";7"17':"' - :"~'.1?'''~;:' A. :.;.~ e~vjJ{esidcntiaIT:S i1igl~:oi~~ult-h~~ +,:."">>''', "", .: -b,); :^);:".~-.";<:,, ~.' -'-, '",\,.A:>,..~_~-.... '_.,.0' ~<...~;j,~i;;,.>;'''':f.....-t,tJh;{.'''..,-:'Ok..'',,~.,-'~_ LEGAL DESCRIPTION 1"( llJS :l-s 3'i- r[)"7gUV JOB DESCRIPTION J 1'''\ L"tLL Uot- ~ uh 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, Electrical Contractor t Cr S pfJ &X ) lfC?d City :;pri()yfiClrL Phon, 7fJj-dd30 4f7lf.C) )0 -0 !-o'l 3~iJq q -J- ()B Address Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date ~\:::7;E~ -- Owners Name~ ~cth) Address 37 '6 Bla01CStDflL s+ Ci"-~'n.;~hon' q Uf - d.ll7 OWNER INST iliA 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 Service Included .he" I c. :~Vfitti~ .,:;,~:.~~ Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps t I ,,,., ..~- -', (' -, ~~.~ Over6&~ W~s or 1 000 Volts see" " D. : ~~~t;~.[ ~.~~~~!;>, _ Ii" ,1.....\), I rUll!LL,:'j 1'4 1(_, I ., Ne~v. AI,' ter~. tiR',n;-,qr Ext"l.l,~. i!'jn pen'JhnfO FOR L \ ,'l~.' ~ ~ 1......_ \ \ '-.-; i......l) On 1\..1 r\ OF\I"'lJ\.l~ onr" ClfcXlti' " 'e" ",', l '1(' II $ 43.00 /"\'1 b.ulJf~ r'C.I\UU Each'?xd mana ircUlt or with Service or Feeder Permit $ 3.00 $ 50.00 $ 69.00 $100.00 ;~};~I~~ . :l" au Lt- -./ . E. :';_:~1Jrr'~B0~T~:;:','(1)/;,I~"~li~;:~7:l~-;v-~,-"g;~\. t~i~}~-lt:;?ti,:r":--",'::~,'~[;:J:~ rfe~ ~r:Il,o t,IIlcl~,~e.fIJ,~ Eaqi,~istana!i()ll~: ""'';_';;.>A.,'.''b;_~ I ;. ",'-';.'i .)<,._,~'$l.~":;ur,,>,,. ;).'" ~~"'>i""t1'"i~l:t\~N:.~\-t~_, H' .:)).,,1'~ Pump or inigation $ 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 jQ.;) .' (1?) 4. 7% State Surcharge 10% Administrative Fee .!.J, ~. (J-lJ f':::>' 3.15 q,5'u ,j1S;;( .&5 TOTAL Shared Drive(T:)lBuilding FormsfElectrical Permit Application I-03.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2004-01505 ISSUED: 12/09/2004 APPLIED: 12/09/2004 EXPIRES: 06/09/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PROJECT DESCRIPTION: Wire Hot Tub Springfield TYPE OF WORK: Electrical Work Only ATTENTION: Oregon law requires you to follow r "In Jj}cmp~t theAQwgeAl Utility Residential Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- uu~u. YOU may OOlaln caples aT me rules oy calling the center. (Note: the telephone number for the Oregon Utility Notification lienter IS l-l:SUU-~~~-~~44). I CONTRACTOR INFORMATION I SITE ADDRESS: 378 BLACKSTONE ST ASSESSOR'S PARCEL NO.: 1703233407800 Owner: SMITH DANIEL M & LORI S Address: 378 BLACKSTONE SPRINGFIELD OR 97477 Contractor Type Electrical Contractor C & SELECTRIC License ,1 c,~~1'!i'" Expiration Date 09/01/2008 Phone 541-741-2236 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: .... L.j II\" rl BUILDING INFORMALI1ION('~.M IT SH Ll.UT'iQ ALL EXPIRE IF THE W # of Stories: COf/ RIZED UNDEBof~~:PERMI ORK Height of Structur.e IMENCED OR IESq1JA~~~lp~fi T IS NOT Type of Heat: ANY 180 DAY PER/~. Ft 2ndi<~b-M:FOR Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: 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: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pae:e 1 of2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2004-01505 ISSUED: 12/09/2004 APPLIED: 12/09/2004 EXPIRES: 06/09/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid $4.50 $3.15 $43.00 $2.00 12/9/04 12/9/04 12/9/04 12/9/04 Receipt Number 3200400000000000362 3200400000000000362 3200400000000000362 3200400000000000362 Total Amount Paid $52.65 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 Reauired Insoections . Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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. -3"\~O ~ ~ ~\~"U~ Owner or Contractors Signature \ o...-l ~~ \ 0 <+ Date Pae:e 2 of2 125 Fifth Street S'pringfield, Oregon 97477 541-726-3759 Phone cav of Springfield Official Receipt ~lopment Services Department Public Works Department RECEIPT #: 3200400000000000362 Date: 12/09/2004 11:05:04AM Job/Journal Number COM2004-0 1505 COM2004-0 1505 COM2004-of505 COM2004-0 1505 Description Add, Alter, Extend Circ Minimum! Adjustment Electrical + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment creditCard Paid By . . MELISSA A. GEHRKE Received By nJm Item Total: Check Number Authorization Batch Number Number How Received Amount Due 43.00 2.00 . 3.15 4.50 $52.65 Amount Paid 009149 Fax Payment Total: $52.65 $52.65 12/9/2004 Page 1 of 1