HomeMy WebLinkAboutPermit Electrical 2004-6-14
225 FIFTH STREET. SPRI.NGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (5dI1~Vam-B~89
ELECTRICAL PERMIT APPliCATION " Zoning_
City Job ~umber {OWl ZOO'f -0070 I Date {;;?-1I-0'l . Date
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LEGAL DESCRIPTION /70 ~ '23-S Y
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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.
A.
Service Included
1000 sq. ft. or less
Each additionalSOO sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
( $63.00 6>3 ~
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Signature of Supervising Electrician
c.
,Cft. s\\~\; j~:S ('\~<t.\) \"
\\0'\ \'~\\~\\ \)~~~~~lltlferation or Relocation
\\\\~ \\G~"'L\:.\) \) G~d&>~ps or less'
~\)\ ~~C~ ~ ~~ps to 400 Amps
\J~~'{ \'O~ \)~ 401 Amps to 600 Amps,
~ Over 600 Amps or 1000 Volts see "B" above.
D.
Supervisor License Number J. J .
Expiration Date
$ 50.00
$ 69.00
$100.00
~onstr. contr. Numbe,r 1.1:)0;6;2/7
JJ(! D# 26-52/ ~ - .
Expiration Date ? LJ r} )?
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
E.
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pump~~~dO~1\\O_~~i!~' '0"
Sign/~, ~\1.~tJ ~BW~~e~Q'\() ~~ 0' ~~ . ~e
OWNER INSTALLATION L~~t~~'2.S~~~~\a\ncO i\W.t)'8 ~. on
The installation is being made on property I own which Lunlt~~g~~~~. ~~\\~ ~ 5.00
is not intended for sale, lease or rent. Minimum El~~,,~ftQnW . ~~~~"li6 + .Surcharges
Owners Signature: ~ 4. ,/ b3~
L\~~' ~~ J))7%StateSurcharge '! "I
~~~ J><..:..~ ~CP~d~ 10% Administrative Fee b.~o
Inspedion Request: 726-3769 ~ #: ~ . TOTAL '73" 7 I
~\\:) ~ Shared Drive(T:)/Building Forms/Electrical Permit Application 1-03.doc
Owners Name lJJLL ZA UAIl/
Address :3/b 81~~ME sr;
City .$j:l..J Phone .,1.~;;l~"
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Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2004-00701
ISSUED: 06/14/2004
APPLIED: 06/14/2004
EXPIRES: 12/14/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 316 BLACKSTONE ST
ASSESSOR'S PARCEL NO.: 1703233404500
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Service change
Owner: ZAKLAN JO E & PHILIP J
Address: 316 BLACKSTONE ST SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION'
Contractor License
C PERKINS ELECTRIC 159537
I BUIlfl,GuWOB.MATION.
# of Units: Q1\C,t.. \, S~~\.\. t.~~~~~~~~~U \
Primary Occupancy . t.\\~ D ~t.\\"1\ ~"~~Q"o'r'Structure
Secondary Occupanc ~\,\\1t: t.\).Q.~\S ~'O Type of Heat:
Primary Construction Wt."C ~'4v~~\\\QD. Water Type:
Secondary Constructio\t 'ZO\) D~' Range Type:
# of Bedrooms: ~~ Energy Path:
Sprinkled Building:
Contractor Type
Electrical
Expiration Date
04/15/2008
Phone
541-895-4466
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
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:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I u\res yOU to
-..nON~ OregOQ)'~~" U\i\\tY
ATTt;I". dOpted~' UI e set forth
'0\\0'11 ~~ ~ntef. 'tltO~~._~O'\"
Not\t\~~2'()01.oo10 \h~~ 01 the fU\es bY
\~~~'IOU ",a~~n ~~ \~e ~~~~=n
MlnnQ the IV S:-:\I'n Ut\\~ ....'.
I uroUV1 Ul'!' U ..sOo-Sa2-;t."
Valuation DeVcrioti~Jer \S '\
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pa!!e 1 of 2
_~liiPRJN~~J"D
,"-~--
. ..,
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2004-00701
ISSUED: 06/14/2004
APPLIED: 06/14/2004
EXPIRES: 12/14/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
6/14/04
6/14/04
6/14/04
Receipt Number
2200400000000000770
2200400000000000770
2200400000000000770
Total Amount Paid
$73.71
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 Reouired Insoections I
Electric Service: Approval required prior to utility company energizing service.
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
Pal!:e 2 of2
225 Fifth Street
Springfi~ld, Oregon 97477
541-726-3759 Phone
.
Job/Journal Number
COM2004-0070 1
COM2004-0070 1
COM2004-0070 1
Payments:
Type of Payment
Check
6/14/2004
RECEIPT #:
Wi~
r.ty of Springfield Official Receipt
velopment Services Department
Public Works Department
2200400000000000770
Date: 06/1412004
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Perm Serv/Fdr 200 amps or less
Paid By
C PERKINS ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
4061
In Person
Payment Total:
Page 1 of 1
3:06:43PM
Amount Due
4.41
6.30
63.00
$73.71
Amount Paid
$73.71
$73.71