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Home My WebLink AboutPermit Electrical 2004-11-22 225 FIFTH ~TREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAX: (541)726-368~ . ~ '/(9 ELECTRICAL PERMIT APPLICATION I ~ 0"0 'O~ City Job Number COVVlz,cO 4 -t:J I Y 3. 7 Date 1'/ Z 'Z 10 '1. ;ol"ot.-~ ~";.?.9,o I I ' OQ "''3-,' 3. 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 1. 1St:- VEYLl-/ LEGAL DESCRIPTION ,- 170'3 Z7Z- L '-()~7':S(yr JOB DESCRIPTION <5L~1J t c...e~ e-rf-/hVG--e 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. B. Electrical Contractor rUt. blc.. ELli..~e Sf.el/lc.t. 200 Amps or less I $ 63.00 b ~ 201 Amps to 400 Amps $ 75.00 Address 1.2()li1tJlII~6~. 401 Amps to 600 Amps $125.00 r 601 Amps tq.JQO.O:~mps $163.00 City Ul~tN E Phone 3L/ l./ - 3b""~ / Over 1000 AlwiB'foltiS:MIT SHALL EXPIB.Esg-ii~(j)i:i WORK, Reconnect O~~THORllED UNDFR TlliS..P~~~WP IS NOT ""1'7...3~O Supervisor License Number ~ T ..:> v Expiration Date { lJ / I / ~() 0 + , Constr. Contr. Number 9 C? :J. CJ D Expiration Date .3 ./ J rl Cl :;- Signature of Supervising Electrician Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps , Over 600 Amps or 1 000 Volts see "B" above. D ~~iWJ. "1-15,"'F!, . t !PI' ~'I ' $ 50.00 $ 69.00 $100.00 ;yJ-PJJ Owners Name b A- IV Address 'Zz,( L City S ;:> r=- ~ lrI ,4 L- (C@... Gf:::Ilc-aLy New Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with .. ServjAq Q)bNe~.eQtsagon taw reQuires Y(JU>~o b the Ore, on Utility E. Phone . PUI1ia9Oi~imay obtain copies of the rl$l~~.~ Signl~et~ter. (Note: the tele~ts~o Limi~m~grAlgon Utility Notltlqa1I9.90 Limited Ener~rt~0-33~-".;Y+")" $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 4. 7% State Surcharge 10% Administrative Fee 63 4'11 b36 73~ Inspection Request: 726-3769 TOTAL Shared Drive(T:)lBuilding FonnsIEI___:....1 Permit Applicatiolll-G3.doc CITY OF SPRINGFIELD C Building/Combination Permit PERMIT NO: COM2004-01437 ISSUED: 11/23/2004 APPLIED: 11/22/2004 EXPIRES: OS/23/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2212 BEVERLY ST ASSESSOR'S PARCEL NO.: 1703272207505 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: PROJECT DESCRIPTION: Service change Owner: DANIEL WALKER Address: 2212 BEVERLY ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION' Contractor Type Electrical Contractor EUGENE ELECTRIC SERVICE INC License 90200 I BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type VN Water Type: Secondary Construc'tt6ilI;.re~ LL EXPIR~fDl~\[y,p't8RK # of Bedrooms: THIS PERMIT SHA THIS r.E~~~rIf~tl,lmT AU1HO,RIZED UNDER OS:pri~f~Auilding: n/a _, d'r..... nn \~ IHU\\\\ vl\\t ;~~\\~'~;'JDAY ~ERI(HDEVELOPMENT 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:: All t:NT10N: Oregon law requires you, ~o fJ.1 .......J.--, o....~r+n'"' h"tnp Orp.oon Utllltv . "'.. n:n'__ ....If.. ,l ", th Notificatiqn =ID111W"lWW>J51~~ in OAR 952-0 - 1 U mrUUYl1 UM' . ",,,,L ~ ~1- 0090. You may obtain copies of the rules by calling the center. (Note: the tel~~ho~e number for the Oregon Utility Notification Center is 1-800-332-2344). Street Improvements: Storm Sewer Available: Special Instruction: Repair Residential Phone Number: 541- Expiration Date 03/17/2005 Phone 541-344-3561 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Paee 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01437 ISSUED: 11/23/2004 'APPLIED: 11/22/2004 EXPIRES: OS/23/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-367() Fax 541-726-3,769 Inspection Line ~Fees Paid-l Fee Description + 10% Administrative Fee + 7% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $6.30 $4.41 $63.00 11/23/04 11/23/04 11/23/04 2200400000000001439 2200400000000001439 2200400000000001439 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 r~quested after 7:00 a.m. will be made the following work day. 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 Ifurther 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 Coinmilnity 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 ~f plans will remain on the site at all times during construction. Owner or Contractors Signature Date l: Pae:e 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3'759 Phone ~~ '-':(y of Springfield Official Receipt ,velopment Services Department Public Works Department Job/Journal Number COM2004-01437 COM2004-01437 COM2004-01437 Payments: Type of Payment CreditCard 11/23/2004 RECEIPT #: 2200400000000001439 Date: 11/23/2004 Description + 7% State Surcharge + 10% Administrative Fee Perm ServlFdr 200 amps or less Paid By WES ROBBINS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 023497 In Person Payment Total: Page 1 of 1 8:22:33AM Amount Due 4.41 6.30 63.00 , $73.71 Amount Paid $73.71 $73.71