HomeMy WebLinkAboutPermit Electrical 2005-2-16
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225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (541)7J6'~689 ..~ 1Jii;<..1
ELECTRICALPE~'PL~ ~:~~10 ',. .:,..~, . ,',;3
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A. 'Ne~ R;~ici~~~i;i=-~iri:r~~ "iti- '~~i1;& ~~W~lIing ~~it. , '
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Service Included '\ ~ ~C> ,/~19
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1000 sq. ft. or less ~, 106.~ ot,..
Each additional 500 sq. ft. or '\.~' 00 i5'61' '17
portion thereof '\.
Each Manufact'd Home or
Modular Dwelling Service or 50.00
Feeder
Dc) 700
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.
2.
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CONTRACTOR-INSTALLATION ONLY -
B. Services or Feeders-Installation, Alterations or Relocation;
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Electrical Contractor
'L.r", I ~ 'c' \ ri c::, E\ fr-tr \('
I -
L\.:- :_~ 1"\,\ t\ \/C:.
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
200 Amps or less
\" 201 Amp~ t9,4QO Am8s .
401 Amp~rt~SoBA~JUJreS you 10
.,,' - ' !1'j u,e'uregon Utiliiy
_- ~,.-.,C\ -," ,.60.1~AIt!P~ ~'182@~s are set rerth
'':)+'F ld I I , ..','Qy.~t; 19QO t\-WH~~OAR 952-00-1-
J~', , -.::) ~JlJItqs~&f?p86pies of the rules t
i~~~:'.:;',~'~~j:~~~~i=~1~t;A~~.=:.
Center is 1-800-332-2344\.
Installation, Alteration oflRelocation
Address ~;2 \ -)=)
City r- l. \f\ (:.)'"'\ ~
J
Phone
Supervisor License Number
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Expiration Date j ~ / ("'J \ / ~).C'C'J
I I
Constr. Contr. Number \ 'l ~ 'S :::;{
Expiration Date C ~/ c '3 /;~ t:t, '\
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f
I
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over_?9.0_~mp.sor}~99Yolts see "B" a~?,:,.e.~
D.Branch:~Circuits
S"o
$ 50.00
$ 69.00
$100.00
Signature of Supervising Electrician ~...__._""'_"", ~"_."
Il -'_~~ New Alteration or Extension Per Panel
~r _ _ One Circuit
.a Each Additional Circuit or with
A/ ) (I Service or Feedefl Permit '..:: : ~ '," ,/ $ 3.00
o rs Name . II e-l t4-, rl(/\. ~ \.A. ( ScL. Cf t-IL' -":-r~ :' "j{,,', ^< !,'
Address h z ~- ( 141 ,4--0l( S. '\ . ., E. 'Miscel~~~~?us(~eJVi~~~[~~~er,noti~cluded~ :-Ea~~' I~stallationj
\;.. '" \ J'. ,_' "-, . _" . '" '.
S p) ~ Phone ' Pilmp..or, irrigation).
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 43.00
City
$ 50.00
$ 50.00
$ 25.00
$ 45.00
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
4. SUBTOTAL OF ABOVE
50
)}"O
:) 0<-'
.- Cl. )0
<"::> c.; --
-_.~....
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building FonnsIElectrical Permit Application I-G3.doc
CITY OF SPRINGFIELD'
Building/Combination. Permit
PERMIT NO: COM2005-00189
ISSUED: 02/17/2005
APPLIED: 02/16/2005
EXPIRES: 08/17/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6200 ASTER ST
ASSESSOR'S PARCEL NO.: 1702343400900
TYPE OF WORK: Use Initials
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Temp power only
Owner:
Address:
WULLSCHLEGER ADELAIDA D TE
6251 MAIN ST APT 1
SPRINGFIELD OR 97478
Contractor Type
Electrical
. ,rr,::t,:T!ON: Oregori law requires you to
" ",;,-,~. GJu/-,u,;J Ly d,l;UIC!::lUII uLiiiLY
CONTRACTOR:iINJFOR1w.NlfI~NJ e rules are set forth
,.. '_'J"" VJt:...-uu .vu ugh OAR 952-001-
Contractor' . 0090. You may Illrreijjseopiempnea~D)tte
REYNOLDS ELECTRIC calling the Cer"~S2 (Note: the tfdf)1.0800Cn
BUILDINGINFO~liON iiOu~~3~~~~31~~)L:'Il;C1L10n
Phone
541-343-7297
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
. Height of Structure
Type of Heat:
Water Type:
~ange Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
. Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION ..
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
REQUIRED PARKING
Overlay Dist: NOTICE: . !'ota1i. WORK
# Street Trees Rq1H\S PERMIT SHALL EXP\RHJ~di~JPRed:OT
Paved Drive Rqd:AUTHORIZED UNDER THIS cijfit~"JJt. ~ I~
% of Lot CoveragC=OMMENCED ORIS ABANDONED FOR
ANY 180 DAY PERIOD.
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description .
$ Per Sq Ft
or multiplier
.Date Calculated
Square Footage
or Bid Amount
Type of Construction
Value
Paee 1 of2
Status
Issued
225 Fifth Street, Springfield, OR
i , 541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
Total Amount Paid
Total Value of Project
~Fees Paid I
Amount Paid
$5.00
$3.50
$50.00
$58.50
I Plan Reviews I
Date Paid
2/17/05
2/17/05
2/17/05
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-00189
ISSUED: 02/17/2005
APPLIED: 02/16/2005
EXPIRES: 08/17/2005
VALUE:
Receipt Number
1200500000000000212
1200500000000000212
1200500000000000212
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.
l Reouired Insoections 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 proj~ct.
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
Paee 2 of2
Date
2ZS Fifth Street
Sprin-gfield, Oregon 97477
~41-726-37S9 Phone
Job/Journal Number
COM2005-00 189
COM2005-00 189
COM2005-00 189
Payments:
Type of Payment
CreditCard
2/17/2005
RECEIPT #:
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Temp Power 200 amps or less
Paid By
ELLEN REYNOLDS
rity of Springfield Official Receipt
velopment Services Department
Public Works Department
1200500000000000212
Date: 02/17/2005
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 057168 In Person
Payment Total:
Page 1 of 1
7:49:30AM
Amount Due
3.50
5.00
50.00
$58.50
Amount Paid
$58.50
$58.50