HomeMy WebLinkAboutPermit Electrical 2007-9-13
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City lob Number ('f)n12(JrY7 - OJ 407
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1.
LOCATION OF INSTALLATION:
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LEGAL DESCRIPTION: .
.11D3dO 33tJ/f:7jj)
JOB DESCRIPTION:
e,- 09Jl0 cfl.J J"/O JlLU-
, .
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Date Cl - \ ~ - Q1
3, C,OMPLETE.FEE SCHEDlJLE BELOlV
.. ,". -'(;',-. - ','"" ^ '," .
A.~ew Residential- SiIigl,e or Multi-Family per dW,elling unit.
Service ,Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
.' . ~ ;,,' - h. ~.
2 CONTRACTORrNSTALL.4.TIO'NONLY. B. Sen'icesorFeeders-Installation,Alterations or Relocation: _
E'lectriCal contractor' -6' vy (j( n fJJ(OS 200 Amps or less $1?oi -10. uO
P I . Cii7 201 Amps to 400 Amps $ 75 00
Address 0 1() ..;.. (y' 401 Amps to 600 Amps $12~.06
~ A .~) (v \~ 7 LJ'7 ~'7~Y 601 Amps to 1000 Amps '({"{"(\7 -- - $163.00 -
, . ... v v c..v'"(;E.t;-uOO- L SI~lUG;)
City ~ i :-..; Phon,. . avec 1000 Amp'""9I\1mO!J!!oN A~:::n '-'o5a~Nal O,opaqwnu
, Reconnect Only GUOLlcJel8l alp '::\'flN~- '1a18'O e~I'3g
L1 " ''1 ";;.' ,Aq salnlaLHJos.~!dOOUI13lqo kew no", '0600
Supervisor License Number U ~ 5 C.TeIllPorary Sef'~reas~W~OnOJLROWO~~OO-G96 BVOUf
" I ~lO,llaS altl selnl aso41 'laluao UO!ltlO!,lJ+ON
Expiration Date I 0 () 1. Installation, AlteraH~\{\NcmTdQ.flbQ Aq paldoPB salnJ MOllOJ
. I [, 01 no" saJjncaJ Ma! UOOSJn ~NOIJ.N311V
1... r ~ I I d 200 Amps or less $ 5U.W
Constr. Contr. Number :)l.fJ IT 201 Amps to 400 Amps $ 69.00
I 0 10 7 401 Amps to 600 Amps $100.00
Expiration Date
I Over 600 Amps or 1000 Volts see "8" above.
~gl1atu(:~. of\Asupervisin.j Electri,c. ia~n lA, D. Branch <=:ircuits
(r\ ' New Alteration or Extension Per Panel
, '~_)l\t,./ . \\ ~ l, \_/ One Circuit 'j '1:" .~$ 43.00 .
~ Each Additional C}j(Mtgr3'NOON'd8't1 SI H-',;, :-~.~ '-. ~-,~ .',
1/l'iI t. 11~ IU,--, f I Service or Fel~NFSri~WtJ=ld S', ' \.ill UdWi~.JUil!! 1(,;
O:nersNam' fU.JlJ ...y/e.AJLU \f... ',' )H:103Hl ... . ,Hl,tElONn 03Zli.-JQi-Unv
Address It. yX? m ,Sf R. .u..Y f E. Mlscellan~ous ~ervlce7Ke1fJi:'f~ IJJl~bk6I)L.J.WhtHdl@'N!1tion
CitPp~~ ~Od Phone Pump or irrigation $ 50.0;~~IlOtJ
--.J Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited Energy/Residential $ 25.00
The installation is being made on property I own which Limited Energy/Commercial $ 45.00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
Owners Signature:
Inspection Request: 726-3769
TOTAL
'~ l.() . Ob
'3.5u
6 ~ &cJ
., , -0-0
jC:~~/O
Shared Drive(T:)/Building Fonns/Elecuical Pennit Application 8-06.doc
4. SUBTOTAL OF .ABOVE
8% State Surcharge
10% Administrative Fee
5% Teclmology Fee
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2007-01407
ISSUED: 09/13/2007
APPLIED: 09/13/2007
EXPIRES: 03/13/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1356 M ST
ASSESSOR'S PARCEL NO.: 1703253301800
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: New Service
Owner: ATCHLEY DEBORAH L
Address: 1356 M ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
BURRELL BROS ENTERPRISES INC
License
136446
Expiration Date
08/20/2009
Phone
541-747-2724
BUILDING INFORMATION I
# 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:
Range 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:
nla
I DEVELOPMENT INFORMATION I
Frontyard 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:
Storm Sewer Avai('~Isz-Z8€-009-~ S! JalUeo
Special l~tJWgti:9n!;)N Al!l!ln uo6aJO alU JO. Jeqwnu
auoljdela~ aLl} :.alON) 'JalUaO a4l6u!II~
Notes: Aq SSlnJ SLll JO sa!doo urelqO ABW nOA '0600
- ~ 00-,96 l:l\fO 46noJ4l 0 ~Oo- ~00-Z96 1:1'10 UI
4lJOJ ~es aJa selnJ 0:)U41 Ji:ltUdO UlI~It;"'!J~.PN
AllI!m u06eJO a4I Aq paIdope salllVAHilion Description I
Ol nOA SeJlnbeJ MBI u06eJO :NOI..LI~::IJ.J.9
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
\Jlm:.ljd AVU U~H AN\!
I PUBLIC IMPROVEMENTS 110.:1 03NOON'tf8\f SI 1:10 038N3V1JII1108
lON SlllS'i~M511lb!P~30Nn 03Z11:I0Hln'tf
}l1:IOM 3Ht!,oU.~ldXsID11\ffi1S IlVIJ1:I3d SIHl
:313UON
Street Improvements:
Description
Type of Construction
Value
Date Calculated
Pal!:e 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2007-01407
ISSUED: 09/13/2007
APPLIED: 09/13/2007
EXPIRES: 03/13/2008
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
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$7.00
$3.50
$5.60
$70.00
9/13/07
9/13/07
9/13/07
9/13107
3200700000000000618
3200700000000000618
3200700000000000618
3200700000000000618
Total Amount Paid
$86.10
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.
Reouired Insnections ,
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.
Owner or Contractors Signature
Date
Pal!:e 2 of 2
225 :Fifth S'treet
Springfiehl, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01407
COM2007-01407
COM2007-01407
COM2007-01407
Payments:
Type of Payment
CreditCard
cReceintl
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
Date: 09/13/2007
3200700000000000618
Description
Penn ServIFdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Item Total:
Check Number Authorization
Paid By Received By Batch Number Number How Received
JOSHUA BURRELLIBURRELL njm 03564b In Person
BROS.
Payment Total:
Page I of 1
11 :37:55AM
Amount Due
70.00
3.50
5.60
7.00
$86.10
Amount Paid
$86.10
$86.10
9/13/2007