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Home My WebLink AboutPermit Electrical 2007-9-13 ZON Lf)2. INITIALS, kJ 1M DATE '1-- /3- Of SOURCE fYv{):5JY2) r \ 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 ~ 1. LOCATION OF INSTALLATION: \'S~ . , .~ . ~~. YYl 5\'(!__~~ 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