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Home My WebLink AboutPermit Electrical 2004-9-28 ~ <;il ~O (9~ ~ ~~ O~ ,.. \9 0/_ Ot- ' <;il -~' c;>>/ "0- %>..0 t "% "'0, o .090' 7(9" '1,' ? ;- '?9.0,... Q>O' ,., ~, .($l "6 2'25 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-~~9 '. .~ (9 ELECTRICAL PERMIT APPLICATION "'00 City Job'NumberC,:;i)U/lZOo4 ~O rZo Z. Date q.- L.g~()4 ~~(90- 0), Electrlcal Contractor .,' ',_ 200 Amps or less ~V-. . 20 I Anw~%.offil~mPf Address Burrell Bros. Electr~cr~: \..\.. 't.'11--~\~\~~\~d6)~ps 401'59 Booth Ke~~b~~W\\\ S\\~ 't.\\ W\~~Rs~re\1000\)"mps Cll;.' Springfield, oreg~S4\T'O \I\:\) \)~\) S fQy~~R;b'~ AmpsNolts I _<:...,<' ....~_'"""L~~\ly00\\ ~C\:\) 0\\ \ Ot)~cOlmect Only C~t. \) \)~'{ ?'t.\\\ , Supef\ Isar LIcense Number ~~ l_\. C\~ ~ c. J. LI U 3.k CA o-dl ,'~ LEGAL DESCRIPTION 17DZ- 3.Z~C( Ql{LfOb JOB DESCRIPTION ~'-l~' (~t:.- f~'~T WA.... -itA.bhtd Permits are non-transferable and expire if work is nor 'started within 180 days of issuance or if work is Suspended for 180 days. 2. Expiration Date \\::::> \C:>~ Constr. Contr. Number \I:::::>'-.d-\.\.:\.\...o Expiration Dale \0 \ \::)~, b~~:ingEI~'~tL O\Vner~ Name ~~AO L Ckll<", b~,Lc:, Address '1'(;5 fa (fiVV\e-(J/A City 5~r~ ., Phone q88-~cll~ OW'NER INSTALLA nON The installation is being made on property I own which is nOI intended for sale, lease or rent. Owners Signature: Inspection Request: 3. 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 ~ $50.00 B. ./ $ 63.00 $ 75,00 $125,00 $163,00 $375,00 $ 50,00 bJ Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Am,ps to 600 Amps $ 50,00 $ 69,00 $100,00 Over 600 Amps or 1000 Volts see "B" above, D. New Alteration or Extensio~~'P\~~~\j\\\\\'l ~ One Circuit ~e~On \a~ne Ol~90 € se\ \<$~..OO Each AA.~b\lIQ;~oilil'l;~htu\es (j;\" 902-OQ S~~ orJ~~de9'P~I??~nos u~'r O~ _'J\@s~'cIo ~ 1 e,,\e . 10 . ~ \n" ' ",e E. \" ""ou ~ ,,\el. \j\\\X 1\1\)- Pu~~f.hr!'i~~B ce O~e~O" ~,;;?./I-~ $ 50.00 Sign/OlLtH'B~~\~~~ \S \-f()OO- . $ 50,00 Limite~rgy,,(?,~mntial :. $ 25,00 -, Limited Energy/Commercial' ..Y'" $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. b3 4 L( / b30 7371 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application 1-03 .doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01202 ISSUED: 09/2812004 APPLIED: 09/28/2004 EXPIRES: 03/28/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4436 CAMELLIA ST ASSESSOR'S PARCEL NO.: 1702323404406 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Service change Owner: CHAMBERS SHANE R & KIMBERLY M Address: 4436 CAMELLIA SPRINGFIELD OR 97478 Contractor Type Electrical N~CTOR IN1~Mtrr'?WNoRK THI IVIII \J"t"\LL IS NOT Contractor AUTHORIZED UNDER THIS ffJ~M~~OR' Expiration Date BURRELL BROS ~tfiOOJ~!OO~-t)SO:R<l5 ABAN!i'3mW 08/2012005 flINSUIDD~~6~ATION I Phone 541-747-2724 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 # 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: Vlhr n/a I DEVELOPMENT INFORMAllUl~ I REQUIRED PARKING Overlay Dist: Total: # Street Trees Rqd: ~feS ~~capped: Paved Drive Rqd: on 'a~ fe~U oiP9ti\k\'lIct: % of Lot Cove~'t\ON: Qreg d 'o~ \he Qreg e set \of\n ~~\N fu\eS_~~~~;e "tnose {~e~~~ 9~-~0~; I PUBLIC IMPRQ~.'O"\ -00"\ ~ \~~;\~S 0\ the \ ~~~e . Ut\I-1I o~ta\n . ~e te\e? . n \n '(oU ma~ {t~~~~'Y.~' Not\\\cat\O 0090.. n tne cen ~.onl~n Ut\ \\!O!A.~\ ca\\\n~ .".EJlOwm !.Qw...fI}VllRYt" 'oer \of \.,' . ~ _~ \)-~"" num centef \s Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01202 ISSUED: 09/28/2004 APPLIED: 09/28/2004 EXPIRES: 03/28/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid-l 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 9/28/04 9/28/04 9/28/04 Receipt Number 1200400000000001401 1200400000000001401 1200400000000001401 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. l....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 Pae;e 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone i:~ rity of Springfield Official Receipt ,velopment Services Department Public Works Department Job/Journal Number COM2004-01202 COM2004-01202 COM2004-01202 Payments: Type of Payment Check 9/28/2004 RECEIPT #: 1200400000000001401 Date: 09/28/2004 Description + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Paid By BURRELL BROS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 4174 In Person Payment Total: Page 1 of I 11:51:11AM Amount Due 4.41 6.30 63.00 $73.71 Amount Paid $73.71 $73.71