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Home My WebLink AboutPermit Electrical 2004-11-10 < - '~\~'i_ " "z", "",'tJ;1 .r,,~',;~~'RINGFlELP 3. . ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72~-3689.)~.. ELECTRICAL PERMIT APPLICATION _. '<'~ <~ ' CityJobNumberU>lM"Z-crol{- tJ/3'87 Date /1 10 0 l{ <y~~ 1. 14 ')0 c.C1A" +r.~v\ l ~I LEGAL DESCRIPTION 17032~33 (;) gzon JOB DESCRIPTION SCfL V ICe- 0l PC? rA-.d~ / Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ,.~tJiL 2. ...... Electrical Contractor' ~~ (\ () ( P (l r (l -6' 6 f) Address <(?q q 'I In 0/\, I l ~~ City S \J\ 1 JtU- Phone ~ <6l.9. ~ (j q 05 Expiration Date \ S (_~ Cb ~ 1 D \ :lo 6 '1 54Y'bl g 3t)( ~l)6 lD Supervisor License Number Constr. Contr. Number Expiration Date Signature of Supervising Electrician U~a~ Owners Name ""'p~t-fl-A ci; (d S Address 14 S-o Ct7,^,~.AJA-1 City "S. ? F J) Phone OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 A. 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 $50.00 B. T ;. 200 ~fleJFl,~~D UNDER THIS PE~M\T$I~.o'oI)T 201 C{Y~~tWC1~B~IOR IS ABANDONED $Q5100 401 AWri~~~Ayt~RIOD. $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 c. Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. $ 50.00 $ 69.00 $100.00 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. : law requires }!OU t~ PurflDlRYWrtgOOSIBdopted by the Oregon\Afu 0 s~~ldfjl{l)ijMer. Those ryt~~ :rs ~f~~ h LIft1aAIB~~i49@tf~ through.QA~ q~~-bffi- LQQOO.~it~lcopies of thEir~I~<t9t Minimum~~lQ~J~~PW~I~QW~~lts~~~bGrSUrchargeS n 4. 6"3 Lit{ I bJo 7") 7!.- 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FonnsIElectrical Permit Application I-03.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01387 ISSUED: 11/10/2004 APPLIED: 11/10/2004 EXPIRES: 05/10/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1450 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 170325330sWOT~ClE: THIS PERMIT SHALL EXPIRE1i&ifE1l>Fv'QSW: PROJECT DESCRIPTION: Service upgrltl,HHORIZED UNDER THIS PERMIT IS NOT r.nMMFNr.Fn OR IS ARANnONFn FnR Owner: CHILDS DONETTA & JAME~ftJIY 180 DAY PERIOD. Address: 1450 CENTENNIAL BLVD SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work Only Repair Residential I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor ROSE CORPORATION License 54431 Expiration Date 09/30/2005 Phone 541-686-0905 I BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # 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: R-3 n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: ATTENTION: OI%gffiLbM:lmltli~ you to follow rules adopted by the Oregon Utility t""~:~:"".?,,r: ':er;~:r: n::'J:'. ~I..:.~ ..., ~ ...J. iv, L1. in OAR,95 -~Ulltl~(Jl'tW 001- 0090. You may 0 taln copies of the rules by Sidewalk Type: calling the center. (Note: the telephone . number for the Oregon Utility Notification Downspouts/Drams: Center is 1-800-332-2344). Total: Handicapped: Compact: 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 Paee 1 of2 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2004-01387 ISSUED: 11110/2004 APPLIED: 11/1012004 EXPIRES: 05/10/2005 VALUE: 225 Fifth Street, SprIngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I 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 11/10/04 11/10/04 11/10/04 Receipt Number 1200400000000001597 1200400000000001597 1200400000000001597 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. 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 win 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 win 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 win remain on the site at all times during construction. Owner or Contractors Signature Date Pal!e 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726~3759 Phone ~- ,....~ty of Springfield Official Receipt _velopment Services Department Public Works Department Job/Journal Number COM2004-0 1387 COM2004-01387 COM2004-01387 Payments: Type of Payment CreditCard 11/10/2004 RECEIPT #: 1200400000000001597 Date: 11/10/2004 Description Perm Serv/Fdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Paid By ROSE CORP Item Total: Check Number Authorization Received By Batch Number Number How Received djb 010559 In Person Payment Total: Page 1 of 1 11:26:37AM Amount Due 63.00 4.41 6.30 $73.71 Amount Paid $73.71 $73.71