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Home My WebLink AboutPermit Electrical 2004-10-13 ~ep-30-04 03:14P " P.02 .. \i ~l~I"..G;1="l.aLD '>', .' ~.~t9 ' .... ;' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . I'H:(541)726-J7S3 . FA-X: (541)726-3689 ~ ~"!Q.H ~...i-' ELEL'11dCAJr !~~-;,,!lT APPLICA1"10N . 0 ;aOI-~:%' ~J! City Job NumooLLUL.~(r1) 4- c9 / d ~ '7_ Date / 0/ /~'i );;J'f)() -l7: "0-0:;$.0" . 0 7t 0& 9<. .. ... '.. .... '?-. ,? , IS' ~ 1. .i.OC'AT10NOFTNSTALI.ATIOl\~': .. 3. CO~IP!-E:TE.FEESCHED[ri:JtB 0'$ "O;<:'IS'. l \ O~. . Ci'Xvtunn ~ rd (b \ vuL ~<:'~ ~9~~. .. LEGAL DESCRIPTION A. .. Nc\\ R~.s.~~~l1tiul- Single or Multi-F~llI) "'I'IIinl!:i~ o.l15 ;;J/~ Y'<...j !-;)b(5i) Service Included (' A (!>0-..2<:,1S' '{-' '$) 1> ~ JOB DESCRlPTION 1000 sq. ft. m less $1 .0::1 "r"" '0..... 6'~ n (7) A '_' C,.. Ea~h additional 500 sq. ft. or ~ \ · v", ~~ _ "I ~j?...Ul-U portion thereof $ 9. X\ IS'@ 1, Permits are non-transferable and expire if work is Ea8h W.unufnct'd ~ome ;:>r 'o~ .' not started within 180 days of issuance or if work i~ Moduiar Dwelling Service or ~ Suspended fol' 180 days. F=cdcr. reo on law rer \$'11;:::; f..S.OJ#3 "",V 2 :~CO;"1'RA~C~STA.LL4.PON ONLI' B. :: s.;~JI.Ie~.~i~~. ~1~\I~fiC", ,QI~;j\l~~i;:' 'j[".;ati"", . . ' . '. \.c. ~. . \ \ ~ t-~O;i~;ation Center. Those ,ri~\':)~~\~) r~)~'~''C'''i)_ 3 . 6V E;ectncal Contractor _ ~~C1T~\.Q 20~~%iRs~r~~_001-0010 thrO~l-il f ;-\,~ 6~'9<1. lJ lP . C'\ '-} h I 201lr:\QRs ~~'O.jt'fl1W~b'ain COPIes Cf tl.$Jis~oo:> y Address V [) h.....X L.C:JL \ 40 1 ~'to ~~~~(fflnt~r. (Note: the te'$'1~~.IQ&\:;; 60 I ~rsl\~~ft\Wj Oregon Uti~!y 1~~1~1~BO' t Cityb:~~:-cn~hone ~S:l ~ Over ~A;mre~'RH~r is 1-800-332-234~.n5.00 U :?econnect Only $ 50.00 . I , '''1 I \ I \ ':' Supervisor License Number t--t, '--\' '-T .:::> \ D\{) \ \D\ Constr. Contr. Number -l-~ I C) L6.- Expiration Date _~. \ 4 AC=S 200 Amps or less 201 Amps to 400 Amps 40 I Amps to ~OO, Amps l " '. L ~ . ... ~ Over p90 Amp~-or ,!:OOO,Voltsjsee ':B.'\~?ove. -I'uf V'I' r: ~/ .: ..iri!~ t:d-'.lvl.l. ~."h",\-t^1 11,- II .IL..,.JV.h.\ D. : BrundiCJrclJl~.. ..U' D'R T IS ....R 11'1.1~. ,'.r . : AUTHUKittD I\! t H r't l~ .v I\lv New WMIVR:rwcffitlQ1N~I~;rABt\WEJONEO FUK Olle CnritN}I. i An ntl.Y PERino. $ 43.00 Each ~8'tiItI'JItf1 l' Cffc\ll t ::>r wan ---::: I t _._ .. Service or Feeder Permit $ 3.00 Owners Name ~H-.rGLL!..1dL}O-.fG1 n .. ... .,. . . .. ..... . . .. .... .. . ... Addres.~ II O'~ (rznf:L.aJ7 {UBI y:}J. '~~li;c.~~~:~~~'us' (S'er~ic~i~d~~ ~ot ~c1~d~d}:Each Inst~U~tlon . Cily ",- ~O.-/ _ Phone Pum? or irrigarion $ 50.00 Sign;OutJine Lighting S 50.00 Limited Energy.'Residential $ 25.00 Limited Energy/Commercial S 45.00 Expiration Date Signll(ul'e of Seoervising Elecuician~. ~~ - OWNER L'I\STALLA TI O~ The installation is heing made on proper:y r OWI1 which is not intcnded for sale, lense or rent. Owner.; Signature: Inspection Request: 726-3769 ." :-:,.. "-';:~ '~;. ":'" ': . .,: ' " . c. ~:,J.e~por:lry..'.: Sen'ice; or Feeders . . .. Installation, Alreration or Relocation $ 50.00 $ 69.00 SI00.00 .Mlnlmum Eiectric Permit Inspection Fee is $45.00 + Surchar::es 3CO G .. LJ.'-II (p. ...30 73. "7/ 4. . 5UjJTOTAJ.., OF AB~WI.'.' : _. '.i..:........ .;" 7% State Surcharge 10% Administrative Fe~ tjJ TOTAL Sha.-ed Driv~(T;)/B\Jilding FomI5lEIc:<;\';:AI P~r.tlil "'pplic;;tion ! -03.doc S"...p. .R1ILN G.....F..IiJil;.."-D... iij. ....'.'....,. r' . ...."...". il~ I-i.~m.~., ; ". f , " ; . ,...1' ' . ~...........""',_."',.:..-.-...:"''''-''*,. Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01267 ISSUED: 10/13/2004 APPLIED: 10/13/2004 EXPIRES: 04/13/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1105 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264412500 Springfield TYPE OF WORK: Electrical Work Only A TTENTI 't~p~ rt)Fl'JsiE~N reqNlmfii~)ju to follow rules adopted' by the Oregon Utility Notification Center. Those rules are set forth :.. 0:.:-: e::ee 1-3,3 13 aIlUU~;1 c,~;; ;;;J~.U...uu 1- Owner: CASLEY RAYMOND LEWIS II & MARLA G 0090. You may obtain copies of the rules by Address: 1105 CENTENNIAL BLVD SPRINGFIELD OR 97~a71ing the center. (Note: the telephone Owner: SETH FALLEN STEIN number for the Oregon Utility Notification Address: 1105 CENTENNIAL SPRINGFIELD OR Center is 1-800-332-2344). Residential PROJECT DESCRlPTIO~: New Service I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor ROBS ELECTRIC INC License 156678 Expiration Date 08/14/2005 Phone 541-686-5444 J BUILDING INFORMATION. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Storif,m:liCE: Lot Size: Height o~'~J;gcPUl~MIT SHALL EXPI~11~~t:~qM:$J< ~:':;~y eR1iHORIZED UNDER THIS ~~ ~~~'ln Range T f)w,MMENCED OR IS ABANI$Qtn~JrG~/Carport Energy P~Y 180 DAY PERIOD. Sq Ft Other: Sprinkled Building: nla Occupant Load: 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: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: Pa2e 1 of2 CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2004-01267 ISSUED: 10/13/2004 APPLIED: 10/13/2004 EXPIRES: 04/13/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description' Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Fees Paid' 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 10/13/04 10/13/04 10/13/04 Receipt Number 1200400000000001470 1200400000000001470 1200400000000001470 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 ~ade the following work day. I ReouiredfiInsoections 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 Pa2e 2 of2 225 Wfth Street SpriugfIeld, Oregon 97477 "541-726-3759 Phone '"'ity of Springfield Official Receipt ;velopment Services Department Public Works Department RECEIPT #: 1200400000000001470 Date: 10/13/2004 2:35:19PM Job/Journal Number COM2004-01267 COM2004-0 1267 COM2004-0 1267 Description Perm Serv/Fdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By CreditCard . DAVID LAWLER Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 013522 In Person Payment Total: Amount Due 63.00. 4.41 6.30 $73.71 Amount Paid $73.71 $73.71 . 10/13/2004 Page 1 of 1