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ns FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726,3753
ELECTlUCAl.. PERMIT APPLICATION
CIC,' Jobt'umber CouA~-ot57'Date
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ParnilS 'He non-rransferable and explre if work is
nOI ",,,,d \l'irhin J 80 days of Issuance or if work is
Suspended for 180 days,
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surrell Bros, Electric
401'59 Booth Kelly Road
Springfield, Oregon 97478
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lj !'lot Intended for sale, lease,or rent.
O',,'ners Sign2fure:
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Illsp,,,ion Request: 726,3769
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Service Included
1000 sq, ft, or less
Each additional 500 sq, ft, or
pOl1ion thereof
Each Manufact'd Home or
'Modulo,. Dwelling Service or
Feeder
$106,00
$ 1900
$50,00
$ 63,00
$ 75,00
$i25,OO
SI6J,OO
S375,OO
S 50,00
Installallon, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Voils see "B" above,
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$ 50,00
$ 69,00
'$ I 00,00
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit I
7% Stare Surcharge
10% Administrative Fee
TOTAL
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$ 3,00
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. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01579
ISSUED: 11/08/2005'
APPLIED: 11/08/2005
EXPIRES: 05/08/2006
VALUE:
Status: Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 4075 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1703344309200
Eugene
TYPE OF
Electrical Work Only
TYPE OF USE: Addition
Commercial
PROJECT DESCRIPTION: Add two circuits for exit lights
Owner: NORMAN FRANK
Address: 2511 LILY AVE
EUGENE OR 97408
Phone Number: 541-
.",'
Contractor Tvpe
Electrical
I CONTRACTOR INFORMATION I
ATTENflON: Oregon law r"n"ir,,~ YOb' 'A. .
Contractor follow rules ador't d b ["cense .. EXPll'atIon Date
BURRELL BROS ~;r~,~RI~~~~~ eT,-_~~Iit'3~~~6g0n UtI!lIy 08/20/2009
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1'1' BUlLp,ING.INFeRMkl1I0NIIAR 9p~-OO1:
uu"u. TlJU may Obtain copies of the r!)IJM;I!><Y
call,#,!!~Sto~J:s"er, {Note: the teleph_ Lot Size:
numfu1ilibt ~(e Oregon Utility NotifiCa.ljm,Sq Ft Ist Floor:
TYel!l"!.~~!lt, -800'332-2344), - Sq Ft 2nd Floor:
Water Type: ' ' Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Patb: Sq Ft Other:
Sprinkled nla Occupant Load:
Phone
541-747-2724
# of Units:
Primary Occupancy Group:
Secondary Occupancy
, Primary Construction Type
: Secondary Construction
, # of Bedrooms:
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street
, Storm Sewer Available:
, Special Instruction:
Notes:
Description
Type of Construction
SPerSqFt
or muItip6er
Square Footage
or Bid Amount
Value
Date Calculated
1 of 2
.
. CITYOFSPRlNGFIELD-
Building/Combination Permi(
PERMIT NO: COM2005-01579
ISSUED: 11108/2005
APPLIED: 11/08/2005
EXPIRES: 05/08/2006
VALUE:
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
. 541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paitll
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
, Add, Alter, Extend Clrc Ea Add
Amount Paid
Date Paid
$4.60
$3.22
$43.00
$3.00
11/8/05
11/8/05
11/8/05
11/8/05
Receipt Number
1200500000000001693
1200500000000001693
1200500000000001693
1200500000000001693
Total Amount
$53.82
I Plan Reviews I
To Request an inspection caD 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. wiD be made the following
work day.
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 wiD 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 wiD reDialn on the site
at all times during construction.
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
Sprfngfleld, Oregon 97477
541-726-3759 Phone
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JoblJournal Number
COM2005-0 1579
COM2005-01579
COM2005-0 1579
COM2005-0 1579
Payments:
Type of Payment
CreditCard
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1118/2005
RECEIPT #:
"
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
1200500000000001693
Date: 11/08/2005'
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Paid By
JOSHUA BURRELL
Received By
djb
I of I
Item Total:
l.:heck Number Authorization
Batch Number Number How ReceIved
01710B In Person
Payment Total:
II :45:30AM
Amount Due
3,22
4,60
43,00
3,00
$53.82
Amount Paid
$53,82
$53.82