HomeMy WebLinkAboutPermit Electrical 2004-4-1
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54])726-3689
ELECTRICAL PERMIT APPliCATION - ---/0 r"e~
City Job Number COM ZOd-l- 000 9- ~ Date \tf?/ i, 0 (/ a~onfn;'h~"'ing p,
, :e,o_& nC/ C/o OleCI &
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I. ~!iP,0!!Qlfpf..J1'f.~X7!f~'!J.!?~'i~'4:;'$~ 3. :PQ1I:f1~dflb~;!I&!f~~f"ft!fl-?JdljJr:'IMt41!:~&~%'~'.t1iIJ,;~,i:~~
4N::tC, "'\', +<.r1 4" e g ~ eClfic 1&~:Oho"'in
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LEGAL DESCRlPTION A. 'New'Rl'Sldenll~~~gle'o, ' Ill, a '. e!;,dwelhng.uDlt.~ ,1i
~~.~..;l';.:.~flltJ..,.~'o.~-. -j;~'~~'_ . ~';.,"~'.!;l:~.:<J'~
· ~~fI~q~'~>,}?)~~1\ ~d?ciitl6.o.~'r~,~\s- Service]ncluded re-.............gy~,_~_a
JOBDESCRlPTION 1000 sq. ft. or less '~$IO:
J \ fl I ~ Each addirional 500 sq. ft, or ..............
'f, P tl'-rCf!)rf\-" J.-VJv-J1 o~Q>n portion thereof $ 19,00
,.
Permits are non-transferable and expire if work is
not started,within ]80 days of issuance or if work is
Suspended for ]80 days,
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50,00
2 ~?eONTRAv~OR.:iNsTA,:;'r:MTIONlONiyJ,l B. HS~;~~;'i~~~~7lf1F~~~~t~{llitili~~~it~~iti~Ksi\trf.R~i~~iilk:~
. J;::~"i'4i.~;''.J:orh~'li~.t,.:.~,:,.'':',;;;,'r,.s.tL'.;P~~~~....:-,.i.<:i;,j;,..,~ ~~._~I>~:.rr~'~x;,t'~~'-'~~~r;.;tJ-i!'r.~~","~"'2:";:1~'1rL;!
ElectricalContractor SlTi\CP.r- ~(f'r<:k'iLJIJG20~Ampsorless , $63.00 f, S
11 A 201 Amps to 400 Amps $75,00
Address ":)l\..1) ()l.e C:,p""eJI LI? Kof 401 Amps to 600 Amps $125.00
I
601 Amps to 1000 Amps $163,00
Over 1000 AmpsNolts $375,00
Reconnect Only $ 50.00
City 1.. I lU'r1P
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Phone ~ (-<1 I)' '4~?
Supervisor License Number C)nro() s
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C ~;T""" '''''''"'''''-5'>>',' '''''''''''''''''f'F''''d'' "l'!',' !(.~~ '."'!!loiI """''". .- ,,~{f.-,!!
. lli~e.2l~ry:.~r,xu;.e~i:~~.~~~e".~n~<i;.;'." ~-,~}~...<it'~~l":', ,-,:?;~~
Expiration Date In - / - 0 t- (
Installation, Alteration or Reloe.ation
200 Amps or less $ 50.00
201 Amps to 40~~~ 'NO"\<' $ 69,00
...\'\nC~:, 4.,r{\~~~~ ~1 \S ~OI $100.00
Expirarion Date 0;) - 0 (p ,,\I ~"NI\1 ~~\S ~&!j}
'1"1::' !O\\\l~Q !; \ "','" . ~(f~~~'--Sil:;~c;;,~;,;;;~~~~,.->, -w- '".,,' ,,':''''''''1
Sign~~'Sing EI trician fl.\l\{\ ~~Q;,@~' ().~~!'_~~4>~(~~.$,'I'Ji~~;-~.,*.f..:Sii?''''
_________ CONl~~U o~e\t~fIl9ration or Extension Per Panel
. d /I ______ fl.~'{ One Circuit $ 43,00
c::::::....--c.~v ~ ' Each Additional Circuit or with h '
./ C · L(G-- Service or Feeder Permit 7. $ 3.00
Owners Name <<3'/ V IL-V'
,
lfO 9'c;- TA SP6"IL ,et
City S?Iq)
, <)'Q,9S9
Constr. Contr, Number
/7
Address
E. ~Misc.~irili~~a;~(s~f{.i~~/f~~~r~ii;&triift;{rlil1t~i)~E~~h~'I~~1~itittiii'h,,'
itri:"'~"","",""",,,,'c.,Y"""~,,;,_x>"':"~..1iG;i';hiit'~~""'-'--"-''''''"'^''''''""''''''.<'?\'..;J;;\i~:':" .. ~.".' .. ""'",',
Phone Pump or irrigation $ 50,00
on laW r~~OiitIlDg't,tting $ 50.00
OWNER INST ALLA nON ATTEN'TION:oreg d by tnEJAjlrrll!aCl!1!ll~ ,idential $ 25,00
Illes aclopte I ",ra se.' CI ,
The installation is being made on'ill\5Jl~h91 own..wN9.IJ 'Tnose ru l\\~ea Ell.er~mercIaI $ 45,00
. . d del ,'-'.... cal)on \,,"'" """.,,,an OAR ~::l
IS not mten e ,or sa e, lease or"...u' 001,0010 '!VImlMum flffilrkJltJ$n\it Inspection Fe. is $45.00 + Surcharges
, In OAR 952- ayobtainco~\~i'.tcl,~~-, ne''''''' "",,~'''''''''''''''-;-'' '"""'H'~ r
Owners Signature: 0090. '{ou lT1 tar ,\'-.ll]ta lU ' ()J;'.cA novEi'&(, 0/'..';;:;1-;' ~}~,:1' ? ') ,
, calling the ce; or~~on \:jt\\itViNOt lCi ,tlon~ r~.J:~' I, h',' '. ,<, ' > c- 'Z ~ '
nl.mber lor tn . . onn/'1?-'la.gt?MSurcharge )
" ~,..... -
10% Administrative Fee 7'5 <::>
<g77'J
Inspection Request: 726,3769
TOTAL
Shared Drive(T:)IBuilding FonnslElectrical Pennit Application 1...o3.doc
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00098
ISSUED: 02111/2004
APPLIED: 01/23/2004
EXPIRES: 04/01/2004
VALUE: $ 67,406.40
Status
Issued
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54] -726-3676 Fax
54]-726-3769 Inspection Line
SITE ADDRESS: 4095 JASPER RD
ASSESSOR'S PARCEL NO.: 1802052300400
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: Bedroom and bath addition
Owner: PASLEY CRAIG T & JUANITA E
Address: 4095 JASPER RD SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Plumbing
Contractor
JEFFREY PLEUARD
SUNSET ELECTRIC INC
RS PLUMBING CONTRACTING
License
135]96
]58859
]038]6
Expiration Date
05/07/2005
02127/2006
01/04/2006
Phone
54] -683-5] 40
54]-9]5-4883
54]-46]-4714
I BUILDING ]NFORMATION,
# 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: c: W 1\-\'rMiPf' I
r~: fiSJII'<.. "11 IS \,-\0
,,\('\,\\1 . ..... c.\-\f\.\.\. .. "r ofR," ,..n
. ...... ......"... -. Jr.! .,..- ... ,\.., P'
'/I-DEVELOPM13N'I"INl!ORfuA:ItIt>N I
I ,
~\.l \ I'V' rED IJ'" ,~
OWlWlE\'-\V ul'\\IO\).
C. i OJfj'I~Y Dlst:
f\.t-I'i ~ Street Trees Rqd:
Paved Drive Rqd:
]
]4.00
Wall Heat
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
774
R-3
SETBACKS
Frontyard Setback:
Side ] Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
205.00
55.00
Urban Fringe
REQUIRED PARKING
Total:
Handicapped:
Compact:
% of Lot Coverage:
4.00
0.00
I PUBLIC IMPROVEMENTS'
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk \liXRl':Jou to
On laIN r64U Utility
.,..,-,-:\,rnON:or6g d ,pownspollU1fiPams1or\'
p\, \ [;. dOp\6 \J~ ."- \ s are se\
10\lolN T.ule~~nter. inose r\e OAR 952-00'
10\itica\\on 001.0010~'1(~s'bl the rules \
In OAR 952- obtain cop' e telepnone
0090. :ou\~:~enter. {Not~~~;ty Notification
calling the oregon ?M4).
umber lor .. ,,,N"~~'?-'"
n . _ __,'_"~
Notes:
Pa2e ] of 3
Status
Issued
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54]-726-3676 Fax
54]-726-3769 Inspection Line
Description
Tvpe of Construction
Dwellines
V Wood Frame
Fee Description
Copies - Ea AddU @ 50 Cnts Ea
Copy 1st @ 75 cents
Plan Review Residential
+ ] 0% Administrative Fee
+ 70/0 State Surcharge
Building Permit
Fixture
Miscellaneous Plumbing
Plan Review - Planning
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Storm Sewer, 1st 50 Feet
+ ] 0% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Total Amount Paid
.
. Lit 1: OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00098
ISSUED: 02/II/2004
APPLIED: 01/23/2004
EXPIRES: 04/01/2004
VALUE: $ 67,406.40
I Valuation Descrintion' I
$ Per Sq Ft
or mu]tiplier
$90.60
Square Footage
or Bid Amount
744.00
Value
Date Calcu]ated
Total Value of Project
$67,406,40
$67,406.40
01/23/2004
F PPO 1.:ailIJ
Amount Paid
Date Paid
Receipt Numher
$8.50
$0.75
$286.55
$57.29
$40.10
$440.85
$42.00
$45.00
$59.00
$11.24
$224.75
$45.00
$7.50
$5.25
$]2.00
$63.00
1/23/04
1/23/04
]/23/04
2/11/04
2/11/04
2/11/04
2/11/04
2111/04
2/11/04
2/11/04
2/11/04
2/11/04
4/1/04
4/1/04
4/1/04
4/1/04
]200400000000000]00
]200400000000000]00
]200400000000000]00
1200400000000000]91
]200400000000000191
]20040000000000019]
]200400000000000]9]
1200400000000000]9]
]200400000000000]9]
]200400000000000]9]
1200400000000000]9]
]200400000000000]9]
]200400000000000424
]200400000000000424
]200400000000000424
]200400000000000424
$],348.78
I Plan Reviews I
Initial Review 01/26/2004 01/26/2004 APP LLH
Plan nine: Review 01/26/2004 02/] 0/2004 APP TAJ
Puhlic Works Review 01/26/2004 02/04/2004 APP VRJ Storm to existing, see Building
Plumbing Inspector if thcre are
questions.
Structural Review 01/26/2004 02/04/2004 APP TCM
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.
~eollirerunsnections I
8 Footing: Aftcr trenches are excavated,
9 Foundation: After forms are erected but prior to concrete placement.
Paee 2 of3
.
.
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2004-00098
ISSUED: 02/1112004
APPLIED: 01/2312004
EXPIRES: 04/01/2004
VALUE: $ 67,406.40
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54] -726-3676 Fax
54]-726-3769 Inspection Line
]] Post and Beam: Prior to 1100r insulation or decking.
7 Floor Insulation: Prior to decking.
]0 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
16 Wall Insulation: Prior to cover.
4 Ceiling ]nsulation: Prior to cover.
5 Drywall: Prior to taping.
I Final Building: After all required inspections have been requested and approved and the building is complete.
]5 Underl100r Plumbing: Prior to insulation or decking.
]3 Rough Plumbing: Prior to cover and including required testing.
6 Drywell: Engineered Drywell is Required. Provide the City with a copy of the DEQ application to keep on file,
14 Storm Sewer Line: Prior to filling trench.
3 Final Plumbing: When all plumbing work is complete.
]2 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
]7 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
Paee 3 of3
225 Fifth Street
., .
Springfield, Oregon 97477
541-726-3759 Phone
.
Job/Journal Number
COM2004-00098
COM2004-00098
COM2004-00098
COM2004-00098
Payments:
Type of Payment
Check
4/1/2004
"'iriIIOFlIILD '
Wi!""'~~"."'~'..-.. - '....
t ' --. ud !
-.'t .~. ~
r 1
. .-.:;1 -. __"
.City of Springfield Official Recei~
Development Services DepartmeD
Public Works DepartmeD
1200400000000000424
Date: 04/0112004
9:11:49A~
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
SUNSET ELECTRlC INC
Amount Du
63,00
12,00
5,25
7,50
$87.75
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Pail
djb
1232
]n Person
Payment Total:
$87.75
$87.75
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