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Home My WebLink AboutPermit Electrical 2003-4-10 , ~'t. " ':.':;' 'CITY bFLJINGFIELD~ OREGON '~' -~ ' , . ,. . '-"' ,~' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATI9N The following project as submitted has the tollowing City Job Number CD Yh ?OO~ _ OO%ll>ate U-I()-Q3 ~::'~'r';;va~nd does not require s~ecific land use ,_ ' I \')1'--" 3, l)l"e. O' -'iJjlTE}ft..--eiSGHJfuuflf,1Eiihv,,; ,.'i;,~y'"" "'c,,: 1'.': ~""~'~I.::}tirf!i;"'9",",.,_,......n"'-.L_'~""~~""l.:....'" ;;: ',oX ' ,'IV"! . ' ~ t~ ~-:":'f.;.,,,,n~~$t{2l:-J:Y ~ltt~.'.rD-',,-:-"(l::'r~h'''-;c-\'J'''' !1.f~~I' ;"'P.' ~~:"~~'l A, r:~~'.t~.~t~!!t!!\?;';.Il!,!g!~9Ir~!~,\!.icl\~!,11!y,P~r, '!I~t~!lng.~l~ 1 t:;.l ,,\. . l =- C. ~~o'l!'a"~"'v.;J5'!srr~~'c'Jf.i!-or'I'f.','e'''''e~'e'''''''''rs' :>>1:<lJO!'Z(WIiIM;f"k,< ~itF'I\;;:',~' ,"Ai,ll Supervisor License Number ,~.".~..-u.. _~. ____ -" ~,,_.P_-':~_!c'.k__.~_Et_~:.l~ U ~flj~s;..l'tt't~!!J~..~,-.Ett'fu\!ll,;~~.l1 _. Expiration Date ~\""~. Constr, Contr, Number ~'r>~"\.4" \.. r> Expiration Date ~\~~ S;Dk::;""~~ Owners Name ~tJ S\-Auht. Address ~6~ Sull)~~ City ~~f ltt- PhoQ ,tilt. ~\ I OWNER INSTALLATION I, E{f9,@~~6.N;{~l1!m$.T;@1tM.-t~g~ti1!~.:;~M 45S5 LV~ 'S\- ~r~ld OL LEGAL DESCRIPTION \W.DS\~ O'?lJ..ff7 JOB DESCRIPTION -D:ll'\m, l-l<...,..~? A",O t>U1">'O'--i')'uCf Permits are non-Iransferable and expire if work is not starled wilhinl80 days of issuance or if work is Suspended for 180 days, ~lc,eoNfRA..~""&i0R;iN'sifJffi~1ii:W:;-ONLy}1 2. t~t;:kd'lit~~~_"",_....,~.;lbto;,j~""""~,,y.,I~iI<";1.r,"'-~""~ Electrical Contractor Address Burrell Bros. Electric 40159 Booth Kelly Road Springfield, Oregon 97478 _ ~~~.-1,..~"L~-.-J City ,,----- The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Service Included 1000 sq, ft, or less Each additional 500 sq, ft, or portion thereof $106,00 $ 19,00 Each Manufacl'd Home or Modular Dwelling Service or $50,00 Feeder S VOU \L. , , . . b,pJ" Ira ~\'\' i',.....f;"iOfj~;lg '. ,;,reb...,,\,..,j, ""';"i""""" . - _",~",~~,,....t"t..'fi.; J B. "Ser:V1ces: ", ~e ",' Btatt~l1 " IIl1S:'Or' ~~ll\c...tion:"'l,~ .,~, -;'-' i ','.,. -. . !fr.l~"'':''~'S5lJ1U.WJ''''-.'~)~j,;J fn\IOW fU e er ihoSe ru a c,.. n52-00;' 200AmPSOF.=S..\iOnceot . ,_....^"n)'\OO~(1' ')-Sh~ NO,I'"'' 01-001v,r, - UhQrU'- . 201 Amp~,~l i-O 'f1I:"l'ieS$)DlUO \ ~_" , ob\a. ."., 401 Amps A/mUmay , ("'ntA:\W11!il'6tx,.~.!;^n . ,~th cente.. \' 'u. "'9.1~ I..~, - 601 Amps to 1l!Q{1\l\:IllP".e h oregon Ut\\'JlY6~l( Over 1000 A'VIUW6lNtor\ e,s t.<p.no-332$~~5.0 ' Reconnect Only center \ $ 50,00 Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above, ~~'Ij<;ll'ot'~""''';:'''\''lr.''.... 'l!''" D. l:l~r~~nclh~u'CUl' ' $ 50,00 $ 69,00 $100,00 ~'l: -, ~':~' .'r';,~:"~.~::~ :Y;.lr~ " ":I~"!"~\I\I~Jl''''I~i(. ,. , New A1te~\?ri9~~fl'_~ OtMRE IF THE WORK One CirC~~.IZ~UN.QER.+l:I!sHRt~WO till:B, ClO Each Add ~lfls ABAIt)O~I1=n ~blR (.,. ~ Service 0 1~"3. M QAY PERIOU. "'~""';' ~~"'l:'r.~' !!'!:', !t,\~"!'ffl':~" ',.....~' "'1.- "... (" "~.,tl.-# E'~~e...e1J:m.~,olls Se 1 et. e~de~ R<ifli, Cl!).~.t~!~E!~l\~"-~~J~~~j,l~!,'~ Pump or irrigation Sign/Outline Lighling Limited Energy/Residenlial Limited Energy/Commercial $ 50,00 $ 50,00 $ 25,00 $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surchargcs 4, "S.r:J1jrj{&P~dF~~~ U<1,C!O ?,tf~ 4,QO Sr,'?3 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)IBuilding FonnsIElectrical Permit Application 1-Q3.doc 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Line Items: Job/Journal Number COM2003-00254 COM2003-00254 COM2003-00254 COM2003-00254 Payments: Type of Payment Check Paid By Description Add, Aller, Exlend Circ Receipt #: 1200200000000000988 Date: 04/10/2003 Add, Alter, Extend Circ Ea Add + 7% Stale Surcharge + 10% Administralive Fee BURRELL BROS Received By Check Number Confirm No ddk Page I of I "'.r- 4/10/2003" 9:19:13~, City of Springfield Development Services Department Public Works Department Official Receipt . Amount Paid 43,00 6,00 3.43 4,90 Line Item Total: $57.33 How Received Amount Paid In Person 57.33 $57.33 . Payment Total: cReceipLrpl . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00254 ISSUED: 04/10/2003 APPLIED: 04/10/2003 EXPIRES: 10/10/2003 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4585 IVY ST ASSESSOR'S PARCEL NO.: 1802051303207 Springfield TYPE OF WORK: Heating System TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Move heat pump and outside plug Owner: Address: STANLEY RONALD M & JOAN W es yoU to 4585 IVY ST SPRINGFIELD OR 97478 "'Olegon laW reClUIlgon UtilitY fr"Cl\rno.... ,~..." the Ole _. 'nrtl' ~"_""HI~5aoU"'-- - eluleSI11g--'-Oo~' I CONTRACTOR INFORMAT.l<ilNlrel. ihoS gh OAR 952 b I~"'t. ,\ 52-O01'OO~ 0 thlOU, 5 oHM lules ~ Contractor in OAf\l~~~~y ob~~1.~~\\d>.atePh'Pb'bJle BURRELL BROS ENTERPRISES INC 0090!.i~'ifffje centel. \1(l~1YG,~otiliC~'P-747-2724 STANLEY RONALD M & JOAN W _~~;'4M'nl'h90~~2~ '}<1??344). I BUILDING INFORMATION ~entel IS Contractor Type Electrical Owner # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: SETBACKS - , DEVELOPMEN1iIIISIl0IDY!ATION I EXPIRE IF 1HE WORK 1HI~ PtlilVlI1 ", ,,,..L PER" BEOl\%IfD PARKING D UNDER 1HIS 1'1111 ~-" Overlay Dis1JJ1H~R\ZE ABANDONEWql@;\ # Street Tr~lidENCED OR IS Handicapped: Paved Drive;AAd:' BO DAY PERIOD. Compact: % of Lot Coverage: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: I Valuation Descrintion I Description Tvpe of Construction $ Per Sq Ft Square Foota!!e Value Date Calculated Pa!!e 1 of2 . . CITY OF ~rK1I"Il>t'u'LD Building/Combination Permit PERMIT NO: COM2003-00254 ISSUED: 04/1012003 APPLIED: 04/10/2003 EXPIRES: 10/10/2003 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 ~ $4.90 $3.43 $43.00 $6.00 4/1 0/03 4/1 0/03 4/10/03 4/1 0/03 Receipt Number 1200200000000000988 1200200000000000988 1200200000000000988 1200200000000000988 Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Pai Total Amount Paid $57.33 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.Rf'nuirf'd Tnsnf'~tilwi.l 1 Rough Electric: Prior to Cover 2 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 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 2 of2