HomeMy WebLinkAboutPermit Electrical 2005-3-28
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225 FIFTH STREET. SPRINGFIELD,'OR 97477 . PH:(541)726-3753 . FAX: (S41)7~3689~0':, ~
ELECTRICAL PERMIT APPliCATION', -v"1:1" ~ '
City Job Number coM L.CoS-oo>oB Date "3 -l"l. ~ 0$, ' . 0"""0\ 'O~i\
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LEGAL DESCRIPTION . ~.,~~~, ,~~ .a ,~.!!!g'~',~~l "u., .-r,"(m,', n n~
a" 0 ~~
l 1:) CJ 'Z... 0 t:;' I::' 03o"LO 1 Service Included Go", \
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JOB DESCRIPTION 1000 sq, ft, or less
Each additional 500 sq, ft, or
'^ " 'C> l l2.ooK Ll \2..C.U t, portion thereof
';
Permits are non-transferable and expire If work Is
not started within 180 days of Issuance or If work Is
Suspended for 180 days.
Each Manufacl'd Home or
Modular Dwelling Service or
Feeder
$50,00
2, 'eb~,,::'';;;'IINST~TI..\TI@1Y~~hY.4l
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Electrical Cont81illREll ~ @t~~ ",'0
P,O. Box 697~'~", "J ~
Wal~ervi"e, OAz97411~" \'0
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Supervisor Lice&~'NJlribe;'3 @~. <;
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Expiralion'Dalef> ,..)...<::i ,0~/b~::}{j 7
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Constr, Contr. Numoer."- 7 ( ) -l.J 4 7 (i
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B. Servic:es.or. F.ee(fers - Installation, ~Iterations or, Relocation:
~ I .', I . ,I .
200 Amps or less
20 I Amps 10 400 Amps
401 Amps 10600 Amps
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601 Amps 10 1000 ~Jk~ ~
Over I 000 AmPst.ft.I~ ,o~ <;:," ,
Reconnect On!!;(b 0<:::- GJW:l/t::j '<S.
'. ~~_<<bGj+<b * ",,<be, <b
'c' Ifif' "~q,.>!lfrV',"'I">',-~.,i.,,. 'iI'''~''''
"-" '~mp ~~ c~'it!,Cf..e~. en .
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&' -0"" <b ~ 0 ....<u;'$
Inston;;Ugn, ~lte.!;atloll or~Rel&aUon
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20~A';''';;sotl~~ 0'1. ri,"~ Pi
;s.' .~..."" ,'V G ~.:'Y 'Ii
~~UI 'A'm~' ~o~<AnWs >:- ~o,'l;
"",,'!> <u 'd;' ,0 OJ
~ ~I Aiilp~o 1!P~....bmJ1,s) r:;,C:; , $100,00
A)"o<::-~;;:\I':',*,'ll
~""r1Qiier 'fu~'?b' IOOO.volts see "B" above,
"~J};~ IIraotli ~rcuits
~o' ,.': ~,o, ,
'.. eW>~lte<;:'ati~n(l)'jl Extension Per Panel
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O~ cliicuJf I
Each Ac&ttional Circuil or with
Service or Feeder Pennil
$ 63,00
$ 75,00
$125,00
$163,00
$375,00
$ 50,00
Address
City
$ 50,00
$ 69,00
Expiration Date
8nr;;7"'P:;:""M<lL
Owners Name 1Z.o~(l..Lt> ~ j~r{ S'\At{LE.'{
Address 4- 5<05 l \('( S'nLE-E:l
City S'\? tt.( f{.(;, n"'Lt> Phone '14!\ - 80 \ l
(-';.00
$ 43,00
$ 3,00
Pump or irrigation
SignJOulline Lighting
Limiled EnergylResidential
Limited Energy/Commercial
$ 50,00
$ 50,00
$ 25,00
$ 45,00
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric PermIt InspectIon Fee is $45.00 + Surcharges
4'~~~:r?:.~DBo.:VE__ ~5.eo
7% Stale Surcharge '3, l$
10% Administrative Fee 4-.50
5<-. bS'
Owners Signature:
Inspection Request: 726-3769
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.
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRIl'''ilj'''~LU '
Building/Combination Permit
PERMIT NO: COM2005-00308
ISSUED: 03/17/2005
APPLIED: 03/17/2005
EXPIRES: 09/17/2005
VALUE:
SITE ADDRESS: 4585 IVY ST
ASSESSOR'S PARCEL NO.: 1802051303207
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: Add 1 room circuit.
Owner: STANLEY RONALD M & JOAN W
Address: 4585 IVY ST
SPRINGFIELD OR 97478
Contractor Type
Electrical
Phone Number: 541-744-8011
I CONTRACTOR INFORMATION I
Contractor
BURRELL BROS ENTERPRISES INC
License
136446
Expiration Date 'Phone
08/2012005 541-747-2724
# or Units: ~*:-
Primary Occupancy Group: ~\S :.::> "-
Secondary Occupancy Group: ,,:<:-'<- f? "'f.
Primary Construction Type ~ ~ :.::>"....
Secondary Construction Type: ~'<- o'<-~ ,,<-\;;) '<.
# of Bedrooms: <& ~ ',,\)"'"
V '\~ ~'V
,'>.~ ,Q.- ,..,'l'
~. NY \"
~<i,'~ .:::;,~~f?~\),
,..4.." 0<3' -!:5-\;;) ~ <::5 f<-~
..." c.." ~ <:;;<(;::\ ~
Frontyard'S~t~ack~S> ~~ \)~
Side 1 Setback:~"\ ~~ 'I;,\) ,
Side 2 Setback: ,,<::5::\"
Rearyard Setback: .;j!'
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Tvpe of Construction
I BUlLD1N"m"Ul~JIIIATIONI
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
,0 nla
".:> ...:~ '^
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMAilON'-I~\)" .,
u. ,t - 't: 'Q'
,'li O,'li, ~0 0:1'" ~0'?
Overlay Dist;>..~~ -S-0 ~0'? O~ 0'~ ~o~~ o~
# Street Trffs ,altdl?, ~ ~ o~ 'S' '0q ,,#
f?J-./?\: ~ ~'{) 0' .~
Paved,Ql'IW~<l? ~o '~0<O ,&-0~~&
% #,o~owagf' c,oq 0":",'~ _~.
^'" ~'Ii ~ s:>'" 'I:' rS .:::;,~' ri?
,~~ >'6 (Jj -;...:<:$ ~~ ~ _~ .,.n,'l;
I pooIJ.€' 1~~Rdv_rif&.,1,.",\)'-
w \., ~
~cY>O~ .J..o" 'S'fb ~-S-v !.'{> Sidewalk Type:
S:>' 'I:'Cb ,0 ~
,~ f:l\)OJ #' ~<$- (,J0t::' ' Downspoutsillrains:
o)~
<'
REQUIRED PARKING
Total:
Handicapped:
Compact:
I Valuation Descriotion I
$ PerSq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
.
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00308
ISSUED: 03/17/2005
APPLIED: 03/1712005
EXPIRES: 09/17/2005
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
L.F..... p~
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
$4.50
$3.15
$43.00
$2.00
3/17/05
3117/05
3/17/05
3117/05
Receipt Number
1200500000000000342
1200500000000000342
1200500000000000342
1200500000000000342
Total Amount Paid
$52.65
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.
I, Rf'nuir..rl ~
Rough Electric: Prior to Cover
Final Electric: Wben 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 contracton 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.
kL~~ ~Cl,'<!_~;~.,
Owner or Contractors Signature'-' (~ ~~,,> e>> s:..>" ) Date
Page 2 of2
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225 Fifth Street
, Springfield, Oregon 97477
, 541-726-3759 Phone
Job/Journal Number
COM2005-00308
COM2005-00308
COM2005-00308
COM2005-00308
Payments:
Type or Payment
CredilCard
o
3/17/2005
.
RECEIPT #:
Description
Add, Alter, Exlend Circ
Minimum/Adjusbnent Electrical
+ 7% State Surcharge
+ 10% Administralive Fee
Paid By
JASON T BURREL
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ljii'.""" -- '........, "..
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1200500000000000342
Received By
Check Numher
Batch Number
Jmp
Pa~e 1 of1
.JIi..ty of Springfield Official Receipt
"elopment Services Department
Public Works Department
Date: 03/17/2005
Item Total:
AUlhorlzatlon
Number How Received
050107 In Person
Payment Total:
2:36:24PM
Amount Due
43,00
2,00
3,15
4,50
$52.65
Amount Paid
$52,65
$52.65