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Home My WebLink AboutPermit Electrical 2003-09-04{ir}TTIHEFISLN Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54r-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00856ISSUED: 0910412003APPLIED: 09/04/2003 EXPIRES: 03/0412004 VALUE: SITE ADDRESS: 1004 sTH ST ASSESSOR'S PARCEL NO.: 1703352103100 TYPE OF USE: New PROJECT DESCRIPTION: Service change, sub panel, feeder and 10 circuits Otner: DAHL ORLO D & DONNA J Address: 5350 NORTIIWEST WAY REDMOND OR 97756 Springfield TYPE OF WORK: Electrical Work Only Contractor Tvpe Electrical Contractor DELLS ELECTRIC Expiration Date 0u03t2004 Residential Phone 541-935-2154 License 109864 CONTRACTOR INFORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Sccondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Sidc I Setback: Sidc 2 Setback: Rearyard Setback: Solnr Setbacks: Strcet Improvements: Storm Sewer Available: Spccial Instruction: Notes: R-3 vN # of Stories: Height of Type of Water Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: \$$ REQUIRED PARIflNG Total: Ilandicapped: Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: Total Value of Project Page I of2 v Dcscription TYPe of Construction Value Date Calculated J -\ |, U lllrll\ u rN r uKlYr,qllgl'u N, 0! 6\ I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 5 4l -7 26-37 69 Inspection Line PERMIT NO: COM2003-00856ISSLIED: 0910412003APPLIED: 09/0412003EXPIRESz 0310412004 VALUE: Fce Description + lD'h Administrative Fee + 7'lo State Surcharge Adcl, Alter, Extend Circ Ea Add I'erm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $21.90 $15.33 $30.00 $189.00 s256.23 Date Paid 9t4t03 9t4t03 914t03 9t4t03 Receipt Number 1200200000000002063 1200200000000002063 1200200000000002063 r200200000000002063 Plan Reviews To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. rvill be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Rough Electric: Prior to Cover 2 Electric Service: Approval required prior to utility company energizing service. 3 Final Electric: When all electrical work is complete. 81, signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all irrforlnation 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 Springlield and the Laws of the State of Oregon pertaining to the work described herein, and tlrat 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 strcct, 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 timcs during construction. Oryncr or Contractors Signature Date Paee 2 of 2 ' . -,."J€.f-tlLD r ees raro Ke(lulre(LtllspcquQ] 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department #: 1200200000000002063 Date: 0910412003 1l:25:26AM coM2003-008s6 coM2003-00856 coM2003-00856 coM2003-00856 Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7%o State Surcharge + l0o/o Administrative Fee 189.00 30.00 15.33 21.90 Item Total:$256.23 Type ofPeyment Paid BY Received By Batch Number Authorization Number How Received Amount Paid Check DELLS ELECTRIC djb In Person Payment Total:$256.23 6Fn$t6FtEI"p $2s6.23 225 FIFTH STREET . SPRINGFIELD,OR97477 o pH:(541)726_3753 o E LECTru CAL P ERMIT AP P LI CATI ON CiryJobNumberCcryra Zco) -S c3 6S6' Date ,o 1. LOCAT'IONOT'INST'ETI-AT'ION 3. cox{PLErEFpp h Zoning A\Jthortzed Stgnature A. Nerv Residential - Single or Nlulti-FaInily per llowing use zQ LEGAL DESCRIPTIONlf)i3;zl C.3lclc) JOB DESCRIPTION rinelling unit. 06.00 Service Included 1000 sq. ft. or less Each additional 500 sq. ft' or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder 200 Amps or less 201 Amps to 400 AmPs 401 Amps to 600 AmPs 601 Amps to 1000 AmPs Over 1000 AmPs/Volts Reconnect OnlY DE, ),'C' iclt.(S C Pc;,, Permits are non-transferable expire if work is not started within 180 days of issuance or if work is Suspended for 180 daYs. ) Electrical Contractor f, Address L d Phone 4a City Supervisor License Number $l $19.00 Expiration Date /o "-/-c/ Constr. Contr. Number /c c.i Expiration Date 0d-{ Signature of Supervising Electrician $s0.00 $ 63.00 s 7s.00 $ 125.00 $ 163.00 $375.00 $ s0.00 C. Temporar-v Services or Feetlers eqq COI\rIRACTOR INSTALIAION ANLY B.Services or Feeders - Installation, Alterations or Relocation: 0u i/'J Llea fn;<.5 '89 Ctrt t /.r',--K "J*'J 1000 Volts see "B" above' D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00i t,:!p 0() Owners Name L. p B. Address City dltd I Phone l: Pump or inigation Sign/Outline Lighting Limited EnergY/Residential Linlited EnergY/Comnrercial Minimurn Electric Permit Inspection 1. SLIBTOTALOFABAV-E 7% State Surcharge 10% Adminisffative Fee TOTAL Fee is $45.00 * Surcharges zt1 $ s0'00 - $ 50'00 $ $ 4s.00OWNERINSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent' Owners Signature:/fr 2(?u Z'L22 Inspection Request: 726-31 69 Shared ffve(T:)/Building Forms/Electrical Pennit Application I -03'doc CITYOF OREGON %*yity'