HomeMy WebLinkAboutPermit Electrical 2005-11-04Buildin g/Co mbin ation Per mit
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676 Fax
541:7 26-37 69 I nspe ction Line
PERMIT NO: COM2005-01548ISSUED: 11/04/2005
APPLIED: 11/01/2005E)GIRES: 05/0412006
VALUE:
SITE ADDRESS: 299 sTH ST
ASSESSOR'S PARCEL NO.: 1703353100900
Springfield TYPE OF
TYPEOF USE:
Electrical Work Only
Addition CommercialPROJECT DESCRIPTION:Add electrical circuit for work at Ltd transit stop
Owner:
Address:
Contractor Tvpe
Electrical
CITYOF SPRINGFIELD
225 FIFTH STREET
SPRINGFIELD OR 97477
Phone Number: 54l-726-3753
Contractor re9'
$ Per Sq Ft
or multiplier
6n\al oreg e
nla
s0(e5e Expiration Date
03n7t2007
Phone
541-344-3561
# of Unib:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
6,o
Type:
Energy Path:
Sprinkled
Overlay Dist:
# Street Trees
Paved Drive Rqd:
%o ofLot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
rpoutMDrains
REQUIRED PARJ(NG
Total:
Handicapped:
Compact:
Frontlard Setbactc
Side I Setback:
Side 2 Setback:
Rearyard Setback:
- Solar Setbacks:
Street
Storm SewerAvailable:
Special Instruction:
Notes:
0s
Square Footage
orBitl Amount
Description Tvpe of Construction.
lof2
Value Date Calculated
the \\on
No\t1tt'"^
SPRINGFIELD
Buildin g/Co mbinatio n Per mit
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Fax
541:7 2637 69 I nspe ction Line
PERMIT NO: COM2005-01548ISSUED: 1110412005
APPLIED: 11/01/2005E)PIRES: 05/0412006
VALUE:
:;' Fee Description
+ l0%o Administrative Fee
+ 7o/o State Surcharge
Add, Alter, Extend Circ
Minimum/Adj ustment Electrical
Total Amount
Amount Paid
$4.s0
$3.15
$43.00
$2.00
$s2.6s
Total Value of Project
Date Paid
Lil4t05
tu4t0s
tu4t0s
lu4t05
Receipt Number
1200500000000001683
1200500000000001683
r200500000000001683
1200500000000001683
Fees Pa:
Plan Reviews
To Request an inspection call the24 hour recording at 72G3769. All inspection requested before 7:00
'a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature,I state and agree, that I have carefully examined the completed apptication and do hereby certify that all
information hereon is true and correct, and I further certiS that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCT PANCY will be made of any structure without permission of the Community Services Division,
Building Safety. I further certi$ 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
C)wner or Contractors Signature
2of2
Date
-225 Fiflh Street
-- -fp-tingn"fd, Oregon 91411
slr:726-t159 Phone
Citv of Springfield Official Receipt
'nelonment Senices D ePartme{
'" ='" *'i;;ic w orts D ePartment
RECEIPT #: 1.200500000000001683 Date:1110412005 e:33:03Alvl
Job/Journal Number
coM2005-01548
coM2005-01548
coM2005-01548
coM2005-01s48
Description
+ 7% State Surcharge
+ l0% Administrative Fee
Add, Alter, Extend Circ
Minimum/Adj ustment Electrical
AmountDue
3.15
4.50
43.00
2.00
Item Total:$s2.65
Payments:
Tlpe of Payment Paid By
CheckNumber Authorization
Received By Batch Number Number How Received Amount Paid
CreditCard RUSS ROBBINS djb 004944 In Person
Payment Total:
$s2.6s
-silar
tl4l200s I of I
ssr$xorlaLD
a9;l6i;" """U-
22s FIFTH STREET . SPRINGFIELD, OR 97477 t PH:(541)726-3753 o FAX: (5al)726-3689
E LECTRI CAL P ERMTT AP P LI CATTON
City Job Number &*1Zo or- olsqI Date l.oA -oJ-
Service Included
1000 sq. ft. or less
Each additional500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
$ 63.00
$ 75.00
$ 125.00
$163.00
$375.00
$ 50.00
$ s0.00
$ 69.00
$100.00
fuzrnq
1. ,::LACATTON OF TNSTALI-AIrOIr
z?'r sf * 5f
LEGAL DESCRIPTION
l?o 33 53 I oo ?oo
A. New Residential - Single or Multi.Family.pgl duelling unit.
3.
JOB DESCRIPTION
Ad[ I t{ C-vr. t
Permits are non-transferable and expire if work is
' not started within 180 days of issuance or if work is
Susnlnded for 180 days.
)CONTRACT O R INSTALI,ATI ON A N LY B. Services or Feeders - Installation, Alterations or
Electrical Contractor
Address
City €-ttat & q-A
Supervisor License Number
rr,\oc200 AmPs or less
201 Amps to 400 AnPS
401Arnps to 600 Amps
601 Amps to 1000 AmPs
&-
Phone 3 qq -35(^ L Over 1000 AmpsA/olts:e:-+'1:+
Reconnectonly
Expiration Date
Constr. Contr. Number ?OF fiCr
Expiration Date
Signature of Supervising Eiectrician
C. Temporary Sen'ices or Feeders
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 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
E. I{iscellaneous (Sen'ice/feedernot Installation
UU cen
$ 43.00
$ 3.00
ownersN"*" Cr !r,*.Sfp\
Address z?9 r(=+
city >)eO Phone zd-3
OWNER INSTAILATION
The installation is being made on properfy I own which
is not intended for sale, lease or rent.
Owners Signature
Pump or
Minimum
4. ST]BTOTAL OFABOW
7o/o State Surcharge
l0% Administrative Fee
TOTAL
\t
1H\$6Boo
[B $ 2s.00
n $ 45.00u.-
Fee is $45.00 * Surcharges
$E
Li-tq$
vTo
ed5UInspection Request: 726-3769
bs Shared Drive(T:)/Building Fonns/Electrical Pennit Application l -03.doc
COXIPLETE FEE SCIIEDDLE BELOI,V
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