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Home My WebLink AboutPermit Electrical 2004-04-19CITY FIELD Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00440ISSUED: 0411912004APPLIEDz 0411912004 EXPIRESz 1012012004 VALUE: SITEADDRESS: 621 STHST ASSESSOR'S PARCEL NO.: 1703352403400 PROJECTDESCRIPTION: ServiceChange Owner: BERGBRUCER& SHERRIM Address: 448 D ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PhoneNumber: 541-726-6119 Contractor Tvpe Electrical Contractor DIXON ELECTRIC Expiration Date 07n8t2005 Phone 541-895-2440 License 66894 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: -no Overlav Dist:rut' # Streei Trees Rqd: Paved Drive Rqd: \S $ Per Sq Ft or multiplier Square Footage or Bid Amount REQUIRED PARI(NG Total: Handicapped: Compact: o/o of Lot Copp4gp,11lON:0re got law requtres you tofollow rulcs ado pted by the O utir ru are set 0090 cal num Total Value of Project Pase I of 2 Description Type of Construction Value Date Calculated \r l rl u llJr-rll\ \, u\ I \rluYr4!!v1]] GFIELD Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2004-00440ISSUED: 0411912004APPLIEDz 0411912004 EXPIRESz 1011912004 VALUE: Fees Paid Fee Description + llYo Administrative Fee + 7Yo State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Amount Paid $6.30 $4.41 $63.00 $73.71 Date Paid 4n9t04 4fi9t04 4trgt04 Receipt Number 3200400000000000048 3200400000000000048 3200400000000000048 Plan Reviews To Request an inspection call the24 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 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 atl 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 construction. lot or Signature Date Pase2 of2 I I Keourreo InsDecttons 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone ^rty of Springfield Oflicial Receipt -evelopment Services Department Public Works Department RECEIPT #: 3200400000000000048 Date: 0411912004 2:57:13PM Job/Journal Number coM2004-00440 coM2004-00440 coM2004-00440 Description Perm Serv/Fdr 200 amps or less + 7%o State Surcharge + l0%o Administrative Fee Amount Due 63.00 4.41 6.30 ltem Total:$73.71 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check DIXON ELECTzuC, INC.nJm 5782 In Person Payment Total: $73.7t $73.7r 4/t912004 Page 1 of I tfSI.l!3D lj'3"r:.". ,' " ".',.,'::' ,-'4. submitted has the following 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH: E LECTRI CAL P ERMIT AP P LICATI ON City Job -so 1. LOCAT'ION OF INST'ALIA'I'ION 3. GA \ 5t'^Slgc* (s4l)726-37 s3 o FAX: (541)726-3689 'fhe lollowing Project as zoning, and does not require specific land use t' A.orLEGAL DESCRIPTIONL?o3 sS O3 JOB DESCRIPTION Permits are non-transferable and if work is not started within 180 days of issuance or if work is Suspended for 180 days. 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 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 106.00 $ 19.00 $s0.00 B. Services or Feeders - Installation, Alterations or Relocation: 1 $ 63.00 Ls.@- -:- { -onn-i?2-23 $ 7s.00 $125.00 $ 163.00 $37s.00 $ 50.00 $ 43.00 $ 3.00 Supervisor License Number Expiration Date lol' /o., Constr. Contr. Number G Expiration Supervising Eleptrician I AHflrUUr,.r 'T5rua.o \a_rr C. Temporary'Sen'ices or Feetlers Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 AmPs $ 69.00 401 Amps to 600 Amps $100.00 Date \ IF II Over 600 Amps or 1000 Volts see "B" above' D. Ilranch Circuits q. Address st City S P<-r"-< Phonet \-) OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: E. Nliscellaneous (Sen'ice/feeder ttot included) -Each lnstallation Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges Pump or irrigation Sigrr/Outline Lighting 7%o State Surcharge 10% Administrative Fee TOTAL $ 50.00 $ 50.00 t ''\ AieSUBTOTAL OF ABA\'E "2> ti - Z.-l /vl Shared Drive(T:)/Building Forms/Electrical Permit Application I -03.doc Inspection Request: 726-3769 4. oAR 952-00 the center.telephone ?,1., I u<. L1 i)ale llsw \\b