HomeMy WebLinkAboutPermit Electrical 2004-12-16Building/C ombination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541 -7 26-37 69 Inspection Line
PERMIT NO: COM2004-01540ISSUED: 1211612004APPLIED: 1211612004
EXPIRESz 0611612005
VALUE:
SITE ADDRESS: 2875 6TH ST
ASSESSOR'S PARCEL NO.: 1703233411300
PROJECT DESCRIPTION: Service and 2 circuits
Owner: MyERS MARy L & NEIL C
Address: 2875 N 6TH ST SPRINGFIELD OR 97477
Springfield TYPE OF WORK: Electrical Work Onty
TYPE OF USE: Alteration Residential
K
\S Expiration Date
03n7t200s
Contractortitl-t c HALL \S PE,N]\\I SContractor Type
Electrical
R 1H Phone
541-344-3561EUGENED0
Square Footage
or Bid Amount
C0\"1
ANY 1
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
# Street Trees Rqd:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
nla
$ Per Sq Ft
or multiplier
DEVELOPMENT INFORMATION
Description Type of Construction
Total Yalue of Proiect
Value Date Calculated
Paved
o
lollow
calling the center.
number for the
Center
Valuation Description I
of the rules bY
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541 -7 26-37 69 Inspection Line
PERMIT NO: COM2004-01540ISSUED: 1211612004APPLIED: 1211612004
EXPIRESz 0611612005
VALUE:
Fees Paid
Amount Paid Date Paid Receipt Number
2200400000000001s17
220040000000000r517
2200400000000001s17
2200400000000001s17
Fee Description
+ llVo Administrative Fee
+ 77o State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Total Amount Paid
$6.90
$4.83
$6.00
$63.00
12fi6t04
12n6t04
12fi6t04
12n6t04
$80.73
PIan Reviews
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Electric Service: Approval required prior to utility company energizing service.
Reouired Insnections
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety
I further certify that only contractors and employees who are in compliance with ORS 70f .005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature Date
Pase2 of2
tFetilcFlSLD City of Springfield Official Receipt
relopment Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
RECEIPT #: 2200400000000001517 Date: 1211612004 10:06:25AM
Joh/.Iournal Number
coM2004-01540
coM2004-01540
coM2004-01540
coM2004-01s40
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 1Yo State Surcharge
+ l0Yo Administrative Fee
Amount Due
63.00
6.00
4.83
6.90
Item Total:$E0.73
Payments:
Type of Payment Paid By
uneckNumber Authorization
Received By Batch Number Number How Received Amount Paid
CreditCard RUSS ROBBINS djb 016981 In Person $80.73
Payment Total:
-SEdF
t2n6t2004 Page I of I
225 FIFTH STREET . SPRINGFIELD, OR97477 . PH:(541)726-3753 . FAX: (541')726-3689
E LECTRI CAL PERMIT APPUUTTON
Ciry Job Number -ot o Datc tz-l6 -OL(
1.3.
Z 6){ (,fL <l
LEGAL DESCRIPTION
t7032 ]3Y /30c Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
JOB DESCzuPTION
Ctt'Lc*7 h
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if rvork is
Suspended for 180 days.
7
Electricat Contractor EU t ette fuAfZtC SU,U\CZ.
B.
A
=,crLJtcc
Address l2O /Ilamle-Srr
city AuarL Pnone 3 -1
Supenisor License Number 3 + 3ss
Expiration Date
Constr. Contr. Number dtoo
Expiration Date 7 os
Signature of Supervising Electr-ician
Owners Name y'||/al /n y'€(L\
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
$ 63.00
s 75.00
s 125.00
s 163.00
$375.00
s 50.00
63
C.
Installation,
200 Amps or
201 Amps to
401 Amps to
Over 600 Amps or 1000 Volts see "B" above.,.,q
K
T
Nerv Alteration or Extension Per Panel
One Circuit $ 43.00
Each Additional Circuit or with -Service or Feeder Permit L $ 3'00 L
Ad&ess
Ciry
*---7
-7{
Phone
f'u s\-E.
fuilor
OAR
ooeoNhirY
or lo0ta-url}tr_
!dlortt
$ s0.00
$ 50.00
$ 25.00
$ 45.00
OWNER INSTAILATION
Thc installation is being made on property I own
is not intendcd for sale, lease or rent.
Owners Signature:
l0% Administrative Fee
TOTAL
a
$45.00 * Surcharges
r83
670
73lnspection Request: 7 26-37 69
Sbrmd Drivo(f:)lBuiHing Foro/Elccticd Pcflnit Applirlbo t{3.doc
6z
\**-h*