HomeMy WebLinkAboutPermit Electrical 2004-08-05Building/Combination Permit
Status Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2004-00968ISSUED: 08/05/2004APPLIED: 08/0512004EXPIRES: 0210512005
VALUE:
SITE ADDRESS: 403 16TII ST
ASSESSOR'S PARCEL NO.: 1703362407500
Springlield TYPE OF WORK: Electrical Work Only
th.ry 6r,
oF usE: Addition Residentiar
pRoJECr DESCRTpTTON: Four Circuitr+ sgtu(gg
Owner: DURR pAMELA LEE
Address: 403 16TH ST SPRINGFIELD OR 97477
Contractor Type
Electrical
Contractor
GROTJNDED ELECTRIC
License
158804
Expiration Date
02t24t2006
Phone
541 726-68s8
CONTRACTOR INFORMATION
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:nla
Notes:DUN
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
Vo ofLot Coverage:
RMIT IS NOT Notification Center. Those rul
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:Sidewalk Type:
Storm Sewer Available:
Special Instruction:
ALL EXPIRE IF THE WORK bllor rules adoPted bY the Oregon Utility
nrrElhumror€Drurr Gqrdt€syotrto
OR IS ABANDO
ANY 180 D
es are set lorth
in OAR 952{01'001 0 throtgh oAn 952-001-
oalling the center.(Note: the telePhone
for the Oregon Utitity Notilication
THIS PER MIT SH
DER THIS PE
NED FOR
$ Per Sq Ft
or multiplier
Square Footage Center is-1€00'332'23441'
or Bid Amount Value Date CalculatedDescription Type of Construction
Total Value of Project
EEI
DU rLrrll\ lJ rr.l r Lr_rllvlA I t (r1\ |
Building/C ombination Permit
PERMIT NO: CO M2004-00968
Status Issued
225Fitth Street, SPringlield, OR
541-726'3753 Phone
541-726'3676Fax
541-7 26:37 69 InsPection Line
Amount Paid
$5.20
$3.64
$43.00
$9.00
$6.30
$4.41
$63.00
ISSUED:
APPLIED:
EXPIRES:
VALUE:
08/05/2004
08/0s/2004
0210512005
Receipt Number
3200400000000000195
3200400000000000195
3200400000000000195
3200400000000000195
1200400000000001215
1200400000000001215
1200400000000001215
Date Paid
Fee DescriPtion
+ lloh Administrative Fee
+ 7o/o State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 10oh Administrative Fee
+ 7o/o St*e Surcharge
Perm Serv/Fdr 200 amPs or less
Total Amount Paid
To Request an inspection call the24
will be made the same working day,
day
$134.5s
hour recording at 726-3769'
inspections requested after 7
All inspection requested before 7:00 a'm'
:00 a.m. will be made the following work
815104
8lsl04
8lsl04
8lsl04
8t13l04
8l13l04
8t13l04
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete'
By signature,I state and agree, that I havetarefully examined the completed application and do hereby certify that all
information hereon is true and correct, and r fufihlr certify that any uno "u
woix perrormed shall be done in accordance with
the ordinances of the city of springtield and the Laws of ihe State of oregon pertaining to the work described herein' and
that No occupANcy will be made of any structure without permission of ttr. colnlnunity 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 ir.ieciion. are requestea at ttre proper time, that each address is readable from the
street, that the permit card is locatet at the front of the property, and the appioved set of plans will remain on the site at all
times during construction.
'i (2,)
Owner or Contractors Signature
Pase 2 of2
Date
3natxotl3.o crty of Springfield Official Receipt
velopment Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
RECEIPT #: 1200400000000001215 Date: 0811312004 11:03:04AM
Job/Journal Number
coM2004-00968
coM2004-00968
coM2004-00968
Description
Perm Serv/Idr 200 amps or less
+ lYo State Surcharge
+ lDoh Administrative Fee
Amount Due
63.00
4.41
6.30
Item Total:$73.71
Payments:
Type ofPayment Paid By
CheckNumber Authorization
Received By Batch Number Number How Received Amount Paid
CreditCard GROUNDED ELECTRIC dlm 000473 r87417 In Person
Payment Total:
$73.71
-mrr
8/t3t2004 Page I of I
RINGFTELD, OREGONCITY OF
225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)72G3753 o FAX:
City Job Number
3.
q6
A. New
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
Permits are non-tratrsferable and if work is
not started within 180 days of issuance or if work is
Suspended for 180 daYs.
,,
Electrical Contractor
Address &cS>s5.h 57,
%
6PlllI}'l TIELD
Qs
$l
$s0.00
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
$ 43.00
$ 3.00
lr3.
t4o
JOB DESCRIPTION
B.
vnone 7Q6'{YSY
Supervisor License Number 37.rA S C
Expiration Date l r> )ot / P eott
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601Ampsto 1000Amps
Over 1000 AmpsA/olts
Reconnect Only
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above
Zg-
---7----7Constr. Contr. Number
Expiration Date a
of Electrician
Owners Name
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Pump or irrigatron
Sigrr/Outline Lighting
Limited Energy/Residential
Limited Energy/Commerci al
Minimum Electric Permit Inspection Fee is $45.00 * Surch
7%o Stale Surcharge
10% Administrative Fee
TOTAL
D.
City $ 50.00
$ 50.00
$ 2s.00
$ 45.00
a)
nixl-
a
Inspection Request: 726-3769
4.
Shared Drive(T:/Building Forms/Electrical Permit Application l-03.doc
Altdrations
or
,/*lRR a 4
Services or
E. Miscellaneous (Service/feedernot
RINGFIELD, ORECONCITY OF
225 FIFTH STREET . SPRINGFIELD, OR 97477 o PII:(541)726-3753 O FAX: (541
PERMITAPPLICA
6 CCiry Job
7
LEGAL DESCRIPTION A.
Service Included
1000 sq. ft. or less
B.
Address
Ynone 7&G^f,VSY
Supervisor License Number 37rfa ,S C.
Expiration Date
Constr. Contr. Number
Expiration Date
of Supervising Electrician D.
FJ ST iit [:IrfllB'Prntffrs,nner WfiPTF THE WORK20fl$nqemiFpn ur,il
?9CCrrnt:ePomouA,trqdO$flfpwr
200 Amps or less Center iS
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
One Circuit
Each Additional Circuit or with
Service or Feeder permit
Pump or irrigation
Sigr/Outline Lighting
Limi ted Energy/Residential
Limited Energy/Commerci al
Lil THtS PERf'llr Bs$gt
iS AEAI{UONEOJOHg.OO
t0D.
Over 600 or 1000 Volts see ..B"above.
New Alteration or Extension per panel
SPR'Il,(3FIELI'
$l
$50'00
$125.00
$163.00
$37s.00
$ s0.00
$r00,00
$43.00 4 o1-)
$ s0.00
$ 50.00
$ 2s.00
$ 4s.00
3.
DESCRIPTION
'rL,; 15-Each additiona.! 500 sq. ft. or
.
portion therdof
j
Each Ma4ufact'd Home or
Modular Dwplling Service or
Feeder lt'.',t .
o
Owners
Address
Ci
OWNER
rz*63q\?$ 3.00
TION
Il-e inst:llalo1r^is being made on properry I own whichrs not intended for sale, Iease or rent.
Owners Signature:
Minimum Electric permit Inspection Fee is $45.00 +Surcharges
a
7%o State Surcharge
l0% Administrative Fee
TOTAL
-3
Inspection Request: 7ZG376g
4.
shared Drive(T:/Buirding Forms/Electricar permit Apprication t-03.doc
6?)
Branch
or
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
t..
Electrical Contractor W a-
-S tA '/.sa-
$
nc:;s :"ules are set forth
E' Misce'aneous lServicelteeder not incruded) -Each Instaration
Status Issued
225Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2004-00968ISSUED: 0810512004APPLIED: 08/0512004
EXPIRESz 0210512005
YALUE:
SITE ADDRESS: 403 16TH ST
ASSESSOR'S PARCEL NO.: 1703362407500
PROJECTDESCRIPTION: Four Circuits
Owner: DURR pAMELA LEE
Address: 40316TH ST SPRINGFIELD OR 97477
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition Residential
Contractor Type
Electrical
Contractor
GROUNDED ELECTRIC
License
158804
Expiration Date
02t24t2006
Phone
541 726-6858
CONTRACTORINF(
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
oh of Lot Coverage:
$ Per Sq Ft
or multiplier
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:nla
NOTICE:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUIHORIZED UNDER THIS PERMIT IS NOT
COMMENOED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
REQUIRED PARKING
Total:
Handicapped:
Compact:
mberforthe O
Center is '
Square Footage
or Bid Amount
Sidewalk Type:
Downspouts/Drains:
PUBLIC IMPROVEMENTS
Description Type of Construction
Total Value of Project
Value Date Calculated
r:r
[},-
-1, UILI ll\ (, lI\I (rI(rYI4!.1!!|ll l
Valuation Descrintion I
Status Issued
225Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-36768ax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2004-00968ISSUED: 0810s12004APPLIED: 0810512004EXPIRES: 0210512005
VALUE:
Fee Description
+ l0%o Administrative Fee
+ 7%o State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Total Amount Paid
Amount Paid
$s.20
$3.64
$43.00
$9.00
$60.84
Date Paid
8t5t04
8t5t04
8t5t04
8t5t04
Receipt Number
3200400000000000195
3200400000000000195
3200400000000000195
3200400000000000195
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.
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 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 OCCUPAIICY 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 tirne, 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
L m
liees Prirl I
Kequrreo lnsDectrons I
225 Fifth Street
Springfield, Olegon 97 477
541-726-3759 Phone
cify of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #: 3200400000000000195 Date: 0810512004 2:10:50PM
Job/Journal Number
coM2004-00968
coM2004-00968
coM2004-00968
coM2004-00968
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 77o State Surcharge
+ l0%o Administrative Fee
Amount Due
43.00
9.00
3.64
s.20
Item Total:$60.84
Payments:
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
CreditCard EzuC MCHAFFY nJm 000464 R46330 In Person
Payment Total:
$60.84
-$60-54-
8/5/2004 Page I of I
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