HomeMy WebLinkAboutPermit Electrical 2004-03-24l;
u
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541 -7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2004-00326ISSUED: 0312412004APPLIEDz 03t24t2004EXPIRES: 09124t2004
VALUE:
SITE ADDRESS:325 23RD ST
Owner:
Address: 3200@YOu
nter
nurnber for the reg
:^ r -aAO-3
Springfield TYPE OF WORIC Electricat Work Onty
TYPE OF USE: use initials
and two new circuits upstairs.
License Expiration Date Phone
3849 0910u2004 541-741-2236
Contractor Tvpe
Applicant
Electrical
Contractor
CHARLENE MCGUIRE
C & S ELECTRIC
TION
the rules i
phone
BUILDIN(
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Overlay Dist:
# Street Trees Rqd:
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:
Impervious Surface Area:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
PUBLIC IMPROVEMENTS
Notes:
Page I of2
LT
PROJECT
NO.:you
Those ate
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Rax
541 -7 26-37 69 Inspection Line
PERMIT NO: COM2004-00326ISSUED: 0312412004APPLIEDz 0312412004EXPIRES: 0912412004
VALUE:
Description Type of Construction
Fee Description
+ l0o/o Administrative Fee
+ 77o State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Total Amount Paid
Total Value of Project
Date Paid
3t24t04
3t24t04
3t24104
3t24t04
Value Date Calculated
Receipt Number
3200400000000000015
3200400000000000015
320040000000000001s
3200400000000000015
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Amount Paid
$7.20
$5.04
$9.00
$63.00
$84.24
Iees Paid
Plan Reviews
ffi
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.
1 Electric Service: Approval required prior to utility company energizing service.
2 Final Electric: When all electrical work is complete.
3 Rough Electric: Prior to Cover
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 onty 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.
S/e-v/ D€D +
or Signature
Pase2 oI2
Date
F)
h.
Valuation Description I
225 Fifth Street i''
Springfield, Oregon 97 477
541-726-3759 Phone
Jity of Springfield Official Receipt
Development Services Department
Public Works Department
#:Date:
coM2004-00326
coM2004-00326
coM2004-00326
coM2004-00326
Perm ServiFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7%o State Surcharge
+ 10%o Administrative Fee
11
63.00
9.00
5.04
7.20
Item Total:s8424
of Payment Paid By
CreditCard MELISSA GEHRKE
Received By Batch Number Authorization Number
njm 000333 024597
How Received
In Person
Payment Total:
Amount Paid
$84.24
$84.24
(
225 FIFTHSTREET . SPIIINGFIELD, OR97477 o pII:(541)726-3753 o FAX: (S4lr7l6_36tg
PERMIT APPLICATION
City Job Nr Date O
3.
ril\
UT
C.
A.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
fplPortion thereof
\
Jach Manufact'd Home or
Modular Dwelling Service or
Feeder TION:Ore
201
401
601
Over 1000 AmpsA/olts
Reconnect Only
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 or 1000 Volts see 'ts'kb"*
D.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
The following Proiect as submitted has the lollowinl'
and does not require sPecific land use
Date
$ 106.00
$ 19.00
I
LEGAL DESCRIPTION
o I (IO
JOB ttrr/3 Qvc*,r
13
Perm are non-transferable and expire if work is
not started withln 180 days of issuance or lf work is
Suspended for 180 days.
irt
B.
Address ilQ8z
City J- rno,,"Lll ZZL
Supervisor License Number Llqqqs
Expiration Date lD-c,l-OLl
Constr. Conh. Number ,lKLl,l
Expiration Date {-t -ov
Signature of Supervising Electrician
owners Nur" (hdrl Lr-r,t.(
Address r?a r!.
Phone
OWNER TION
The installation is being made on property I own which
is not intended for sale, Iease or rent.
Owners Signature:
3 Q.oo
$37s.00
$ s0.00
$ 50.00
$ 69.00
$100.00
$ 43.00
$ 3.00
$ 50.00
$ 50.00
$ 2s.00
$ 45.00
E.
Minimum Electric Permit Inspection Fee is $45.00 * Surcharges
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
7o/o State Surcharge
l0% Administrative Fee
TOTAL
0't)
A4Inspection Request: 726-3769
4.
Shared Driv{T:/Building Forms/Elcctical permit Application t{3.doc
t
2.
1
6D1-0010
cent6r.