HomeMy WebLinkAboutPermit Electrical 2003-08-20Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-00798ISSUED: 0812012003APPLIED: 08/2012003EXPIRES: 0212012004
VALUE:
SITE ADDRESS: 66 SHADY LP
ASSESSOR'S PARCEL NO.: 1703262300608
PROJECTDESCRIPTION: Reconnectservice
Owner: CRAWFORD VINCENT JAMES
Address: 66 SHADY LOOP SPRINGFIELD OR 97477
Springfield TYPE OF WORK: Electrical Work OnIy
TYPE OF USE: New Residential
License Expiration Date PhoneContractor Tvpe
Electrical
Contractor
OWNER
CONTRACTOR INFOR]VIATION
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
# of Stories:
Height of
Type of
VN Water
15
Dist:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
w
PARIflNG
# Street Trees Rqd:
Paved Drive Rqd:
o/o of Lot Coverage:g{
o$-{
\$
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project
Page I of2
Description Type of Construction Value Date Calculated
9
$
o\
Valuation Description I
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-00798ISSUED: 0812012003APPLIED: 08/2012003
EXPIRESz 0212012004
VALUE:
Fee Description
+ l0o/o Administrative Fee
+ 77o State Surcharge
Service Reconnect
Total Amount Paid
Amount Paid
$5.00
$3.50
$50.00
$58.50
Date Paid
8t20t03
8t20t03
8t20t03
Receipt Number
1200200000000001984
r200200000000001984
120020000000000r984
To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Electric Service: Approval required prior to utility company energizing service.
Reouired Insoect
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature Date
Pase2 of2
ffi.i
r ees raro I
225 Fifth Street :
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Receipt #: 12 984 Date:9:16:36AM
coM2003-00798
coM2003-00798
coM2003-00798
+ 7Yo State Surcharge
+ l0% Administrative Fee
Service Reconnect
3.50
5.00
50.00
Item Total:$s8.50
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid
CreditCard VINCENT CRAWFORD djb 000149 015741 In Person
Payment Total:
$s8.s0
$58.50
225 FIFTH STREET . SPRINGFIELD, OR97477 c P
E LECTRI CAL PERMTT APP LICATION
City Job Number Coc,.tZc C,S. -o <> lz 7 8 Out"
I LACA'TION OF' INSTANIE?IO}T
LEGAL
'H:(541)726-3753 o
llli
o roval
Zoning
i7o SZ;Zs DC
lo6'6pscmpl6N
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/V olts
Reconnect Only
$ 106.00
$ 19.00
$ 63.00
$ 75.00
$ 12s.00
$ I 63.00
s37s.00
$ 50.00
or Feeders
or Relocation
$ s0.00
$ 69.00
$ 100.00
3.
I
576tr1,rr<_q Zc<> /r/e<_T
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. cotrIrRACroE INSTALIATTOATONT,T'
Electrical Contractor
Address
Phone
Supervisor License Number
$s0.00
B. Services or Feeders - Installatian, Altera!iolrs or Reloratiorr:
City
,O
(,C.
Expiration Date JV
Constr. Contr. Number
Expiration Date
Signature of Superuising Electrician
less
to 400 Amps
to 600 Amps
or 1000 Volts see "B" above.
New Alteration or Extension Per Panel 1U
One Circuit
Each Additional Circuit or with
Service or Feeder Permit e,
Owners Name
Address (, (: SAa vli ' ,tD
v
E.
Minimum
City Phone 7ft/"SVIr
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners
1oh State Surcharge
l0% Administrative Fee
TOTAL
$ 25.00
$ 45.00
Fee is $45.00 * Surcharges
'O3to
,oo
<Q5ac)L)-Inspection Request: 726-3769
4.
Sharcd Drive(T:)/Building Fonns/Electrical Pcnnit Application I -03.doc
fiI $HHffi$N
hr(rrorized stgnature
A. Nerv Ilesidetrtial - Single or folulti-Family per dnclling unit.
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