HomeMy WebLinkAboutPermit Electrical 2005-02-23Building/ Com bin a tio n permi t
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2005-00204ISSIIED: 0212312005APPLIEDz 0212212005
EXPIRESz 0812312005
VALUE:
SITE ADDRESS: 359 S 41ST ST
ASSESSOR'S PARCEL NO.: 1702323302500
PROJECT DESCRIPTION: New Service
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Owner:
Address:
Contractor Type
Electrical
ARATA ROLYN J
359 S 4TST ST
SPRINGFIELD OR 97478
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1 -800-332 -2344
Contractor
GROUNDED ELECTRIC
License
158804
Expiration Date
02t24t2006
Phone
541 726-68s8
CONTRACTOR INFORMATION
; 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:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
oh of Lot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Sidewalk Type:
Downspouts/Drains:
REQUIRED PARKING
Total:
Handicapped:
Compact:
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
DEVELOPMENT INFORMATION
PUBLIC IMPROVEMENTS
Description Tvpe of Construction
Pase I of2
Value Date Calculated
vrtNUil
Valuation Description I
Building/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: COM2005-00204ISSUED: 0212312005APPLIEDz 0212212005
EXPIRESz 0812312005
VALUE:
Fee Description
+ l0o Administrative Fee
+ 7o/o Stile Surcharge
Perm Serv/Fdr 200 amps or less
Total Amount Paid
Amount Paid
$6.30
$4.41
$63.00
$73.71
Total Value of Project
Date Paid
2t23t05
2t23t05
2t23t05
Receipt Number
2200s00000000000213
2200500000000000213
2200500000000000213
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.
Electric Service: Approval required prior to utility company energizing service.
lnsnections
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 Springlield 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.
zla<lo-t
Owner or Contractors Signature Date
Pase 2 of 2
11 ,
rees rato I
225 Eifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
.velopment Seryices Department
Public Works Department
RECEIPT #: 2200500000000000213 Date: 0212312005 2:26223PM
Job/Journal Number
coM2005-00204
coM2005-00204
coM2005-00204
Description
Perm Serv/Fdr 200 amps or less
+ 7o/o State Surcharge
+ ljYo Administrative Fee
Amount Due
63.00
4.41
6.30
Item Total:$73.71
Payments:
Type of Payment Paid By
CheckNumber Authorization
Received By Batch Number Number How Received Amount Paid
Check DARRELL W. ROSIN njm 7203 In Person
Payment Total:
$73.71
-
2123/2005 Page I of I
SFFTf,IliFIGLD
CITY OF SPRINGFIELD, OREGON stlst ili.(itrEL{,
225 FIFTH STREET . SPRINGFIELD, OR97477 r PH:(541)726-3753 o FAX: (541)726-3689
PERMIT APPLICATION
City Job )o / out"!-.<
I 3
-l.t? s v-=-F
LEGAL DESCRIPTION/7 0) .?f,33 0 )560
JOB DESCRIPTION
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1
Service
1000 sq
Each
portion
Each 6Fnter.
Modular
Feeder
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsAy'olts
Reconnect Only
Over 600 or 1000 Volts see "B" above.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
7%o State Surcharge
l0% Administrative Fee
TOTAL
you to
rules
litv
Electrical Contractor
Address
G,spr t " ?Cxjr $ 63.00
$ 7s.00
$125.00
$ 163.00
$375.00
$ 50.00
$ 43.00
$ 3.00
(rc
City SaClJ. Phone 72(,- GP str//
Supervisor License Number 3/56 .\C.
Expiration Date /6 / o/ ,/o7 Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Constr. Cont. Number
/
,/5Pr+bq
$ s0.00
$ 69.00
$100.00
Expiration Date a/a//oC- / '1
of Supervising Electrician D.
Owners Name
Address 3 5 4 /)/ s
citv<L Phone
"[
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature
E.
Pump or irrigation $ s0.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection f,'ee is $45.00 + Surcharges
.p
flqr
. -(,';-T
,#7q- 7tInspection Request: 726-3769
4.
Shared Drive(T:)/Building Forms,'Electrical Permit Application l-03.doc
COMPLETE
A. New
BELOW
per dwelling unit.
-
INSTALIATION ONLY B. Services or Feeders - Installationo Alterttions or Relocation:
Services or Feeders
+
,rvLfl I
re
SUBTOTALOFABOW (,