HomeMy WebLinkAboutPermit Electrical 2005-05-12Building/C ombination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fa,x
541-7 26-37 69 Inspection Line
PERMIT NO: COM2005-00568ISSUED: 0511212005APPLIED: 05/1212005
EXPIRESz llll2l2005
VALUE:
SITE ADDRESS: 1490 sTH ST APT I
ASSESSOR'S PARCEL NO.: 1703263101100
PROJECT DESCRIPTION: Work is for street lighting - One branch
Springlield TYPE OF WORK: Electrical Work Only
n OAR 952-00 1-0010 tho rutesbY
You maY obtain copies olOwner:
Address:
MAINSTREAM HOUSING INC
433 W 8TH AVE APT OO1
EUGENE OR 97401 0090
the center'(Note:the telePhone
isl
li
Contractor Type
Electrical
Contractor
THOMAS LEE BALCOM JR
License
138r21
Expiration Date
10fi9t2007
Phone
54t46t-2590
# 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 Building:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
Yo ofLot 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 PARI(NG
Total:
Handicapped:
Compact:
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
DEVELOP
PUBLIC IMPROVEMENTS
Description Type of Construction
Page I of2
Value Date Calculated
l,UllJl,rll\U rI\I UI(TVIA r !\,1l I
Valuation Description I
E
TR
OD
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fa'x
541-7 26-37 69 Inspection Line
PERMIT NO: COM2005-00568ISSUED: 0511212005APPLIEDz 05112/2005EXPIREST llll2l2005
VALUE:
Fee Description
+ l0oh Administrative Fee
+ 7%o State Surcharge
Add, Alter, Extend Circ
Minimurn/Adj ustment Electrical
Total Amount Paid
Amount Paid
$4.50
$3.rs
$43.00
$2.00
Total Value of Project
Date Paid
sn2t05
5lt2t05
5fi2t0s
5n2tos
Receipt Number
3200500000000000197
3200500000000000197
3200s00000000000r97
3200s00000000000197
To Request an inspection call the24 hour recording at 726-3769. AII 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.
Reouired Insnecti
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 ln 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 witl 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.
Ow.-€-,6l l?- lo s l-)
Owner or Contractors Signature
Paee2 oI2
Date
rees l-atrl I
$52.6s
225Fifth Street
Springfietd, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
evelopment Services Department
Public Works Department
RECEIPT #: 3200500000000000197 Date: 0511212005 2:17:58pM
Job/Journal Number
coM2005-00568
coM2005-00568
coM2005-00568
coM2005-00568
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+7o StateSurcharge
+ l0% Administrative Fee
Amount Due
43.00
2.00
3.15
4.50
Item Total:$s2.65
Payments:
Type ofPayment Paid By
uheckNumDer Authorization
Received By Batch Number Number How Received Amount Paid
CreditCard THOMAS LEE BALCOLM JR njm 002462 Phone
Payment Total:
$52.6s
-$ffit
5n2t200s Page I of I
rl.ryffiI
225FIFTIISTREET.SPRINGFIELD,ORST4TToPH:(541)726-3753oFAX:(s41)726-3689
PERM:IT APPLICATION
5-o(fl06arc
gPflITT'CF'ELE
$s0
City Job N
LEGAL
Address
Sigt
DESCRIPTION
E"r)
A.
B.
c.
D.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
Permits are non-transferable and expire if
not started withiu 180 days of issuance or if work is
Suspended for 180 daYs.
Electrical Contractor 200
401 Amps to 600 Amps
601 Amps to 1000 AmPs
Over 1000 Amps/Vols
Reconnect Only
Minimum Electric Permit
7% State Surcharge
l0% Administrative Fee
TOTAL
be lotification
4).
$ 63.00
$ 75.00p0Bo x 4zr; lrp $125.00
$163.00
$375.00
$ s0.00
$ 50.00
$ s0.00
$ 25.00
Ciry eutTr lta. Q HM""4klzsqa
Supervisor License Number 3S
Expiration Date
Constr. Cont. Number L
Expiration Date
of Supervising Electrician
Installation, Alteration or Relocation
200 Amps or less $ 50'00
201 Amps to 400 AmPs $ 69'00
401 Amps to 600 Amps 5100.00
Over 600 or 1000 Volts see 'T!" above'
H*ff'on
or Extension Per -2-$
43.00 # '*
Each Additional Circuit or with
Service or Feeder Permit $ 3'00
City
Owners Name #
{puon"
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
.00
rcharges P
3.trcq52
Fee is $45.00 +
Inspection Request: 72G37 69
4.
Shared Drive(T:/Building FormVElectrical Permit Application 1-03'doc
,s
BfubE mtes are
1-001 through
201 Amps to
,,
Utility
4
ND tn
Pump or irrigation
Si grr/Outline Li ghting
Limited EnergY/Residential
Limited Energy/Commercial