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Home My WebLink AboutPermit Building 2004-08-18Status 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: COM2004-00390ISSUED: 08/18/2004APPLIED: 04/0812004EXPIRESz 0212512005VALUE: $ 40,000.00 SITE ADDRESS: 546 7TH ST ASSESSOR'SPARCELNO.: 1703352404401 or PROJECT DESCRIPTION: Owner: Address: SHOUDY 1033 TWIN HILLS Contractor Type General Electrical Mechanical Plumbing OR Notrl 6 coP rhe \cat\oo c nurnb ert Contractor XXL INC EUGENE ELECTRIC SERVICE INC MARSHALLS INC SUSAN JANE ARNOLD License 109867 90200 25790 49561 Expiration Date 1u09t2004 03n7t200s 12t23t2005 12n6t2004 541-344-3551 541-747-744s s41484-3787 Phone # 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: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: %o ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 VN 01 nla Sidewalk Type: Downspouts/I)rains: REQUIRED PARKING Total: Handicapped: Compact: PLR\O Notes: Paqe 1 of3 \mLI \aul TYPE OF WORK: Fire Damage OF USE: Repair utility porch structure above plumbing fixtures. Rewire building. Residential .tt-\\i0ED v 1BU DAY )' 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: COM2004-00390ISSUED: 08/18/2004APPLIED: 04/0812004EXPIRES: 02/25/2005VALUE: $ 40,000.00 Description Bid Amount Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 40,000.00 Total Value of Project Amount Paid Date Paid Value $40,000.00 $40,000.00 Date Calculated 05t06t2004 Fee Description + l0/o Administrative Fee + 7o/o State Surcharge Temp Power 200 amps or less -Mechanical Issuance Fee- + l0oh Administrative Fee + 7o/o State Surcharge Appliance Vent Building Permit Fixture Furnace - up to 100,000 btu Gas Outlets 1-4 Minimum/Adj ustment Mechanical Plan Review Residential Vent Fan + l0Yo Administrative Fee + 7oh State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Sidewalk Permit Total Amount Paid Planning Review Structural Review $s.00 $3.50 $50.00 $10.00 $41.32 $28.92 $6.00 $312.1s $s6.00 $12.00 $4.00 $11.00 $202.90 $r2.00 $14.10 $9.87 $78.00 $63.00 $7s.00 418t04 418t04 4t8t04 5n7t04 5lt7t04 5n7t04 5lt7t04 5lt7t04 5lt7t04 5n7t04 5lt7t04 5lt7t04 5n7t04 sn7t04 8lt8t04 8n8t04 8tr8t04 8n8t04 8t27t04 Receipt Number 2200400000000000333 2200400000000000333 2200400000000000333 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 r200400000000000746 1200400000000000746 1200400000000000746 1200400000000001230 1200400000000001230 1200400000000001230 1200400000000001230 3200400000000000223 Reviewed for compliance with historic restoration requirements. For plan review comments see Documents. $994.76 05t07t2004 0st06t2004 0sn4t2004 05t06t2004 KMG DLM APP APP To_Request an inspection caII the24 hour recording at 726-3769.will be made the same working day inspections req-uested after 7 day. All inspection requested before 7:00 a.m. :00 a.m. will be made the following work Feps Prid Plan Paee 2 of3 t:Lj Valuation Descrintion I 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: COM2004-00390ISSUED: 08118/2004APPLIED: 04/0812004 EXPIREST 02125/2005VALUE: $ 40,000.00 Temporary Electric: Approval required prior to Utility Company energizing pole. Framing Inspection: Prior to cover and after all rough in inspections have been approved. WalI Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Final Plumbing: When all ptumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including requiredtesting. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When alt gas work is complete. Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Eleclric service: Approvar required prior to utility company energizing service.Final Electric: When all electrical work is compleie. sidewalk - setback: After forms are erected but prior to placement of concrete. By signature, I state and agree, that r have carefully examined the completed application and do hereby certify that allinformation hereon is true and correct, and I-further certify that any and all work performed shall be done in accordance withthe ordinances of the city of Springlield and the Laws of ihe state of oreg-rn p..t';inirgio flre work described herein, andthat No occuPANCY will be madi of any structure without permission ortn. co.-,iit1s_""i.es Division, Buitding 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 inspeciions ,r. ""qru.tud at the proper time, that each address is readable from theHt."J'r'#lltt"filfi'ffi: is located at the front of the propertv, and the appiovea sei oipraos wirr remain on n. site at a1 ,s/,t/o Yor Contractors Date Pase 3 of3 t]! Keourreo lnsDecuons I 225. Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Citv. of Springfield Official Receipt L llopment Services Department Public Works Department RECEIPT #: 3200400000000000223 Date: 0812712004 11:42:36AM Job/Journal Number coM2004-00390 Description Sidewalk Permit Amount Due 75.00 Item Total:$75.00 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Numtrer How Received Amount Paid Check MCKENZIE/TAYLOR CONSTRUCTION vd 2860 In Person Payment Total: $75.00 $75.00 8/2712004 Page I of I 225 I'in'Tg SIREEI r ELECTRIC,AL CityJob }.irobcr 0\97171 o PH:(3{1)ZG311S ofAX: ?o o*{*t r *o\ b1 sts cqetol lOl'l: Cregon la1 requires esa IOBDESCRIPTION Cld-Ltt, PermlB gre and crpire if workh notstrrd wtthis 180 nf issuuse or if rork fu Suspendcd for lE{l drya: uma EsEh 200Amps orl6s 201 Amps to 400 AmPs 40i Anpsb600Arops 601 AEps to 1000 AnPt 0vcr 1000anPsA/olt Bcconect Only F{chAdditimal Circuit or with Ssrrica oFoodcrPaait 7% StrE Surdargr 1096 A&inbtrllivc f€o TOTAL | $ n.oo $ 7s.00 t125.00 $163.00 $37s.00 63Etcctrical Cotrtrector Add]ass PhoDc 24q45bl Srpcrvisor Liceosc 3115s F.rpiratioa Datc lo Coost- Couts- Nuaber 'uD Expiratioa Date SigDanro of SUP€n/isitrg olmerrNauc S O"* Add$ss S\- Ctry S Photc OWNER. Tbc iruhlldionfu bciug otrprcpcrly I own rvtich is ootioladod forsalc, Orruffi Siguttrtl: Inrpcctlon Rcqurt: Irtrllrtion, Alterrtbu or Brlocedon 200Aops mlcss S 50.00 201 Arpo E 400A.aPc S 69'00 401Arnps to 600 AEPs . $100.00 Over 600 a 1000 Voltc sce '8" abovo, New {lteretioa or Extorion Per Pand O'ne Cirtnit S 43.00 --- Gtv D. 1. 50.00t c. E. Rrnp or irrigttim $ 50.00 Sig/OutliooLi$ti"g 350'00 € LindtldEln5tlRcsitcnrial 3 25-00 IJmitcdEncrpr/Councrc.ial $45.00 - Mlnimom Dcctlc Pcrnit Inspecdoa Fcc b 345.00 * $urchergo 7b s 3.oo lql g t'7 grzd Hrru(f:liEr0rlhg fcur/Ecrdet Pu{t rntictlo l.6'doc I0o o dnnl c-raldcNlud8 d0 ftlc 0898e3tlr9 M rI:00 oIx ti/la/Jo I.EGAL through OAR copiET6ffi!rules by 95C,(m1- 26 lL/ro,, ?7 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springlield Official Receipt velopment Services Department Public Works Department RECEIPT #: 1200400000000001230 Date: 0811812004 e:59:00AM Job/Journal Number coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 Description Perm ServiFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7Yo State Surcharge + lUYo Administrative Fee Amount Due 63.00 78.00 9.87 14.10 Item Total:$164.97 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard EUGENE ELECTRIC SERVICE NJrn 000477 018666 Phone Payment Total: $164.97 -$16-457 8t18/2004 Page 1 of I ryma Building/Combination Permit SITE ADDRESS:546 7TH ST Springfield i qqtFD 6p Uronl{i c wrrubryrugo et f o rt h ASSESSOR'SPARCELNO.: 1703352404401 in OAR 952 001 OCl0through OAd952-001- 00g0fimDq/Id$Dai n cQqoiof the ru leBgidential PROJECT DESCRIPTION: Fire damage - temp power issued 040804 dhlRuglf!CI udti$rpqtftffrUqgrtsOphtg1e existing floor, add forced air heating, replrum&Epplrmbi0gfg0qfertililfl6fitrUft*ng. Owner: SHOUDy HENRy E & SHIRLEy M Address: 1033 TWIN HILLS DR JEFFERSON OR 97352 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Contractor Type General Electrical Mechanical Plumbing PERMIT NO: COM2004-00390ISSUED: 0811812004APPLIED: 04/0812004 EXPIREST 0211812005VALUE: $ 40,000.00 LicenseContractor XXL INC EUGENE ELECTRIC SERVICE INC MARSHALLS INC SUSAN JANE ARNOLD 109867 90200 Expiration Date LU09t2004 03n7t2007 Phone 54t-344-3561 CONTRACTOR INFORMATION 744siRE i # 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: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Vo ofLot Coverage: MMENCED OR IS ABANDONED FOR ANY 180 DAYJTE$OD, Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 VN nla REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: BUILDING IN] )PMENT INFORMATION PUBLIC IMPROVEMENTS Notes: Page I of3 r lgL. S PERMI] 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: COM2004-00390ISSUED: 08/18/2004APPLIED: 04/0812004EXPIRES: 02/1812005VALUE: $ 40,000.00 Description Bid Amount Tvpe of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 40,000.00 Total Yalue of Project Amount Paid Date Paid YaIue $40,000.00 $40,000.00 Date Calculated 0st06t2004 Fee Description + l0o/o Administrative Fee + 7o/o State Surcharge Temp Power 200 amps or less -Mechanical Issuance Fee- + l0o Administrative Fee + 7oh State Surcharge Appliance Vent Building Permit Fixture Furnace - up to 1001000 btu Gas Outlets l-4 Minimum/Adj ustment Mechanical Plan Review Residential Vent Fan + l0Yo Administrative Fee + 1%io State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid $s.00 $3.s0 $s0.00 $r0.00 $41.32 $28.92 $6.00 $312.rs $56.00 $12.00 $4.00 $11.00 $202.90 $12.00 $r4.10 $9.87 $78.00 $63.00 4t8t04 4t8t04 4t8t04 5n7t04 sltjt04 5tr7t04 5fi7t04 sn7l04 5fi7t04 sn1t04 5lt7t04 5n7t04 5n7to4 5lt7t04 8tr8t04 8/r8/04 8fi8,t04 8n8t04 Receipt Number 2200400000000000333 2200400000000000333 2200400000000000333 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 r200400000000000746 1200400000000000746 120040000000000r230 120040000000000r230 1200400000000001230 r200400000000001230 $919.76 E ees Pa Plan Reviews Planning Review Structural Review 05107t2004 05t06t2004 0s114t2004 05t06t2004 APP APP KMG DLM Reviewed for compliance with historic restoration requirements. For plan reyiew comments see Documents. To Request an inspection call the 24 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. Reouired fnsnections Valuation Descriotion Temporary Electric: Approval required prior to Utility Company energizing pole. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Page 2 of3 F 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: COM2004-00390ISSUED: 08/18/2004APPLIED: 04/0812004EXPIRES: 0211812005VALUE: $ 40,000.00 Wall Insulation: Prior to cover. Ceiling Insulation: Prior to coyer. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. 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 OCCUPAI\ICY 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 thestreet, that the permit card is located at the front of the property, and the appioved set of plans will remain on the site at alltimes during construction. Owner or Contractors Signature Date Page 3 of3 J 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: COM2004-00390ISSUED: 0511712004APPLIED: 04/0812004 EXPIRESz llll712004VALUE: $ 40,000.00 SITE ADDRESS: 546 7TH ST Springfield TYPE OF WORK: Fire Damage ASSESSOR'SPARCELNO.: 1703352404401 TYPE OF USE: New Residential PROJECT DESCRIPTION: Fire damage - temp power issued 040804 db. Replace utility porch structure above existing floor, add forced air heating, replace four plumbing fixtures. Rewire building. Owner: Address: SHOUDY HENRY E & SHIRLEY M 1033 TWIN HILLS DR JEFFERSON OR 97352 Contractor Type General Electrical Mechanical Contractor XXL INC EUGENE ELECTRIC SERVICE INC MARSHALLS INC License 109867 90200 25790 Expiration Date 1U09t2004 03t17t2007 12t23t2005 Phone 541-344-3561 541-747-7445 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: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type:ATTENTION: Range Type:lotlow rules adoPbd Energy Path:Notification Centel Sprinkled Buildin9AR e52-m{010 Oregm Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh ofLot Coverage: Centet b 1 Sidewalk Type: Lot Size: Sq Ft lst Floor:R-3 YN b 0{oE: &o ARIflNG Handicapped: Compact: NOTICE: Downspouts/Drains THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 1BO DAY PERIOD. PUBLIC IMPROVEMENTS Notes: Pase 1 of3 I t ulLlrll\u rNr\,K1YI,q,f +r!J Status Issued 225 Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00390ISSUED: 0511712004 APPLIED: 04/0812004 EXPIRESz llll712004VALUE: $ 40,000.00 Description Bid Amount Tvne of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 40,000.00 Total Value of Project Amount Paid Date Paid Value $40,000.00 $40,000.00 Date Calculated 05t0612004 Fee Description + l0o/o Administrative Fee + 7oh State Surcharge Temp Power 200 amps or less -Mechanical Issuance Fee- + l0o/o Administrative Fee + 7o/o State Surcharge Appliance Vent Building Permit Fixture Furnace - up to 100,000 btu Gas Outlets 1-4 Minimum/Adj ustment Mechanical Plan Review Residential Vent Fan Total Amount Paid $s.00 $3.50 $s0.00 $10.00 $41.32 $28.92 $6.00 $312.15 $s6.00 $12.00 $4.00 $11.00 $202.90 $12.00 s7s4.79 4t8t04 4t8t04 4t8t04 5fi7t04 5n7t04 5n7t04 5n7t04 5n7104 5n7t04 5n7t04 5n7t04 sn1t04 s^7t04 5n7t04 Receipt Number 2200400000000000333 2200400000000000333 2200400000000000333 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 1200400000000000746 Plan Reviews Plannine Review Planning Review Structural Review 05t07t2004 05n412004 0st06t2004 05n3t2004 05t0612004 APP APP KMG DLM Reviewed for compliance with historic restoration requirements. For plan review comments see Documents. To Request an inspection call the 24 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 Temporary Electric: Approval required prior to Utility Company energizing pole. 2 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 3 Wall Insulation: Prior to cover. 4 Ceiling Insulation: Prior to cover. 5 Drywall: Prior to taping. Paee 2 of3 Reouired Insnecfions Valuation Descrintion I Iees Patd I Status Issued 225Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-00390ISSUED: 0511712004APPLIED: 0410812004 EXPIREST llll712004VALUE: $ 40,000.00 6 7 8 9 10 Final Final Building: After all required inspections have been requested and approved and the building is complete.Plumbing: When all plumbing work is complete. l1 t2 13 Underfloor Mechanical. Prior to insulation or decking and including required testing. Rough Gas: After line is installed and required testing and capped ii noi attached to"an appliance. Gas Service: After line is installed and line has been connected io a minimum of one appliance inctuding requiredtesting. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that allinformation hereon is true and correct, and I further certify that any and all work performed shall be done in accordance withthe Ordinances of the City of Springlield and the Laws of the State of Oregon pertaining to the work described herein, andthatNO OCCUPANCYwilt be made of any structure without permission of the Community Seryices Division, Building Safety.I further certify that only contractors and employees who are in compliance with ORS 701.005 wiII 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 thestreet, that the permit card is located at the front ofthe property, and the approved set of plans will remain on the site at aIItimes during construction. or Contractors Date 7 Pase 3 of3 I 225 Fifth Street Springfield, 0regon 91 411 541-726-3759 Phone -T of Springlield Official Receipt - dvelopment Services DePartment Public Works DePartment RECEIPT #: 1200400000000000746 Date: 05/17/2004 8:24:58AM Job/Journal Number coM2004-oo390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 coM2004-00390 Description Building Permit Fixture Furnace - up to 100,000 btu Vent Fan Appliance Vent Gas Outlets l-4 Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 7%o State Surcharge + 10%o Administrative Fee Plan Review Residential Amount Due 312.15 s6.00 12.00 12.00 6.00 4.00 I 1.00 10.00 28.92 41.32 202.90 Item Total: Payments:$696.29 Check N umberType of Payment paid By Check Received By Batch Number Number How Received 2792 In Person Payment Total: MCKENZIE TA coNSTR djbYLOR Amount Paid $696.29 $696.29 5/17/2004 Page I of I gPBIllcFTELO FD-016 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD TO: Building Department FROM: Springfield Fire Department SUBJECT: Structural Damage to Building Address or location of building 546 7th St. Date: 04-07-04 04.r:fiqo Name of Owner Henry Schu dy Type of Building Dwelling (Dwelling, Store, Warehouse, etc.) Estimated value of building Estimated loss to building $ under investigation Date oifire 04-07-04 Location of damage to building Entire buildine (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result of the fire Rafters Joists (Burned rafters, Beams, Joists, etc.) Additional pertinent information ElectricalHazard Wiring (Wiring, Outlets, etc.) Signed CC: C:\I)ocuments and Settings\helt6840.SPRlNGFIELDl\Desktop\Report Forms\Fl)-0l6 FIRE DAMAGE REPORT'doc 225 FIFTH STREET . SPRINGFIELD, OR97477 . E L E CTRI CAL P E RM IT AP P LI CATI O N Ciry Job Number - @3rO Date 1. 5qb 7u- 5+- LEGAL DESCRIPTION t70i 3sz '( 6q qo( JOB DESCRIPTION -fA,fi/ Q:-"e,r-- ftoc btd,-r Permits are non-transferable and expire if work is not started rvithin 180 days ofissuance or ifrvork is Suspcnded for 180 days. 1 Electrical contra*or EUOgNg {,lEffi.tc Address ifr,rt Mo N Rne PH:(541)726-3753 . FAX: (541 3. A Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Horne or Modular Dwelling Service or Feeder B. 200 Amps or less 201 Arnps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only C. lnstallation, Fr?fr6rffglng Broiect as submitted has the lollowlng .on'nl snolori not r€quire specilic land use u>(Lapproval. Sonlng 'rzerr Si s 106.00 s 19.00 Cify Eorrort6 6W"3d tet s50.00 $ 63.00 $ 7s.00 $ r25.00 $ 163.00 $375.00 $ 50.00 Oregon UtilitY / sso.oo 5O are setToTr- $ 69.00 OAB 952To- stoo.oo Panel $ 43.00 $ 3.00 Phone Supen,isor License Number Expiration Date /o-/-a{ Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name AelEr Sfta,tt-, Address 5ab a++- st- ciry sPFa Phone OWNER INSTALLATION The installation is being made on property I is not intended for sale, lease or rent. Owners Signature: ATTE NrlefrQ rLrt# AB9 0090 D. calling numbe One ^- -iLircOlt onn- Each Additional Circuir'or with Service or Feeder Permit E. Pump or irrigation WORK $ 50.00 $ s0.00 $ 2s.00 $ 4s.00 1 Permit Inspection Fee is $45.00 + Surcharges 7%o Stzte Surcharge I 07o Administrative Fee TOTAL s go 500s8elnspection Rcquest: 726-37 69 4. Shared Driv{T: )/Build in g Forms/Electrical Permit Appl ication I {3.doc :: L( .72 z ANY 1 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: COM2004-00390ISSUED: 0410812004APPLIED: 04/0812004EXPIRES: 10/0812004 VALUE: SITE ADDRESS: 546 7TH ST ASSESSOR'S PARCELNO.: 1703352404401 Springfield TYPE OF WORK: Fire Damage TYPE OF USE: New PROJECT DESCRIPTION: Fire damage - temp power issued 040804 db. Owner: SHOUDy HENRy E & SHIRLEy M Address: 1033 TWIN HILLS DR JEFFERSON OR 97352 Expiration Date 03fi7t2007 Residential Phone s41-344-3561 Contractor Tvpe Electrical Contractor EUGENE ELECTRIC SERVICE INC License 90200 CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group : Primary Construction Type # of Stories: Height of Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 VN 1 $ Per Sq Ft or multiplier outo Utlt\U Square Footage or Bid Amount REQUIRED PARIilNG Total: Handicapped: Compact: NB SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: \ss Type: Total Value of Project Page 1 of2 Description Type of Construction Value Date Calculated Secondary Construction # of Bedrooms: -r, u rrJlrrl\ (, rN r Lriuv!.q,!_!vNl Building/Combination Permit Status Issued 225 Fifth Street, Spring{ield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2004-00390ISSUED: 0410812004APPLIED: 04/0812004EXPIRES: 10/0812004 VALUE: Fees Paid Fee Description + l0o/o Administrative Fee + 7%o Stzte Surcharge Temp Power 200 amps or less Total Amount Paid Amount Paid $5.00 $3.s0 $s0.00 $58.50 Date Paid 4t8t04 4t8t04 4t8t04 Receipt Number 2200400000000000333 2200400000000000333 2200400000000000333 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Temporary Electric: Approval required prior to Utility Company energizing pole. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Pase2 of2 Keoulreo lnsDectrons I 225 Fifth Street Springfield, Oregon 97 477 54t-726-3759 Phone ,"'*y of Springfield Official Receipt - -velopment Services Department Public Works Department RECEIPT #: 2200400000000000333 Date: 0410812004 8:56:12AM Job/Journal Number coM2004-00390 coM2004-00390 coM2004-00390 Description + 7o/o State Surcharge + l0% Administrative Fee Temp Power 200 amps or less Amount Due 3.50 s.00 50.00 Item Total:$s8.s0 Payments: Type of Payment Paid By Received By Batch Number Number How Received Amount Paid CreditCard RUSS ROBBINS djb 000350 008085 In Person Payment Total: $58.50 -$5sso-- 4/812004 Page I of I -a uheckNumber Authorization