HomeMy WebLinkAboutPermit Building 2000-6-21
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I Job# 00-00985-01 I
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Page 1 of2
TRANS#:01-0002263
DATE:JUN 21 2000
AMT RECD:2 $ 108.90
CHANGE:
CASHIER: 061
SPRINGFIELD
~.,
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-00985-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 444 Mansfield St Spr
Assessors Map#: . 17032334
Lot: Block: Addition:
Tax Lot #: 05800
Subdivision:
Owner:
Address:
Ken Cerotsky
PO BOX 1391
Phone Number:
Scope Of Work: Single Family Residence
City/State/Zip: Springfield, OR 97471
Alteration Value: . $0
This is a copy with a new Application Number
Contractor Type
Electrical Contr
Contractor Registration #
Builders Electric Inc 4296
195 Madison St, Eugene. OR 97402-5030
Expiration Date
12/10/2003
Phone
541-485-0922
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
Rough Electrical
Final Electrical
To request an inspection call the 24 hour recording at 726-3769. All inspec\i~ns requ~.st~d.b~fore'?:Q9,u:!"" yv~,
a.m. will be made the same working day, inspections requested after 7:00 a.m:-wilJ'lJe)iiade:the,!ollowihggon Utilit
k. d fOllowrUl8:;'duu~U:hJu} lIICOVt.,.. .~
wor mg ay. . . T I c~+for
,IOli!IC.-<!IOr. Gemel nr.&t '0 e5 ir8"~. '
R . dl t" ,... -. .",.., ft,' .",'t,..' ",,.,.r"lu:-:l,,,'~~_nn1,
equlre nspec Ions . _. .. . "-- - - . ._ "
I J090 YOu ,Tla\' obtam cOfJle~ ollj'~ lules b.
Electrical h I
call;n!,j :tlc CSII:C'. {;:c:::. ( Eo t:: "i-nO;le
'lumber lor the Oregon Utility l\Jotification
rt':1.~~l.~" ;.-' ."10~L~''':/4~)''~.14).
.Prior to cover.
-When all electrical work is complete.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
I Main: Accessory:
# Of Stories: Height (feet):
Current Units: 1~'a~geg~nits:
Census Code: Does not apply
THIS PERMIT SHALL EXPIRE IFTHE WORK
Total: I AUTHORIZED UNDER THIS PERMIT IS NOT
--....-..--- -ro- ._."._-~.-....__....
V\JIVIlVll...' \IVr.-V \,.,1'1 I''''' ,..."'..."', ........... ......... .....' .
ANY 180 DAY PERIOD.
.
Fee
Permanent: 200 Amps or Less
Branch Circuits W/O Feeder or Service
State Surcharge For Electrical Permit
Electric Administrative Fee
Total Electrical
Grand Total
Job# 00-00985-01
Paid On Receipt#
Electrical
06/21/2000 2263
06/21/2000 2263
06/21/2000 2263
06/21/2000 2263
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Page 2 of2
Value/Quantity
Fee Amount
1
8
$50.00
$49.00
$6.93
$2.97
$108.90
$108.90
By signature. I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein 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. I further state that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are
requested at the proper time, that the project 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.~~ j ~ () 'PJ''^ ~
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(p-;;2f-eo
Date
"-03
DATE: JUN 21 2000
AMT RECD:2 $ 108.90
CHAN9E:
CASHIER: 061
ELECTRICAL PERMIT APPLICATION
Tile following project as submitted h~~ the following
and does not require specIfic land use
zoning,
approval LbO<-
225 FIFTH STREET Zoning ~
SPRINGFIELD, OREGON 97ldiJe e., -. . .-d. \
INSPECTION REQUEST: 72~;ii:rlr&~d Signature {~
OFFIC~: 726-3759
1. . LOCATlp~ OF INS;t4L~IpN
444 MfA n'S \-1 {yO
LEGAL DESCRIPTION
JOB DESCRIPTION
:){')\J AiYJr:? c::.P(VI'Cf' {\ mmF
9-. -:(i~'< c:. ,- t :s - ~ ,j
Permi~ a~~on~transferable and expire
if ~ork is not started ~ithin 180 days
of issuance or if ~ork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor Bui lclers EectriC-
Supervisor License Number
?QHO -S
Expiration DatelO,;./-n I
Cons t r Con t r. Numbe L- 4-Zq (p
Expiration Date 12-(O-O~
Signa~Of Supervising Electrician
;!~!/~j /--
S:ty Job NumberOO-OO9gS--0{
3. COMPLETE FEE SCHEDULE BELOll
A. Ne~ Residential-Single or
Multi-Family per dyelling unit.
Service Included:
1000 sq.ft. or less
Each additional 500
sq..ft or portion
thereof .
Each Manuf'd Home. or
Modular .Dyelling
Service or Feeder
B.
Services or Feeders
Installation, Alterations
or Relocation:
Items
f
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
5QJJO
C.. Temporary Services or Feeders
Installation, Alteration or Relocation
Oyners Name
Address 44 4 !vi Ctn:s r;;;'€j)rP
City tusen.p Phone 4~~-cq.;).;)
OVNER INSTALLATION
The installation is being made on
property I oyn yhich is not intended
for sale, lease or rent.
Owners Signature:
---------------------------------------
DATE:
RECEIPT #:
RECEIVED BY:
200 amps' 'OT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000.volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see tlB" above
"
Ney, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or yith Servi2( ~
or Feeder Permit ~ $
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lightin~
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
7% State Surcharge
.3% Administrative Fee
TOTAL
,
'$ 35.00 '3:;-
.N
2.00 '+~. 00
no t included)
s
s
S
$
9~.{)D
b. '7.3
2.77
10';<;'10
40.00
40.00
20.00
36.00