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Home My WebLink AboutPermit Electrical 2003-12-10 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number a.\.1'\l.O03 - 0/2"3 ~ Date Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 OWNER INSTALLATION Limited Energy/Residential I $ 25.00 The instaIlation is being made on property I own which Limited Energy/Commercial $ 45.00 is not intcwtJ'tfee~le, lease or rent. Minimum Electric Permit Inspection Fee is<S4SJiii) Surcharges TJit~,PERMIT SHALL EXPIRE IF THE WORK Owners S.!.tiTH5RIZED UNDER THIS PERMIT IS NOT 4. SUBTOTAL OF ABOVE COMMENCED OR IS ABANDONED FOR ANY 180 DAY PtHIUU. 1. LOCATION OF INSTALLATION 3. ~~~ S:~ ~ if, ?,tfgo LEGAL DESCRIPTION J70'L19Lf ~ 07'-; 00 JOB DESCRIPTION . ~i)W 1/, It.-'lL 1[,"'" 'frJ.i:d'1) Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. CONTRACTOR INSTALLATION ONLY 2. Electrical Contractor 0 I d ~L lJ) I tJ c- Address 1 Lf~ <s w 7 ~ City ~~ Phone ~g 5(PODO I , Supervisor License Number .3 c; 0 I L efJ (0/01/20D5 (Z,?ft3b Expiration Date Constr. Contr. Number Expiration Date Db ,- OC{ - "2- OD~ Signature of Supervising Electrician ,></ (A~,~ ,;?/{)~.--- ,. ./' / ownersLe ~ c=PF 77~ d,4-( I Address 3 [(go 1t;VI hler.:;. ., J. c~ s9f{J City Phone Inspection Request: 726-3769 ,.-: "i.,~, the tollowing ,~ cl,-,C" flU, ''''ljulre specific land use 12-10'-0'") c.uvdl Zoning LbVc2..... COMPLETEFEESClfE.~:~:ELOW \.2.-10 ~ A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular DweIling Service or Feeder $106.00 $ 19.00 $50.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to .600 Amps $ 50.00 $<?Q.99 C, ..i $lQO.OO! ,,,' ) Over 600 Amps or 1 000 Volts see "B" above. D. BranchClrc'uits' I "\rj~'1 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with .;1,.' , Service or Feeder Permit , ' I $43:00, $3'.00. ')f1 E. MiscellaneouS (Service/feeder not inclUded) -Each Installation ;') 7% State Surcharge 10% Administrative Fee Lf) 'j:/J Lf5D 52~ TOTAL Shared Drive(T:)/Building Fonns/Electrical Pcnnit Application I-03.doc CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2003-01235 ISSUED: 12/10/2003 APPLIED: 12/10/2003 EXPIRES: 06/1012004 VALUE: ~~~~,!'!,~~I~4 '~LWI~11 1~ Jf' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3480 Ambleside Dr ASSESSOR'S PARCEL NO.: 1702194307300 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: PROJECT DESCRIPTION: Low voltage Owner: TYNDALL JEFFERY D Address: 1357 33RD ST SPRINGFIELD OR .97478 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OLDFIELDS INC License 129736 BUILDING INFORMATION. # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure Secondary Occupancy Group: J~~'fb!Jeiit: Primary Construction Type V~n \a\i\l feq\.~ate~[~p.~=1 Secondary Constru,ct\o,!!tl'fpe:N: o\'e~d b~ tn9 O!~O~l~P!,;Jrt # of Bedrooms: p;.\ w '(U\eS ado'Pt ,hOse fU\aErihg~*a.!h{)~ ,\i~\i~cat\on ~~~~~10thfO~~~~~~e f~~; t ,n ~p..R ~::~;v obta\~{D;E-,V~l!O~MiNiJNRORMATION I , SETBAQKSO.. t'ne center. \ Ut\\\t'/ \~U\l"-~ ca\"nQ oregon nt:1.4A). ' Frontyard Setback: u'rt'lbef 10\ toe. 1_800-332.0Verlay Dist: , ' Side 1 Setback: n (';pl'itAf IS, # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: Solar Setbacks: New Residential Expiration Date 06/09/2006 Phone 541-485-6000 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Total: Handicapped: Compact: % of Lot Coverage: N01\~~: I cu~1 ~ FXPIRE IF lHE '{VORK IM\\) r :lMJ e, " ~. ,~HOl AU:rH . I~N~ . OR COMMENCED 0 Sidewalk Type: ANY 180 DAY PERlOD. Downspouts/Drains: ' Street Improvements: Storm Sewer Available: Special Instruction: Notes: ' I V~luation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Pae:e 1 of2 Value Date Calculated' Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2003-01235 ISSUED: 12/10/2003 APPLIED: 12/10/2003 EXPIRES: 06/10/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line, I Fees Paid I Fee Description +. 10% Administrative Fee + 7% State Surcharge Low Voltage - Residential Minimum/Adjustment Electric,al Amount Paid Date Paid $4.50 $3.15 $25.00 $20.00 12/10/03 12/1 0/03 12/1 0/03 12/10/03 Receipt Number 1200200000000002580 1200200000000002580 1200200000000002580 1200200000000002580 Total Amount Paid $52.65 I Plan Reviews I 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 ~~ : Reouired InsDections I 1 Low Voltage: Prior to cover. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all hiformation 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 Pal!e 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-01235 COM2003-01235 COM2003-01235 COM2003-01235 Payments: Type of Payment CreditCard Paid By OLDFIELDS Receipt #: 1200200000000002580 Description + 7% State Surcharge + 10% Administrative Fee Low Voltage - Residential Minimum! Adjustment Electrical Received By djb Check Number Batch Number Authorization Number 000244 010500 City of Springfield Official Receipt Development Services Department . Public Works Department Date: 12/10/2003 3:05:45PM'. ' Amount Paid 3.15 4.50 25.00 20.00 $52.65 Item Total: How Received In Person Payment Total: Amount Paid $52.65 $52.65