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Home My WebLink AboutPermit Electrical 2003-9-22 " 225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 It FAX-h~~i!~~~~Y~2ct as submitted has the following ELECTRICAL PERMIT APPLICATION ;:rJtllng and. does not require specific land use 0-22 _ 0"'- approval. . 17 City Job Number (n.AA zoo] -co 7'1 '7 Date I...) L'"j--.,., '- ur~' Zonmg - ',..J q-~-03 3. COMPLETE _FEE:.t;C11:E'f!ULE BnLv i'I' ..... J /."",,,UIiL80 Signature i<\ 1. LOCA110N OF INSl'ALLA110N AM 11 e-":,.I .1 E \J( 331 S- LEGAL DESCRIPTION )7021'73<f C) 7 ZO-O JOB DESCRIPTION Lo w Vol +A-c; e- / fLEs I Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or pOliion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. Services or Feeders-=Jns"taIlation, Alterations or Relocation: Electrical Contractor a ve.r~\ \' ,eA. t;;. (e-c:.t-ron {e~ Address P < a . '(SOl' '-to SLJ cr 200 Amps or less 20 I AlllpS to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/V olts Reconnect Only .. . v.\O, . Supervisor License Number .3A q ~ L-E A- .. ~$.(~Ql~, \. )~~S.rJvic~~orFehlers r'\c ;..:,:::' \ \ .,. d O~,~ ,,:,'(.\0'(\ l I '\t-.~~.""'''''''' \i~'J \.~\ . '1'\~tt~ ,.' ,,~('\t>, o / I oS ., C\'~ \tv \l.. ,j,.:;'\ '. .".,.}p~ta~at,ion"A1tei'a~!on or Relocation ~\ ".......-" -. ':;"....-' . ..', ........ ,....~ '~- '. - ,'\' "'-~-... \:,. , ,., \'':-J;'c'''~'"' . :,,' ". ,...,..}90' }\~PS?~ I!~ss" .~ Constr. Contr. Number l L/ t..{ lJ;'-~'?:, . " " ;",- .' .' · ...20 rAmps JoAOO'A.inps . _ .1- ~ '.-' _J '. .",.'.y, '._w..\~'Ol'IJ: ':>"'~;,. ,> . ." i ,'; .~ ,,,,,-4QT.~~ps:to',QbOA:mps \i J{). f)..' 'Ie> t{,;_.': . :~'-O\ ',':\6.0:0'.. ~Ar .'\ 1000 V I "B" b :".)1' ,.., .. ... . ",.,"~,~ M ver. " ;-'J"mps or 0 ts see a ove. u '.\'''-v'. ,", ,..,,,q,'3t.....: ,.. nEle tric an t','~.I".'.' ....:'~. ",":"'. "\-'l>)Qmranch Circu.,its nu~;JfrI ;on\e~ \5 ' ,. ... , VV . New Alteration or Extension Per Pa,nel One Circuit Each Additional Circuit or with Service or Feeder Permit 1\-\E.-\f~OP;~ $ 3.00 N01\CE:, \4p..t;L E.)\\?\BE. \r \5 ~01 1\-\\~.ptJW~kll~b'~~~(~ M\JnB\:(IlclUded) -Each Installation 1\U1\-\OB\IEp U~ \Q. 1\B1\NOONE.O r OM~ID~ti'6h $ 50.00 C N'i S{eG~(lin~i~&l~g $ 50.00 1\ Limited EnergylResidential ; $ 25.00 Limited Energy/Commercial $ 45.00 City ~~ Phone '-t t4 ~ ~O I~ Expiration Date Expiration Date s;~~' X ( J// .. '-- Owners Name SCOTT 2'6Z3 S- City ~ (;:,.ero/r:::~ T~M c/ E,+tL / A-- ke Address Phone OWNER INST ALLA TION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 $ 43.00 zS:- Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OFABOVIJ LIS- 'J,!) Lf ')0 SlbS 7% State Surcharge 10% Administrative Fee TOTAL Shared Orive(T:)/Building Fonns/Elcctrical Penn it Application I-G3.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2003-00949 ISSUED: 09/23/2003 APPLIED: 09/2212003 EXPIRES: 03/23/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3315 AMBLES IDE DR ASSESSOR'S PARCEL NO.: 1702193407200 TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Low voltage Owner: SCOTT JORDAN Address: 28235 CLEAR LAKE RD EUGENE OR 97402 Phone Number: 541-688-3998 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor DIVERSIFIED ELECTRONICS INC License 144685 Expiration Date 06/23/2004 Phone 541-484-9078 BUILDING INFORMATION I Street Improvements: # of Buildings: # of Stori.~s:O Primary Occupancy Group: R-3 Height\.of'Sfructure .,'l~':l) \'\\\\\. 'j . Secondary Occupancy Group: ~eCf.ype o{\Neat:O'<'t Primary Construction Type VN :{\ \'3-\l'l ~{at~~~)\pe~:~O'\ Secondary Construction Type: .O'\e~Oo. 'Oi\'0e\~!!.figt~!~?. !;,'C, # of Bedrooms: ~'\\O~. o.o'9\e '\'00se ~ Energy PatlJ~:}\~' e ~~I ,\u\eS :e{\\~~~'\O ~\~~~~~~ o~ ::~9~~':\0" \O~~\ce.\\~~~_()<y\ ~~~I\~EV-in:0P.i\.iiN,p~iNFORMA TION I SETBACKSNO ~?-. g ~a.i :\,16\' - :{\ V' 1.6"'<" , :\ 0 '-to\} e ce{\, '(eQP ^}!>?>~~ Front yard Setback: CogC). ~\'(\~ \'\'1 \'00? ,\-'oC0verlay Dist: Total:. Side 1 Setback: c0-\ :oe'\ \0'\ ~e~ \S # Street Trees Rqd: Handicapped: Side 2 Setback: (\\)~ C~r-.' Paved Drive Rqd: Co~act: Rearyard Setback: % of Lot C\M'!.age: t:~?\t\r. \r "n-\r. ~~6"\ Solar Setbacks: N01 ~~ ' "\ S\1~ll L ?r.t\W\\\ \v 1.\.\~ o~~W\\ ' . \~~Q 1\-\\S. ill.D t:l\~ . PUBLIC 1M (D~ln\"Ii t\ \S ~~~NUU CO '{ ,\eo G~'{ ?r.t\\(8\1rewalk Type: M~ Downspouts/Drains: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: '1: REQUIRED PARKING Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee 1 of 2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2003-00949 ISSUED: 09/23/2003 APPLIED: 09/22/2003 EXPIRES: 03/23/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid. Fee Description + 10% Administrative Fee + 7% State Surcharge Low Voltage - Residential Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $4.50 $3.15 $25.00 $20.00 9/23/03 9/23/03 9/23/03 9/23/03 1200200000000002189 1200200000000002189 1200200000000002189 1200200000000002189 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 day. ReQuired Insnections 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 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 Pae:e 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00949 COM2003-00949 COM2003-00949 COM2003-00949 Payments: Type of Payment CreditCard Receipt #: 1200200000000002189 Description + 7% State Surcharge + 10% Administrative Fee Low Voltage - Residential Minimum! Adjustment Electrical Received By djb Check Number Batch Number Authorization Number Paid By ALLAN WOOSTER 000177 055445 City oi Springfield Official Receipt Development Services Department Public Works Department Date: 09/23/2003 8:59:51AM 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