HomeMy WebLinkAboutPermit Electrical 2005-5-10
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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ELECTRICALPERMITAPPLICATION ) / ~""o.,?(!)-o
City Job Number L OWt ZOO S ...co SSV Date t;; / a{ (j ~ . '0'0 ~ ~~
~/~ ~
1. 3.
4. 5"0
,/\\ ~\p 7% State Surcharge '3 SO
~~ '&:::mnistratiVeFee _S-~:,
k ~\t) Shmd Dri"cr')IB,i1di" ,,,..lEI""',,, "=i< Appli,"'" I .Ii'.do<
IOOL(
LEGAL DESCRIPTION
17033 5~( 0 S- $"00
JOB DESCRIPTION
S GZ-J l c..t:" ~ E c..O~VN t:'L. T
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.
Electrical ContJ:.~C;t9J:. '
fjUfiliEt:t1mUS. cU:lI11K;
P.O. Box 697
~'_r~~~~r/:flc, O~ 7740~
541-747-2724
Phone
Address
City
Supervisor License Number
tt"l7, I ~
Expiration Date i () - 0 "/
Constr. Contr. Number 7 D "WL! zr:
Expiration Date ! 0 'OC
Signature of supervisinhEleCtriCian
6\f)UM. ) - )~~',,) _
Owners Name A I bbtV+ Gt> fde:-N
Address I 00 C{ -:5 1--1.. f> L.
City S?Fb. Phone 747-/7eJ
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
ATB;
follow u es ado t
,Notific~~J:.l;~ by the Orego,., Utility
In OAR ~T2IOOI1S.~~J~lu/es are set forth
0090. Y@01ln\By>~l9t&W1 ell~h OAR 952-001.
callinf6<1V0..if.1pSlterl o~~:f of the rules by
numbE0tw tb(il()~~9!Jf' .he telephone
, MdfiIDatQt;qn'{iOO_33~~Z~~~ti~I/onl
c.
$ 63.00
$ 75.00
$125.00
$163.00
$375,00
$ 50.00
-<<;'"Q
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
Q)~
TN' 'I" ~rtD' 'tl.... ,." ,~..,., D D I
ew ~ eJia lon.or A,.enslOnrrE"er/A' ane - W
"T '~,n,~':" ~.. 'LoL.. Ll\r In ,.. I Ht QRk'
AOn~-,€ircuJtD UNDER THIS PP". "~.~ $lf3,OO
CEacn ~rlrlitionalrGircuit/P8r, wilh Imlll 10 NOT
- ....,j~'tVUL.U un '" ';1 ANOONED
A Serv.ice,or...Feeder. P.ermit Fn~ $ 3,00
IVI IOU UAY PEHIOD.
E.
$ 50,00
$ 69.00
$100.00
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
. PERMIT NO: COM2005-00554
ISSUED: 05/11/2005
APPLIED: 05/10/2005
EXPIRES: 11111/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: . 1004 3RD PL
ASSESSOR'S PARCEL NO.: 1703352105500
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Service reconnect
Owner: ALBERT GOLDEN
Address: 1004 3RD ST
SPRINGFIELD OR 97477
Phone Number: 541-747-1785
I CONTRACTOR INFORMATION.
Contractor Type
Electrical
Contractor
BURRELL BROS ENTERPRISES INC
License
136446
Expiration Date
08/20/2005
Phone
541-747-2724
VN
I BUILDING INFORMATION. .
A trENT/ON" Ore
. foWcAf ~m69~ :do gO" law requIres yotltd Size:
Noti~t8~ e r~tQfttg by the Oregon UfJt 1st Floor: .
in OA~ _ B~' er. Those rules are set ft 2nd Floor:
OOg(}Y 'lff6 f )~:-OO 1 ~ thro~gh OAR 952- tf 1t Basement:
c~~~# .~pbtam COpIes of the rule fJ. "ft Garage/Carport
nU Berl ~!ill-P.ter. (Note: the tele h ijli<'t Other:
P~!l! M~mr~" Utility tVtlliC Oti"(;ccupant Load:
\.ient'V.1:' ~ ~~S :Ji-<", ca on
I DEVELOPMENT INFORMATIO~.
REQUIRED PARKING
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
,.,
"
~
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC Il\f~fi~l\fENTS I
THIS PERMIT SHALL ~}[t;~:Ol{Ffyp~ WOt\K
AUTHORIZED UNDER ili~).PJfo~MMr~~n~:Of
COMMENCED OR IS ABANDONED fOf\
ANY 180 DAY PERIOD.
Notes:
I Valuation Description I
:,
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal!e 1 of 2
_~~~JJ~~I!!;.!?\',>,.,~ .~,
.'!,
'1
r
~",.4
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-00554
ISSUED: 05/11/2005
APPLIED: 05110/2005
EXPIRES: 1111112005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
$5.00
$3.50
$50.00
5/11/05
5/11/05
5/11/05
Receipt Number
2200500000000000562
2200500000000000562
2200500000000000562
Total Amount Paid
$58.50
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.
I Reouired Insoections I
Electric Service: Approval required prior to utility company energizing service.
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
Pal!e 2 of 2
225 Fifth Street
Sprjngfleld, Oregon 97477
;541-726-3759 Phone
.. ."
Job/Journal Number
COM2005-00554
COM2005-00554
COM2005-00554
Payments:
Type of Payment
CreditCard
',~' I.~
" (
;.:.
5/11/2005
RECEIPT #:
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Service Reconnect
Paid By
JASON BURRELL
tJty of Springfield Official Receipt
"'welopment Services Department
Public Works Department
2200500000000000562
Date: 05/11/2005
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 018180 In Person
Payment Total:
Page I of 1
7:47:35AM
Amount Due
3.50
5,00
50.00
$58.50
Amount Paid
$58.50
$58.50