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Home My WebLink AboutPermit Electrical 2007-7-11 ZON L1?2- INITIALS N yV\ DATE f - I'L.-- 0-' SOURCE YYt ~_ - .; ,- 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number (;OJ)"1 2-Ol) 7 - () '0 ~ Date 1. LOCATION OF INSTALLATION: '2feu '6 M ~c1f{. LEGAL DESCRIPTION: i -, 0 '3 ;;)':b S'5 0 \ 5 crO JOB DESCRIPTION: L ,'Vlt\.. ~ pd.1 ~ W ~e. j<.~ p 4-:rYL ~ vUvVtz (/VI ~ -r 4 Pe~mits '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 C'{~.h~ '?:.JkAYl~'-- Pi 0 1 (j d,... 1.. J l( City ~~eIlJ\t (0 Phone C)5'{ -Lc;f) L{ Address Supervisor License Number ?:> 6Gro- 5 Expiration Date ~ / I 0 I (J ~ I { Constr. Contr. Number /I)-ZqqC Expiration Date 10/ ( 0/0 '1 , . Signature of Supervising Electrician ;te CA, ~frU( Owners Name ~ CAi-ol L-tw -e-ll&v\ Address 2SIo8 tv\cM.n t5"Y City ~L.--D , ""ph,o"n"e, ,01" "J.,~~~hL\-4 l) '-'''- ~ ~ 1fGt9i1J1-j <&G! IJ '-.Y owrOO1fN~UO~i~J:r: ~~ ~~~ Q}_o The~~~~~~~,~~~~W5~~: IS no:tJJlte1'lIJo/Ul"t,0'-OiUe-wasJJfftem; , ,,,, \',l-g~-"o' ""~' ,', ~""I~ @'~Q;"~ <& QPOl "\f@')Jl 'ffi/i,y ~~uM' " '~, 'I\IrMi!J ~e;s:;)\1b':1t@~~ Own~rs~tift~~@ ~@ITi~@~', (~~~~~lt1\1 ~Q&'Wi~~ft ~Ti't~~rr ~@, ~ ~:n~ ())'~M ~~~~~~ <<::?@l\1I~~~ %\'lJ u U\8i>0~ ~ Inspection Request: 726-3769 3. A. , New Residential- Single or MuJti-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 Dwelling Service or Feeder $117.00 $ 21.00 $55.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 _~ c., , tJl ') C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 J Amps to 600 Amps $ 55.00 $ 76.00 $110,00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 48.00 $ 4.00 E. Miscellaneous (Service/feeder not included) -Earh Installation \h.\t"\'1\l' '~Y:. 'l'J~' '\ Pump or irr~!tion '. ~?\'f\'f:. W "J(\ $.~~1 Si~~ . . ~tt ,~\~ ?t.\'\~_.: 'fG~OO Li~ .. ~ ~~ ~~~~\)a~W;'v! $ 28.00 Lim~~ \ f&i\~ ~. $ 50.00 Minimum ~tlj.. ,', I~~~on Fee is $50.00 + Surcharges 4. SUB~~ FABOVE ss: eo 8% State Surcharge Lf: L/ U 10% Administrati ve Fee ,C::; S1) 5% Technology Fee 2- 7~ TOTAL --10 -:7. c,,\- Shared Drive(T:)/Building FormslElectrical Permit Application 7-07.doc Gv.-y ~ ~ 72~~~~(R3 L~ N r-J' O'1~ 1 ..~~q\'- Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2568 MANOR DR ASSESSOR'S PARCEL NO.: 1703233301500 Springfield PROJECT DESCRIPTION: Reconnect Owner: LEWELLEN DONALD E & MARJORIE C Address: 42037 HOLDEN CREEK LN SPRINGFIELD OR 97478 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01023 ISSUED: 07/11/2007 APPLIED: 07/11/2007 EXPIRES: 01111/2008 VALUE: TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor CAMPBELL ELECTRIC BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: License 73995 Expiration Date OS/24/2008 Phone 541-744-0705 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I Frontyard Setback: Overlay Dist: Side 1 Setback: # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: law requires you.t\~ -i Fr.",\1:.D,epon Orsgnn UtI I" ~,;~ rUleS adoPte~:s~~~~es Ef\l!1JBLWllvtPROVEMENTS, ...W1lW1iQ.1',l center. gh OAt, naB Street ImItt'b'W1 ~02."()O'\-001 0 throu. 01 the rutes by In 0 obtain cop,es \ hone Storm Sew60SO'.al(a'I~aY nter (Note~ the te e~oatlon Special Instr1Oltt\\'8Q the: Oregon UtititY No~i number for e 1-8oQ-332-2344,. Notes: center \8 I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pa!!e 1 of 2 REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: NOTICE: THIS PERMtT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER ~HIS PERMIT IS NOT COMMENCEU UK f~ I'\bAIJ&BU[B fer. ANY 180 DAY PERIOD. Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01023 ISSUED: 07/11/2007 APPLIED: 07/11/2007 EXPIRES: 01/11/2008 VALUE: 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 + 5% Technology Fee + 8% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.50 $2.75 $4.40 $55.00 7/11/07 7/11/07 7/11/07 7/11/07 1200700000000000899 1200700000000000899 1200700000000000899 1200700000000000899 Total Amount Paid $67.65 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Fi-fth Street Sp.ringfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-0l023 COM2007-0l023 COM2007-0l023 COM2007-0 1023 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Service Reconnect + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By GLEN CAMPBELL City of Springfield Official Receipt Development Services Department Public Works Department 1200700000000000899 Date: 07/11/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received ddk 098147 In Person Payment Total: Page 1 of 1 1l:54:16AM Amount Due 55.00 2.75 4.40 5.50 $67.65 Amount Paid $67.65 $67.65 7/11/2007