HomeMy WebLinkAboutPermit Electrical 2005-7-13
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPliCATION ..,}.., i
City Job Numberto.HZOOr-oO 'Of Date 7;'/7/)'
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Phone Pump or irrigation "
- Sign/Outline Lighting 1\-11'. '-N\.l\\\~
OWNER INSTALLATION . Limited EnergylReSidc'\!;a1J\\\ IS 'I\\! \
'-'\"'~' L' , d'E" \ t.I" '- o(:~\ OQ
The installation is being made on properly I own which' \ ,,;~' _ Iml~ nergy/<(wpmerclaln r "
, , d dC"" ",,\,\,'\\\ 'h'''''\\ \ ",!:'\O'Nt.v
IS not mten e ,or sale, lease or rent. '\AI~MinimumIElectric.Pefmil'laspection Fee is $45.00 + Surcharges
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p-IJ 4.- 'Sr!lB'IJ.(j)T,m@F.l~<!I.""" 7C"
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v I'D\J' '"2r
\'.~'{ 7% State Surcharge J
~~ ~O% Administrative Fee ; S-~)_
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LEGAL DESCRIPTION
170J 23Yt.(
JOB DESCRIPTION
ZCOIrW'f> S/2.t/L. ~ t/ cfit.c.....d-r
Permits are non-transfera/ie and expire If work is
not started within 180 days of issuance or If work is
Suspended for 180 days.
2. I~CI.ul/..l,.rt:t1~..i:I-.!JI:J.'l...tiVSrr!A!lHM~W@..Ni.DY1
Electrical Contractor
BURRElL BROS. ELECTRIC
P,O, Box 697
Walterville, OR 97489
541-7~lo~l24
Address
City
Supervisor License Number
4'TLI c;
10-07
7,0 -qyZfO
10-OCo
Expiration Date
Constr, Contr, Number
Expiration Date
:gnV)l::isin~e=ul ,
1N'= TA....4~ ~"";1L..
Address Z It-7 L hv\"'1A:r ~ Q..
City c:::.. ??;')
Owners Signature:
Inspection Request: 726-3769
A. New Resiilential Single o. Multi-Eamillj p'e. i1weliing 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
$106,00
$19,00
$50,00
200 Amps or less / $ 63.00
201 Amps to 400 Amps aUtO$ 75,00
401 Amps to 600 Amps,a'Il teO,U\te5 i 'j'\I\\1125,OO
601 Affib\q'.IQlJ~W~~ \\'\8 Ote~~'li-;'\ \cs'i'a3,OO
~lj~~ ~ll!P~ose tu\8S" 1" QC;'2.~~,OO
\~\l'll\lh~~c~ <e>t..xi\et. \ntOUgn v~", ~ oleoS '6lf,oo
",~\f\Ca\\Otl n1-00~O _II>,S 0' \"~ ' I, e
c ".'~ il~.1 '/"'" " '~II'., ,
,n j), r, ':~". Sl CQ e
0090., t\'\ cel\\e. U\i\i .
Ins,!.l!lIa'iiiln>~te~l!diln%t~-':'~~4)
",netlO ,,, '\-ao~
20~1lII" ot%f\l.et ...
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above,
D. BrancH @ircuits
6J
$ 50,00
$ 69,00
$100,00
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43,00
/2
l./ $ 3,00
$ 50,00
$ 50,00
$ 25,00
$ 45,00
.
.
CITY OF ~n~,.l1'iGFIELD
: Status
Issued
Building/Combination Permit
PERMIT NO: COM2005-0090I
ISSUED: 07/13/2005
APPLIED: 07/1212005
EXPIRES: 01113/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspectlon Line
SITE ADDRESS: 2472 DUMAS DR
ASSESSOR'S PARCEL NO.: 1703234400116
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: 200 amp service and 4 circuits
Owner: THOMAS SMITH
Address: 2472 DUMAS DR
SPRINGFIELD OR 97477
Phone Number: 541-
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor License wcf:xpiration Date
BURRELL BROS !!i,~.:ERi!ius!j;~..I.Ill,q \ EXI'1Ii3644~.~J,e ~1r;1 08/20/2005
d,,", . .._~."'" \ - _..., '"~''11'''
unB'lILDlNG INFCilRMATI01'f'ltO rOR
I\u ,''v' -- 00 \':J 1-10""--
. ",..r'I'O "
COM #Iof Stories:co\OD,
,,, <'I>." x,-"
M~'( Heiglit'ofMructure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Phone
541-747-2724
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
R-3
nla
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
r Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Total:
Handicapped:
.n.,..m.ct.
~teS "\)\\fif .
O{l \0.'l4 ttl Otegot\ ~ \at\\'
-x-', ::"'. Ote~J' ",,\"~,,\,~ ~e ;.~ "",.
I PUBLIC IMPROl<E,MEtsl"il1a.O~~t. 1nose ugn 0pS\: tU\eS '01
'\O-'~ '{lten ,,~t'\\ntO~p\~ ~One
~~\ca.\'O "0\ .SlOe1':al!oloW:;' \e\e9 ...\nt\
\'010 \ P. 9fJ?.'v dO\0.\n GW~ riJ,W:;(J....'
'In 01>' '/ou f(\a.'J 1:I~'gt!si!ll~'IJ'IiI'"!JtjP
0090, , \ne cen Otego~ ""''2..~).
ca.\\ln~t \ot \ne is ....~O~
nutt\'o cen\8t
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
_ or mu,ltipUer
Square Footage
or Bid Amount
Value
Date Calculated
Pal!e I of2
.
. CITY OF ~rIUr~GFIELD
Building/Combination Permit
PERMIT NO: COM2005-00901
ISSUED: 07/13/2005
APPLIED: 07/12/2005
EXPIRES: 01113/2006
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
Fee~ p'\W
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$7.50
$5.25
$12.00
$63.00
7/13/05
7/13/05
7/13105
7/13/05
Receipt Number
2200500000000000914
2200500000000000914
2200500000000000914
2200500000000000914
Total Amount Paid
$87.75
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.
~p1 In~np"'ion'i.l
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
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 of2
225 Fifth Street
Springfield, Oregon 97477
54f-726-3759 Phone
.
.~~~;--..' ..'.
u.-.
~"~.~~ ;
~ity of Springfield Official Receipt
.evelopment Services Department
Public Works Department
Job/Journal Number
COM2005-00901
COM2005-0090 I
COM2005-0090 I
COM2005-0090 1
Payments:
Type of Payment
CreditCard
:'
:'
7/13/2005
"
RECEIPT #:
2200500000000000914
Date: 07/13/2005
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
JASON BURRELL
Item Total:
Cbeck Number Authorization
Received By Batch Number Number How Received
djb 025637 In Person
Payment Total:
Page 1 of I
7:57:16AM
Amount Due
63,00
12,00
5,25
7,50
$87.75
Amount Paid
$87,75
$87.75
.
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