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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERJl,IIT APPLICATION
City Job Number Com ;)f)()t..f-0016lj Date g/Q3/07
, r::h.rrlnl\J.~'~{JI"GlVV l-.:lyl.llIC::J fUU 1.\J
1. LOCATION OF INSTALLATION: 8\TT aJ'M'PLE SteiB ~C.fHH6~~OOWI
). wllow rules a op y 1 tfo.
-a \.10 /'Io(1\-\- \ Cf 1: $ r(i-"5f\e\~ : Cf7~dtification Center. T~ose rules are s~_O~:i
LEGAL DESCRIPTION: in oAR g~~~~llt~~gt,l Q~m~a~tJlvsPfr dwelling unit.
,J I btain copies of tne rUle~
C <:TV I&U.!TM\Ir'ib 0090.sY~~l11~~Miie() (Note' the telephone
JOB DESCRIPTION: call~9W:t~~{~~o Utility Notificatio~]06.00
~lo5 ~5~ I LI:) 0 ) nU~~&l~ik 1~g&Q!.3!32-2344). $ 19.00
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
Electrical Contractor See Of~ ~ *\~''''' CCf-p
Address ~'1 ~~V\ S'T s €...
City JArLfYrlV-/
I
Phone g J-8 ~L{ 54(..(
Expiration Date
Q04LEA
I{ 0 {OS
Supervisor License Number
Constr. Contr. Number ~ 15 1 C. L.IZ...
O?lb~
Supervising Electrician
Owners Name fi ()( ~ rparn ~ h
Address 2-130 19ft.
City ?rt~
Phone 7'f7~r3i t
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
U~ -*- 4a5q l
~ I ~ (Or
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. Sen'ices or Feeders -Installation, Alterations or Relocation:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpslVolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c. tloficf Services or Feede~;"
In~rll5liP'Elm1f1fl1S~At~e}(~~ IF THE WORK
20~~'rft'{}lqI~D UNDER THIS PEHMI"fl'f5!.mH
~~9~~Fo~~~~~~ IS ABANDONED ~~o~~~o
OV1~6~~1 ~~p~ ~rl ~RJ BPs 'see "8" above.
D. B/"3nch Ci.'cnits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E. Miscellaneous (Service/feeder nol included) -Each Installation
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential L $ 25.00 --.Z. S' .-
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4G'/
~ (gD
'4'~
()..,. S
'~'JS
4. SUBTOTAl., OI" ABOVE
~s --
a
7 so
\- z. .r
8% State Surcharge
10% Administrative Fee
5% Technology Fee
TOT AL 3 0 7..~
Shared Drive(T:l/Building Forms/Ekctrical Permit ApplicationS-Ub.doc
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit ,
PERMIT NO: COM2004-00954
ISSUED: 10/27/2006
APPLIED: 08/02/2004
EXPIRES: 07/29/2007
VALUE: $ 61,416.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Springfield JT~f~OY~ iC8lhgI\4Flt'd1nyY.,&\st~fPce
A aggjJted by the Oregon I.y,
fo~I?W r.t4~Uh\'ep.~oM1<<l1eooare set m~idential
PROJECT DESCRIPTION: Roof alteration; enclose exterior space~~tif~~gn ~~Hgoorffl\4ffi~l\0AR 952.001
in OA~ ~52:._.. ^ht'!lin ~ooies ofthe rules b
uu~v. IV~ "'-J ~- ~ . h tel~~!lJIl1'
Owner: PARRISH FLOREINE T ca\\ing the centGThQ~~~'~ta-N' ollUcalfoif34
Address: 2130 19TH ST b for the Orenon UtI I y
SPRINGFIELD OR 97477 lf1um e~enteriS 1.8OC-332.2344).
SITE ADDRESS: 2130 19TH ST
ASSESSOR'S PARCEL NO.: 1703252111201
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Low Voltage Electrical
Plumbing
Contractor
OWNER
J K GUCKENBERGER ELECTRIC INC
MARTINVEST,INC.
JAMMAL INC
License
8699
45129
40591
158262
Expiration Date
12/18/2010
04/24/2008
09/28/2007
01/12/2008
Phone
541-747-6638
541- 7 46-4656
541-928-4544
541-484- 7 440
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
R-3 Height of Structure: Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
VN Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: nTlC!: Occupant Load: F 1HE WORK
" " l e~p\Ql= I .. '
I DEVELOPMENT INFORMA~RM\l brt~~R i~~s PERM\1 \5 NU \
'A\ffiW'R\IED UNR \S ~~~NG
Overlay Dist: COMMENCED 0 rl'otal:
# Street Trees Rqd: f\N'l180 Of\'l PER\Olflandicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS'
Street Improvements:
Storm Sewer Available:
Special Instruction: to existing
Yes
Sidewalk Type:
Downspouts/Drains:
Notes:
Pal?;e 1 of 4
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2004-00954
ISSUED: 10/27/2006
APPLIED: 08/02/2004 .
EXPIRES: 07/29/2007
VALUE: $ 61,416.'00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description I
Description
$ Per Sq Ft
or multiplier
$1.00
$92.40
Square Footage
or Bid Amount
30,000.00
340.00
Bid Amount
Dwellines
Tvpe of Construction
Use Bid Amount
V Wood Frame
Total Value of Project
~
Value
Date Calculated
$30,000.00
$31,416.00
$61,416.00
08/0212004
09/15/2004
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $164.87 8/2104 3200400000000000189
+ 10% Administrative Fee $47.65 9/20/04 1200400000000001363
+ 7% State Surcharge $33.35 9/20/04 1200400000000001363
Building Permit $417.45 9/20/04 1200400000000001363
Fixture $14.00 9/20/04 1200400000000001363
Plan Review Residential $106.47 9/20/04 1200400000000001363
Sanitary Sewer - Improvement $36.56 9/20/04 1200400000000001363
Sanitary Sewer - Reimbursement $48.08 9/20/04 1200400000000001363
SDC Sanitary/Storm Admin $10.91 9/20/04 1200400000000001363
Storm Drainage Impervious Area $133.46 9/20/04 1200400000000001363
Storm Sewer - 1st 50 Feet $45.00 9/20/04 1200400000000001363
Plan Review/Residential Hourly $90.00 11/3/05 1200500000000001672
+ 10% Administrative Fee $4.50 2/23/07 3200700000000000113
+ 5% Technology Fee $2.25 2/23/07 3200700000000000113
+ 8% State Surcharge $3.60 2/23/07 3200700000000000113
Low Voltage - Residential $25.00 2/23/07 3200700000000000113
Minimum/ Adjustment Electrical $20.00 2/23/07 3200700000000000113
Total Amount Paid $1,203.15
Initial Review
Initial Review
I Plan Reviews I
08/03/2004 08/04/2004 APP LLH
10/20/2005 10/20/2005 APP LLH
08/04/2004 08/06/2004 APP TAJ
08/04/2004 08/04/2004 APP MS
08/04/2004 08/17/2004 WE DLM
Plan nine Review
Public Works Review
Structural Review
Paee 2 of4
Revised drawings requested by Don
Moore.
No Planning review necessary -
setbacks and solar OK
Submitted plans are noted as "not
for construction". Contacted
designer - he will deliver 2 new
copies of plans for permit review.
8/19/2004 dim
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2004-00954
ISSUED: 10/2712006
APPLIED: 08/0212004
EXPIRES: 07/29/2007
VALUE: $ 61,416.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Structural Review
08/24/2004
09/15/2004
APP DLM
Structural Review
10/20/2005
11/03/2005
APP DLM
Structural Review
11/28/2005
11/28/2005
OK DLM
Contacted owner for additional
informatino regarding existing
structure9/1/04; met w/ owner 9/2 -
owner to provide information on
existing roof and underfloor
framing. 9/9 - met w/ owner who
proivided most of requested info.-
should be enough to complete plan
review. 9/15 Plan review complete.
Revised plans are approved. See
documents for revised plan review
comments
Owner proposes to substitute
2x12@16" o.c. instrad of2x14@24"
o.c. for rafters over garge. Ridge
board to be 2x12 also. 11/28/05 dIm
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.
~eouire~nsDections I
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to floor insulation or decking.
Floor Insulation: Prior to decking.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Shear Wall Nailing: Before covering sheathing with finish materials.
Final Building: After all required inspections have been requested and approved and the building is complete.
Underfloor Plumbing: Prior to insulation or decking.
Rough Plumbing: Prior to cover and including required testing.
Shower Pan. Prior to covering and including required testing.
Final Plumbing: When all plumbing work is complete.
Low Voltage: Prior to cover.
Pal!e 3 of 4
CITY OF SPRINGFIELD'
Status
Issued
Building/Combination Permit
PERMIT NO: COM2004-00954
ISSUED: 10/27/2006
APPLIED: 08/02/2004
EXPIRES: 07/29/2007
VALUE: $ 61,416.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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
Page 4 of 4
225 Fjfth Street
Springfield, Oregon 97477
541-726-3759 Phone
c;~, of Springfield Official Receipt
1 Aopment Services Department
Public Works Department
Job/Journal Number
COM2004-00954
COM2004-00954
COM2004-00954
COM2004-00954
COM2004-00954
Payments:
Type of Payment
Check
CreditCard
Job/Journal Number
COM2004-00954
COM2004-00954
COM2004-00954
COM2004-00954
COM2004-00954
Payments:
Type of Payment
Check
CreditCard
cReceintl
RECEIPT #:
3200700000000000113
Date: 02/23/2007
Description
Low Voltage - Residential
Minimum! Adjustment Electrical
+ 8% State Surcharge
+ 10% Administrative Fee
+ 5% Technology Fee
Paid By
MARTINVEST
MICHAEL MARTIN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk
ddk
46648
By Mail
006614 Phone
Payment Total:
Description
Low Voltage - Residential
Minimum! Adjustment Electrical
+ 8% State Surcharge
+ 10% Administrative Fee
+ 5% Technology Fee
Paid By
MARTINVEST
MICHAEL MARTIN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk
ddk
46648
By Mail
006614 Phone
Payment Total:
Page 1 ofl
11:03:40AM
Amount Due
25.00
20.00
3.60
4.50
2.25
$55.35
Amount Paid
$30.75
$24.60
$55.35
Amount Due
25.00
20.00
3.60
4.50
2.25
$55.35
Amount Paid
$30.75
$24.60
$55.35
2/23/2007