HomeMy WebLinkAboutPermit Electrical 2003-10-3
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.225 FIFTH STREET . ,.,.,
, SPRINGFIELD, OREGON 97477 i.;
INSp~crIoNjlliQUI?ST: 72~)769:
OFFICE: 726~3759>("" .<'
ELcLf'RICAL PERNfITAPPLICATION
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<City'Joh Nhmberq~MCS3,:,'00<1'11<'
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1. LOCATION OF iNSTALLATION
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COMPLETE FEESCHEbut~BELOW
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A. New Residentiill-Singie or
Multi-Family per dwelling unit.
Service Included:
Items Cost Sni:n
JOB DESCRIPTIO)' ,_, ,1000 sq,fL or less
~V l(L LAfl~ Each additional 500
J The following project as submittee.( .hft5<lt1fJtn1timing
Permits are non-transferable and e25i'primg, and does not require sflAAi~ef1and use
if\,"ork is n~t~tarted \:ithin 180 d1llf!:Proval. '. Lb\<.... ,Each Manufd ~ome or
oflssuance opfwork IS suspended for Zonmg' IhvJula. G IYdllUiS
180 days, ' Date l(')-O~-D3 ,C:p",irpl\rFpprlpr $50,00
2. CONTRA~OR INST ALLA T~'/WJLdy';;9oa,""h. ,,~li"'?I;f r.'Clflihon laW raqUlres you to .
:;-'7) C ,~. ATIEW;U:\11mlR~ ffiab1?l\~<<0i'egon Utlhty
Electrical'Contractor~DSe-- .1)"~(o...:t-\OY?o\lgW1M\~~~b\Y:'~ Those ruls$ are set for
- - ~ ,l\!o~l~i~~~ion c~m~i'. Uuou h OA-Re~~
Address 8<1 <1 'ita \-..,)C.I.,.'{ L~~ '\ OP.~52~1oAQs\? ' i~S of th ,,, :63.00.h ~. 011
C GOgO. Vt})l.lcmfS.o/t@~~mn~~p. h telepllooe> 75.00
Ci ty T ..LLI~ Phone La. Q)~- Oq OS ' ; cail~ tMPli:&nt~'a~te. "t. e N tifteaijd~25, 00
, ' ' . . . nU9t\6~fm~ {J>>[190~JJtlltty 0 $163.00
Supervisor License Number \ t5l.a e S, "" , OV~MW@.~ffipt~~.3~2.2344). $375,00
EXPiratiorib~le<'\:C~'~~\:~::OW:',:'_.\. ":-,;',','" 'c::'R~c~nne~tp~~!i:',';~'. . $,50,00
, , ',.; " ,:;"C,t~nll)Ohiry Sei.:Yrc~ior'F~edel"S,
':Constr conti:~utn?~r:''9'qq3:l\ . 's, ': ~:i,~,~~~.tanation;Aiter~tioti ot:J.{etQcatio.n,
;Expiration Date q ~ '2J)~'6q':q
$106,00
$ 19.00
200 aIilps: or:Ies5 . ' '.
20 f ~fnps'to400 amps:
. 2,Signafure,gi' Supervising Electrician ".OVer.401to 60Q,amps, .
~' , ~~.., N01'~~:::::~:::::O:::ORK
'. OW;lers~ am, 'e,', M1i,','""", 4' {1-t,.:....,~,,' . 1HU\HORIZ~e'\M0~on-H&i~\lM\l Js..~Rll
. .'., '.' ,"'c~,: " A p~.~~ABANOONEO FO\('
Address ~15,~~\ l~ ~~~~i~l_o.
City 3pY\ n6f;4d.PhoneSS4--11-\(Q
$50:00
.. $69.00
, $100,00,
$43,00
Each Additional Circuit or with Service
or FeederPermit
$ 3.00
OWNER INSTALLATION
The lnstaIlationis being made on
property I o\vn ,vhich is not intended
for sClle, lease or rent.
E. Miscellaneous (Service/feeder not included)
-Each installation . '
Punip or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$50,00
$50,00
$25,00
$45,00
OwnCI'S Signature:
Minimum Electric Permit Inspection Fee is S45.00 + Surcharges
TOTAL
I()?],OO
LI,4-1
(p. ~a
l-=),{ I
4. SUBTOTALOFABOVE
7% Statc SUI"Charge
l D~o Administrative Fee
Status
Issued
, CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2003-00991
ISSUED: . 10/0112003
APPLIED: 10/0112003
EXPIRES: 04/0112004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE, ADDRESS: 715 C ST
ASSESSOR'S PARCEL NO.: 1703351311900
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Service Change
Owner:
Address:
MARY LEE HALBERT ATTENTION:Oregon law requm!%ryd'iJlrober:
715 C STREET SPRINGFIELD OR 9741'blJow rules adopted by the Oregon Utility
. Jvl;l;...al;v" ':''::;I.lQ,. 71,v"g ,ulv" ~,v algi /"'"
I CONlW(jfoo!lNP0IDWA!'PI~J19h OAR 952-00
VV::1U. JUU IIli:lY UUli:llfl liU~es of the rules I
Contractor calltng the centu.cW*: thiEl'<tJftPftlmeDate
ROSE CORPORATION number for the CStiI90n Utility NomJiB8'JtiOffil
BUILDING INFOWl fIONi'U-,j,jt:::-t:::.j44}.
541-554-7216
Contractor Type
Electrical
Phone
541-686-0905
# of Buildings:
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:
, Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area: .
SETBACKS
I DEVELOftMF;~ifdNFORMA TION .
THIS PERMIT SHALL EXPIRE IF THE WO~QUIRED PARKING
Ov~ftfZED UNDER THIS PERMIT IS N()'Qtal:
# Se~M~f{<ft11DR IS ABANDONED FOR Handicapped:
Pa'A~f"~um PERIOD. Compact:
% of Lot Coverage:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
11'utlLIC IMPROVEMENTS'
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
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
Pa2e 1 of2 .
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00991
ISSUED: 10/01/2003
APPLIED: 10/01/2003
EXPIRES: 04/01/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone.
541-726-3676 Fax ,
541-726-3769 Inspection Line
L Fees Paid J
:~
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
10/l/03
10/l/03
10/l/03
Receipt Number
2200200000000001609
2200200000000001609
2200200000000001609
Total Amount Paid
$73.71
'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 ReQuired Insoections I
1 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.
~1 ~ruTh, .(~ ')
Owner or Contractors Signature
t1tJ.1J10J/
10/Ot ( 0<-
. I
Date
Pal!e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-0099I
COM2003-00991
COM2003-00991
Payments:
Type of Payment
CreditCard
Receipt #: 2200200000000001609
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
ddk
Check Number
Batch Number Authorization Number
Paid By
ROSE CORPORATION
000184 001817
City of Springfield Official Recfipt
Development Services Department
Public Works Departmen.,t"
Date: 10/01/2003 1l:26:26AM
Amount Paid
Item Total:
63.00
4.41
6.30
$73.71
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71