HomeMy WebLinkAboutPermit Electrical 2007-7-25
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INITIALS NM
DATE 1-:1-f(J """0-'
SOURCE NVO~
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CC::>V'-'" "Z 0 a 7 - 0 I 0 7 ?:,
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1. LOCA.TIO~ OFIN.ST.AL~TION:-!! .
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LEGAL DESCRIPTION:
17D"3'2b2Z
JOB DESCRIPT~N:
A-c1J /A-lTdL -; L(.fc.~~'J
Permits ar~on-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
~t.
DOz.oZ-
2. . ~ONTRACT01J.:~'iS,T1lfLA,TION ONLY ,
Electrical Contractor EA"5J5d)f GLfcrf(JC
Address 3~)S'~ 5oSCAG-E LANE
City Sf~LO
Phone 7lf (~ Ilf~.q
Supervisor License Number l.j 7 ~ 7 5
) 0 ~ I -). 00 7
) (777 0
J () - I,. :l OOr
Expiration Date
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
~~ /61
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Owners Name --+--=>0 ..........
Address
/87
<;;# (~
City
OWNER INST ALLA TION
D'te 7 ;7 ~,/c, 7
COAfPLETE,FEESCHEDiJLE BELOW
3.
A. New :I~esidenti~~_-:- Single or I\'lul!~-Family pe,r 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
$ I 06.00
$ 19.00
$50.00
.~J;;.~"\:_~":S.;'.-2:.~.-..', .'. .' :-~-',-'~' .' '_ ,,", ".' _' '.'.' '.
B. , Se~vices~r Feeders -:ln~~a~~tion, Alterations or Relocation: .
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only .
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
'-, ,. .
C. ,!;~oremporai-yServices or.Feeders
>>'>;'< ." ".". ''"'''' -.-....,-. '. ,.. ,.-"'-:"."">
A TTENTI ON: gh~gH(lJ~~W~FJ!:'t~~D!~. t~_loca tion
~E/~L:w'li'iUI~es adopfecroy m~8WUl!nw .
Notification Ce~@~ ~89VdJt96 are set forth $ 50.00
in OAR 952-001~w~gCfD~Aml6152-001.. $ 69.00
0090. You may .tWPll~~~9RJ~@w~[ule$lb)f $100.00
calling t.he cente~,. J!~P1e:t.h.S s. tei.~p'.h. 0111.. e ""
number for th~e~NI6t~)itt~eeB above.
. Centltt i$I\ro~a44l... -. .
The installation is being made on property I own which
is not intended for sale, lease or rent.
~
~C>f~S
& e-er..... ",4. {c:r
Phone 7~7 - 5 "34 fc,
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
" r C::,
~(o)l~~\E: 4. : S~'!!!9!~h<?l'AB~~ --:>
nll~ PFRM1T SHALL IEXPIRE If lH&W@B" Surcharge 4 '18
AUTHORIZED UNDER THIS PERMIT la~(fministrative Fee <<0
COMMENCED OR IS ABANDONED F{mTechnology Fee '780
7W)'7~~O DAY PERIOD. TOTAL . b f ~
Owners Signature:
Inspection Request:
New Alteration or Extension Per panel,
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$.0
$~.oo
'IS
8
7
^~ . < ,. '-,,," " .. -" '.' "
E. . Miscellan~.o~lS_(~ervice/f~eder. not incl~ded) '-Each Ihstallation
Shared Dnve(T:)/Building Fonns/Electncal Pennit Application 8-06.doc
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01096
ISSUED: 07/25/2007
APPLIED: 07/25/2007
EXPIRES: 01125/2008
VALUE: $ 2,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 187 GREENV ALE DR
ASSESSOR'S PARCEL NO.: 1703262200202
Springfield
TYPE OF WORK: Kitchen
PROJECT DESCRIPTION: Kitchen remodel
TYPE OF USE: Remodel
Residential
Owner: DONALD ROGERS
Address: 187 GREENV ALE DR
SPRINGFIELD OR 97477
Contractor Type
General
Electrical
Mechanical
Plumbing
I CONTRACTOR INFORMATION I
Contractor
NEIL KELLY CO INC
EASTSIDE ELECTRIC INC
NEIL KELLY CO INC
BILL BAILEY PLUMBING INC
License
1663
117770
1663
84110
BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: R-3 Height of Structure:
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VB Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: All cirnON: Oregon 1a.j~~vU to
follow rules adopted byb!1iQ&;~~J1WIi1V: n/a
~~=SWF=ATlON I
aaIIlng the ClIIll8r~lhg .;.
llUmb8rforthe~on ees qd:
Center ave Dr ve Rqd:
% of Lot Coverage:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
. Storm Sewer Available:
Special Instruction:
Notes:
I PUBLIC IMPROVEMENTS I
Phone Number: 541-747-5346
Expiration Date
11/01/2007
10/04/2007
11/01/2007
06/24/2009
Phone
503-288-7461
541-915-9828
503-288-7461
541-998-1141
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
NOTICE:
THIS PERMIT SHAll EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED fOR
ANY 180 DAY PERIOD.
Paj!e 1 of 3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description Tvpe of Construction
Bid Amount Use Bid Amount
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Building Permit
Exhaust Hoods
Fixture
Minimum/Adjustment Mechanical
Total Amount Paid
Structural Review
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01096
ISSUED: 07/25/2007
APPLIED: 07/25/2007
EXPIRES: 01125/2008
VALUE: $ 2,000.00
I Valuation Description I
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
2,000.00
Value
Date Calculated
Total Value of Project
$2,000.00
$2,000.00
07/25/2007
~
Amount Paid Date Paid Receipt Number
$20.00 7/25/07 1200700000000000960
$22.00 7/25/07 1200700000000000960
$11.00 7/25/07 1200700000000000960
$17.60 7/25/07 1200700000000000960
$48.00 7/25/07 1200700000000000960
$8.00 7/25/07 1200700000000000960
$50.00 7/25/07 1200700000000000960
$10.00 7/25/07 1200700000000000960
$64.00 7/25/07 1200700000000000960
$40.00 7/25/07 1200700000000000960
$290.60
I Plan Reviews I
07/25/2007
07/25/2007
DON DJB
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~nsnections I
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Pal:!e 2 of 3
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2007-01096
ISSUED: 07/25/2007
APPLIED: 07/25/2007
EXPIRES: 01/25/2008
VALUE: $ 2,000.00
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.
'V'_#
~
7/~/(f7
o~r Co~tractors Signature
Date
Page 3 of3
225 Fifth "Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01096
COM2007-01096
COM2007-01096
COM2007-0l096
COM2007-0l096
COM2007-0l096
COM2007 -01096
COM2007-0l096
COM2007-0l096
COM2007-01096
Payments:
Type of Payment
CreditCard
cReceintl
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1:31:41PM
1200700000000000960
Date: 07/25/2007
Description
Building Permit
Fixture
Exhaust Hoods
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 1 0% Administrative Fee
Amount Due
50.00
64.00
10.00
40.00
20.00
48.00
8.00
ll.00
17.60
22.00
$290.60
Paid By
KATHLEEN S DONOHUE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 515213 In Person
Payment Total:
$290.60
$290.60
Amount Paid
Page I of 1
7/25/2007