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Home My WebLink AboutPermit Electrical 2007-9-21 ZON L..\~?- INITIALS N j'V\.. DATE q --~i-01 SOURCE ~b 2?,5 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number . rJJrn 2/57)7 ~ QIL/37 Date ignD':;~~i~E;;;~ ners Namecp~ ~\ b\<...L.- al.teeh Address\ \lli \/~ ~t1?b' CIty s:;:.r\ . ..P.l1D.n~ Pump or irrigation $ 55 00 . L,~ EJgon ,a'N requlr6o',uu io . ~ . rules adopted by the Oregon Utility Sign/Outline Lighting . ' $ 55.00 . ... . OWNE ~'Pf't.inn.~"""'r: Th I L' . dE IR 'Q..tii.ll OOIH~~~~ 08 ~ AI\Jv AIf'U'BR.'1'1\!J.JllIl . ose ru es are set forth Imlte nergy eijoe:fU3 DON' '8' , 81 H N3itit1fIt~ ~ !hein.st.9Q!1~~~t,~~~~~8\~~~~c4101. .. LimitedEn~rgl.~m. Til. 3.~.~lV~~a. I~OH1~~ Isnotmten_~~'ciTfe~rn:~Pt. h erulesbYM,mmumElectrlc ~r. 1 ue<t. "'''. + ""3nl~' numbe f th o. '(No e. t e telephone .~, .. .J.:II Q,\;J U\lt.jc~. IlL/ Owners Signatur/c' or e. regon Utility Notification 4. SUBTOTAL OF ABOVE . :. , enter 18 1-800.a32-2344\ . . --- .. - iJ ," 8% State Surcharge . 3-,. ._ 10% Administrative Fee q_ KU. 5% Technology Fee 6 _() V 73 ,g i) 1. LOCATI()N OFJN'$].'ALLATION':> >: _" J~""tfiJ-~oJ- f;.Lftf LEGAL DESCRIPTION: \.]0'3 ~(p 44 to { o-D JOB DESCRIPTION: (i Yl tJ 11 (J Yl))Ay1f)! Permits are nOd-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ""','-.'..,.. '.c",,-, . ".,..". ",,.........,,- 2. ,.. CONI'RACTOR INSTALLATION ONLY .: Elec~rical Contractor '(J;V V r y / ,. By 0 <) , Address P () b~ y [pq 7 City J (.1 Ii 'rrv,') )-r Phone]!d:J") 7 ~ Y Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Inspection Request: 726-3769 3. A. , New Residential- Single or Multi-Family per dwelling unit. ..;"._;"-,;,:,-,';<)';"""".,c:-""_:,,,,,"r.,X",,;;",_,,\",~ ;,""~",.,:.,,."_ "~";,,.""""'"'''' .. ".',__,:';'-':".';;;";0.",. '_..,_...,.-.~. .' ..... ... ....... . ' 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 o~ 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 Amps/Volts Reconnect Only $ 70.00 $ 83.00 $138.00 $180.00 $413.00 $ 55.00 c. Temporary Services orF:eeders ~ ...., ~ - Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 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 '-.) L-/-16D (:2.0 V " $ 48.00 $ 4.00 E'.I\1iscellaneous' (Servic~{~eeder not included)-Each I nstall'ation TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 7-07.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01437 ISSUED: 09/21/2007 APPLIED: 09/21/2007 EXPIRES: 03/21/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1116 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264410700 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Commercial. PROJECT DESCRIPTION: Underground Electric Owner: OPEN BIBLE STANDARD CHURCH Address: 1116 K ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION. Contractor Type Designer Contractor BURRELL BROS ENTERPRISES INC BUILDING INFORMATION I License Expiration Date Phone 541-747-2724 # 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: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n1a I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' Street Improvements: ATTENTION: ~mgmtJ~fSMlulres you to follow rules adopted by the Oregon Utility Storm Sewer .A vailable: Notification Ce~@tYnm69~fRre\j~ set forth sPttc~1il&iuctionS: HAll EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- THIS PERMIT MIT IS NOT 0090. You may obtain copies of the rules by Notl\UTHORIZED UNDER THIS PER calling the center. (Note: the telephone ~n~IIl(,J:nJlR IS ABANDONED FOR number for the Oregon Utilif\lNotiflcatJon ANY 180 DAY PERIOD. I. .. tenter IS 1-~bu.332-2344). . . ValuatIOn DescrIPtIon . Descriotion Tvoe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pal!e 1 of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01437 ISSUED: 09/21/2007 APPLIED: 09/21/2007 EXPIRES: 03/21/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project ~ Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $6.00 9/21/07 2200700000000001485 $3.00 9/21/07 2200700000000001485 $4.80 9/21/07 2200700000000001485 $48.00 9/21/07 2200700000000001485 $12.00 9/21/07 2200700000000001485 Total Amount Paid $73.80 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. ~eouire~nsDections I Rough Electric: Prior to Cover 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 ofthe 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 Pa2e 2 of2 . " 225 Fifth Street , Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01437 COM2007-01437 COM2007-01437 COM2007-01437 COM2007-01437 Payments: Type of Payment CreditCard cReceintl City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2200700000000001485 Date: 09/21/2007 10:42:57AM Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Amount Due 48.00 ]2.00 3.00 4.80 6.00 $73.80 Paid By BURRELL BROS/JOSH B. Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 045]38 In Person Payment Total: $73.80 $73.80 Amount Paid Page] of] 9/21/2007