HomeMy WebLinkAboutPermit Electrical 2004-11-15
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LEGAL DESCRIPTION
17033b")'Z
07(02-
JOB DESCRIPTION
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. Pennits are non-transferable and expire if work is
,.. not started within 180 days of issuance or if work ,Is
Suspended for 180 days.
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2. ~~U<r._"',~~'-~""",~~"::Il<!"",",<;.
Electrical Contractor
<)zc~~ 7'hr.4
Address
<)17' N"",,- s?Z:2..L.l# R/,,,,j_
City ~c~....f..-v~
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Phone 5';2./ - 283 :;-
Supervisor License Number
:J UB Lvi
Expiration Date / /'> - 0'-
Constr. Contr. Number / ~ A 6/f3
Expiration Dare
~-8 - o5~
Signature of Supervising Electrician
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Owners Name ?;hefiy ?7.?A"-S5 L. Y
Address ) " /7- .5 'JI '" .5 'I.
City ~">-??r:'t-/d Phone
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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
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Service Included
1000 sq. ft. or less $ I 06.00
Each additional 500 sq. ft.,or
portion thereof $ 19.00
Each Manufact'd Home or TUE "'OR" '
1'~r.. . S 'O~\f\fl"
"0 MOiIularDw.eUin~ \:.w.c.ear i IS 1'101 $5000
T\1\~~Cr!J\\I 'S\i~~o 1\1\5 PERI'N . .
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"B.e-c., . r F " ':',.,.;!.~ta)latron"i\I!.eralions:o',rJ"ReloCalion:~
CO\\'..'---'-~PY~TU~;~~"""""".'."'~-~-'~"'~- '
MI203lJ.9n~for less , .' $ 63.00
201 Amps to 400 Amps $15.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsIVollS $375.00
Reconnect Only' .. $ 50.00
~
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c. emp'or~Se~ce5lor.'Feeoer '" .d.~..;-;~.:.'~~~-.;J:~~~~
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ATTEN!l.O~: Oregon ~aw~~ Utility
10\lQ~~ru~fI ~e~~h~~ rules are ggt forth
N 'f21 'I~m~ h O^~-,,,::,,_nn1.s 50.00
otllC OTT C\.!htOug ", . - -
\ O.2llI....mmrtQ4$1'""'P"-. Ith"0.,10" by$ 69.00
n ~~;,.;.'w . oples 0 u ,
o096!>t~6llOWbp5' . \hete'::-rhnne $100.00
c~~PJ,le~J8a."~dBfNa1\liQP'
DJ~~'t'J:\~' ~m~~li't~~~~~,(~
New Alteration or Extension Per Panel
One Circuit $ 43.00
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
E. ~~1l?nto"dt:(s"r,'rv?ceJii~1f'~Fill~llf.fe"d)~qE{,ih;ffikillij;~
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Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial { $ 45.00 L/<i, 00
Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges
4. ~fu,_,ro1,:tA:E,":":"','7OFMiOJ;E~~~ I / \~
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7% Stare Surcharge 'J I ,.
I, )0
loolo Administrative Fee "f
~2-~
TOTAL
Shared Drive(T:VBwldin~ FonnslElectrical Permit Applicntion (.o3.doc
.
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01396
ISSUED: 11/12/2004
APPLIED: 11/12/2004
EXPIRES: 05/12/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1517 S A ST
ASSESSOR'S PARCEL NO.: 1703363207102
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION: Security system
Owner:
Address:
Contractor Type
Electrical
JOHNSON RALPH V & LINDA M
10730 CLEVELAND AVE RIVERSIDE CA 9.J5Q3. 'AlORK
NO I I\;t.: , . . ~ rvnlQt: It: iHE "
18.1<;' ptKN\I \ 011"~':: ::. 'I.:' PERMI! IS NU I
I CONTRACTOR(I!yYQ~TfON 'I) OONEO FOR
MMENCEU UK \0 I"u",1j
C~'( 160 0(\'( ptJ~ense Expiration Date
(\ 156618 08/08/2005
Contractor
SECURETECHINC
Phone
541-521-2837
I BUlLDlNl. ,,,rvN,IA nON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of ]Jedrooms:
# 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:
nla
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:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I law requires you to
~ regon U 'Im,
1-\' 1~1"1""''''' 1kGrY\ll90 ti"J
follow rules adoPte~lltt\\lllrules are set forth
Notification Center. -RS~'Il'm'!!5'2'()01.
AR 952.()01.()010throug
In 0 obtain copies 01 the rules by
0090. You may (Note' the telephone
calling the center. '.. Noll cation
_, ,~hc' fnr the Oregon Utility. , ..II
. 1""" ~~'L-.....-rl/'
I \"tlllrr IS -......---
Valuation DescriDtion '
Notes:
Description
. Type of Construction
SPerSq Ft
or multiplier
Square Footage
or Bid Amount
Vatue
Date Calculated
Total Value of Project
Pagelof2
.
.
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2004-0I396
ISSUED: 11/12/2004
APPLIED: 11/12/2004 .
EXPIRES: 05/12/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I F....s P3irl I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcbarge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
$4.50
$3.15
$45.00
11/12/04
11/12104
11/12104
Receipt Numher
1200400000000001604
1200400000000001604
1200400000000001604
Total Amount Paid
$52.65
I Plan Reviews ,
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 R..ouirerl lnsn..r.tions I
Low Voltage: Prior to cover.
By signature, I state and agree, tbat I bave carefully examined the completed application and do bereby 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 readahle from the
street, tbat tbe permit card is located at tbe front of tbe property, and tbe approved set of plans will remain on tbe site at all
times during construction.
Owner or Contractors Signature
Date
Page 2 of2
225 Fifth Street
Springfield, Oregon 97477
54'1-726-3759 Phone
Job/Journal Number
COM2004-0 1396
COM2004-0 1396
COM2004-0 1396
Payments:
Type of Payment
CreditCard
11/12/2004
.
RECEIPT #:
.P~''''N~,.Fl~' ,.',. ,.",
WiLl
.,...,
, ,
_. ,,;' l
....__n_. .
.. of Springfield Official Receipt . '
~elopment Services Department
Public Works Department
1200400000000001604
Date: 11/12/2004
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Paid By
SECURETECH INC
Item Total:
l.:heck Number Authorization
Received By Batch Number Number How Received
djb
012940 In Person
Payment Total:
Page 1 of 1
lO:45:19AM
Amount Due
3.15
4.50
45.00
$52.65
Amount Paid
$52.65
$52.65