HomeMy WebLinkAboutPermit Electrical 2007-10-29
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225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number C0IA-1"'t:..007 - 01 S 80
1. LOCATION OF INSTALLATION:
Z7,S'O
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LEGAL DESCRIPTION:
1703'3 b \..1 I
JOB DESCRIPTION:
e'lreNtt. eYIJflNf 1'5i..t Ctnt,,\7"+
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
00400
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor ''\ I" ~ -\e."", \L \e.c,:\v\.<- -:LV\C
Address 2 '0 '"2...1 \ G:.~ GW;l. .\-<:..-- S).r .
City _ w\ .e 11\ e.
Phone <..\ eA - '1 <e,C)'i::)
Supervisor License Number
L\I/~ 'S.
Expiration Date I ~ Il I C) I
Constr, Contr, Number I Co'-\ 8<::::',
Expiration Date ~ 12-< /2-0 Co 4
Signature of Supervising Electrician
L/~~ ~
T eFt=: '15:o.wt.4 (Lv-
Address ~ 7 7 t.( b 1? L.f:'-t( ~et
~ity 0 t:N".f.A Phone
Owners Name
3. COMPLETE FEE SCHEDULE BELOW
A. New Residential- Single or Multi-Family per 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
$117.00
$ 21.00
$55,00
B. ' Services or Feeders - Installation, Alterations or Relocation:
$ 70.00
$ 83,00
$138,00
$180,00
$413.00
$ 55.00
S a<~~E if THE WORK
c.~~ U r1\1mltRMIT IS NOT
~ML~iDemliJ~/.I~~~~D fOR
&m\fA~OcP4\Yst'i)E~l~!JD" $ 55,00
201 Amps to 400 Amps $ 76.00
401 Amps to 600 Amps $110.00
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
~~~!fKVgJ)nly
e'u ,-u; iJ u IW 6"
Over 600 Amps or 1000 Volts see "B" above,
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit I
Each Additional Circuit or with
Service or Feeder Permit
$ 48.00
$ 4,00
LIB
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation $ 55.00
Sign/Outline Lighting $ 55.00
OWNER INSTALLATION Limited Energy/Residential $ 28.00
;::o~~~:~:~:~n;; ::::~l~':~'O;~~~~;;~:h~41~='d E::;~:::t;on Fee le~~:'h''''''
Owners Signature: ~~J@\fa , 8Q;~:C::1iJi~ .' ...'. . &iJfl_OVE SO
~.,G@~'U\ffi@M,' ~Q@JiJJ' . . r;..,Il~Cii~j~~.,~.~~~~:rth, u
r e [\!Rl ~V"^' (iNI;)<", R".0<!i lI'il ^ ' .. ,.' '~\'4\<~.. ?
-.l1i iriJ' ",~i:ScGi~b~0,j"';''i0"''''l\ y "J4~~ r
~~@. 1fiEW ~~l~Yti~' .,,)
tOOlm7!@ . ,,(lJ:0tJ'0"~~~~ Zs-o
i'n =%6" fb,,, ft."""",,,, l 7i\f''40n "r.i8'(\nW""8M,l1i~ / " "'0
~~~,(t;c!gLJ D~J ~1:ri~~l~;;:":::~::/BUilding Fonns/Electrical Permit APPli~n ~
Inspection Request: 726-3769
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01580
ISSUED: 10/29/2007
APPLIED: 10/22/2007
EXPIRES: 04/29/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2750 MAIN ST
ASSESSOR'S PARCEL NO.: 1703364100400
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Commercial
PROJECT DESCRIPTION: Extend existing lighting circuit
Owner: BOMARK JEFFREY A
Address: 87746 BLEK DR
VENETA OR 97487
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
TRITON ELECTRIC INC
License
164857
Expiration Date
OS/25/2009
Phone
541-484-9800
I BUILDING INFORMATION'
# of Units: Aw .'cIll1OftOregottfaw~.ywto
Primary Occupancy Gt..." ruIeI adopted by th8IOtMC<<~ure:
Secondary Occupanc~ Center. Those ~_"'IArttl
Primary Constructio~ 962.Q01.oo10throu~~ Q01-
Secondary Constructi~r. may obtain cop~9f. . by
# of Bedrooms: oaIflno the center. (Note: ..
IUI'I'IIJ<< far It. Oregon Utll ing: n/a
CInt8 .. t.a00.332
I DEVELOPMENT INFORMATION I
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
N OTI CE: Downspouts/Drains:
THIS PERMIT SHALt EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
. P~n .
Valuation Descri tion
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of2
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01580
ISSUED: 10/29/2007
APPLIED: 10/22/2007
EXPIRES: 04/29/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
I ' Fees Paid'
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid Date Paid Receipt Number
$5.00 10/29/07 2200700000000001643
$2.50 10/29/07 2200700000000001643
$4.00 10/29/07 2200700000000001643
$48.00 10/29/07 2200700000000001643
$2.00 10/29/07 2200700000000001643
Total Amount Paid
$61.50
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.
Reouired Insoections 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 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
Pa2e 2 of 2
225 F.ifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-0 1580
COM2007-0I580
COM2007-0 1580
COM2007-01580
COM2007-0 1580
Payments:
Type of Payment
CreditCard
cReceint I
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2200700000000001643
Date: 10/29/2007
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
BARRY LISTER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 02539C In Person
Payment Total:
Page 1 of I
10:24:11AM
Amount Due
48.00
2,00
2.50
4.00
5,00
$61.50
Amount Paid
$61.50
$61.50
10/29/2007