HomeMy WebLinkAboutPermit Electrical 2004-10-1
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$ 19.00
Permits are non-transfe.-able and expire if wo.-k Is Each Manufact'd Home or
not started within ISO days of issuance or if work is Modular Dwelling Service or $50.00
Suspended for 180 days. ' Feeder
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Z. .' 'i~~~.R, !l\'$,l~:rrq!t;PWi"!;': B. ~~ \t. ~\'~~ 'r;!""~tion. ":\t~r~tiqn. ~r Reloc.ti~q:
Electrical ContfRctor AnT <; F (" i..I (J. frY \.. 'l;,~~\~~~J~~ess $ 63.00
~'i;:. '1~~ ,1;\'''' ~~. to 400 Am", $ 75.00
Address !i.6b.O L"\A tAA\\)~"''''\.~ t>-~~~ 1 Amps to 600 Amps $125.00
\'~\:. ~<;) IJ\\ '''' ()IJ. 60 1 Am", to 1000 Amp. $163.00
City _5Pfl.IAJb F/t:I...fL. Phone I. ~ "J1~ Over 1000 AmpsNolts $375.00
\J ~ \ 'O~ Reconnect Only $ 50.00
~~'
.. ~r; 7/ Ll;.:4
Supervisor License Number
Expiration Date ~
c. ~~T;~P.~f~rys:~i+~c,!~;~fi~~.~~~::i':?';:;':'iL ':.'
I':~ :'~\~?~:!,'" ":,::' ,.,'M II,' ," .
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ConstI'. Contr, Number 59'1 tfif
Expiration Date _- ~ / OS
,
Signawre of Supervis. g Electrician
Installation, Alteration or Relocation
ZOO Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
q~~~6~.6-~~~ ~\,I~o.i~~?~1.s,~~::,above.,;,/".. ?:':" . "
D. ~Br.anch Clrcmb,. "H"q,' ~<O' ......~ ~ ,'i :-" I'.
" "" . . ,- I". "fB>~~~' ~: ' , '
New Alteration or EX~o~~~~~
~ _ ~ , One Cm:n~ ,# < O,,,,,},,, <1>'''.(1)'</1 $43.00
~. Each Additionab~~~t~~ rtJ ~ (;)~6
" ,I _/1" Service or E.l\~r~ <: ~ ~ ~ .j':~)'~4' 3.00
Owners Name /JI~~C' Wlt/~1C ~i".'\" I', ~~ 0~~'O 1t..~O ~o~~~ 0 0'V;, ~(?' ,
Address ICfh 0 C' s ~ E. :;-~~!g~~.~s~~e~M\~\ik~ded)-EBCh Installation
__ '""'" . ,(\X5 ,.s-0 (;0 ~~(;:j ~~~ ~~ \)~ fl,~-'
City S,~ _ Phone \>P~t~~~O'Q 0'. ~O~"V"-~ $50,00
_ ~~~~ ~~ti(!8~ 0''0 !O~~ . $ 50.00
OWNER INSTALLATION ~ '~~nW ~~~trA'" , $ 25,00
~ ~~~ '?:'A"'- . .-.
Limi~ W~~V~..rcial _ ,)( $ 45.00 4 )
Minimum Elect~~ermlt Inspection Fee'is $45.00 + Surcharges
The installation is being made on property I own which
is not intended for sale, lease or rent.
Ovroers Signature:
)'::..t(II(~,'7:..~;,\,.':.. "/.l'I"" 'i'~:'?:" "'11,1. '.
4. ',SUBTOTAL OF ABO~",
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Inspection Request: 726-3769
~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared [lrive(T:)lBuilding Forrn$/Electrical Ptnnit ApplicUlioo 1-03.doc
E0 39'itd
al3I..:l9NI~dS la'it
996t>9ELIt>9
GE:S0 t>00G/t>G/50
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01222
ISSUED: 10/0112004
APPLIED: 10/01/2004
EXPIRES: 04/0112005
VALUE:
SITE ADDRESS: 1621 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703253404500
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION: Low voltage
Owner: MCKENZIE WILLAMETTE HOSPITAL
Address: 1460 G ST SPRINGFIELD OR 97477
I CONTRACTOR IN~(>.AP;ON I
A..-TENTION' ureYUl1 I..." . - 1\ 1 . .
1"\1 , . th Oregon Vt1ltty
Contraqtjt~w rules adopted by e ~iceu~e
ADT SlU~r..TD.:r:l\lO~sT~e rules are s_,h944 I
"1l'Ilf1tt~C!~ I - h n ^ D Ql{'jf-. h I I -
1... OAR 952j""1-:\\H.'\.I.\ J'''''V:'"' -
tll -BVVJl~.F~1tl()):NiI)Y
0090..YOU '-1 (Note: the telephone
calling the ce~'f S't8R~ti\ity Notification
number for the,r~~i6R!r$t~1!~tJ1.f~) .
Center Ify )C offi:'eat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
Expiration Date
05/07/2005
Phone
541-736-4973
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
<<Yt\At.Lot Coverage: lHE WORK
MOl \,t: l EXPIRE If
II ~I.: DI=R~\1 S,~.~:;; ~\ \~C pt:QMIi IS NO!
L~~lm~~lMBRt#Ji~~NDONEO fOR
COMMt\~v'::D ~ .
O^;< PERIOD. Sidewalk Type:
AN\{ '\ BO t\
Downspouts/Drains:
I Valuation Description I
$ 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: COM2004-01222
ISSUED: 10/01/2004
APPLIED: 10/01/2004
EXPIRES: 04/01/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid.
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
$4.50
$3.15
$45.00
10/1/04
10/1/04
1011/04
Receipt Number
1200400000000001424
1200400000000001424
1200400000000001424
Total Amount Paid
$52.65
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.
L Reouired Insnections I
Low Voltage: Prior to cover.
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 of2
225 Fifth Street
Springfiel~, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-01222
COM2004-01222
COM2004-01222
Payments:
Type of Payment
Check
10/1/2004
RECEIPT #:
'''''ty of Springfield Official Receipt
.;velopment Services Department
Public Works Department
1200400000000001424,
Date: 10/0112004
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Paid By
TYCO FIRE AND SECURITY
Received By
djb
Page 1 of 1
Item Total:
Check Number Authorization
Batch Number Number How Received
13 795
In Person
Payment Total:
1 :52:52PM
Amount Due
3.15
4.50
45.00
$52.65
Amount Paid
$52.65
$52.65