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Home My WebLink AboutPermit Electrical 2004-8-25 . It >0 0 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (S%t7!l~.;16J9 ELECTRICAL PERMIT APPLICATION b<$'. q,l' 0' O'o;"'%c ~ Z - '$ ~ \SO jI' City Job Number ~~~Y~o, ObO Date 0 - S --cf),1C;;( 0,,0.' "01 qu-u- v.,. :9 "'19 "6 ~. JOB DESCRIPTION 1000 sq. ft. or less / _ + Eac~ additi~~al_ ~O~sq. ft. or l=:;::t C-I o(l."...... , '- portIon ~eJeofl7 \\\\\\'l - o.\N ~GW.\I' ~\'\ v X\ Permits are non-transferable and expire if work is ~eQpt\ \"E~IVMRSfact~d.;H\sm1: or not started within 180 days of issuance or i{ M~ 0 :\.eO 'o'M"bd~~(]j)~f1li~1.~'~~~e or Suspended for 180 days. ~~t-\' ies a.OO'? \ntH~~de O~lf\ - u\eS 'o'l t\\e~. ~ t\:l-l} ( \_OO'\Q. rl -;0\'0.\, . 00..., ~~ ~~1) l~O,- L'!\~ . Electrical Contractor E/ e v ~lV/J ~e~'20{b<\m\W~o/~s~< \ Q~ ~\\\t\9/:. t \ne 01~%~1to 400 Amps Address ~ lOw 6-1 J / S' 5Y,ff\'rf~ @d.et \S ~61 Amps to 600 Amps \ ,\;. vel I\: F.. 601 A.mps to 1000 Amps City d '-t '1 e ne- Phone -'137" b '19 / Ov~; 1000 A~psNolts Reconnect Only InstalIation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. 17ctriCia D. / ~ New Alteration or ExtensiM~(8 I D ~ One Circuit "-O\~t.. \r '\ \1 ,c, ~O / , C~.Each Att~dUJt~r~t~h rO\\ S- Owners Name CA I \I A 0.-, C>t'ciV ~ ~t.~t~W;cf, ~~~e~ ~~~\)O~t..\) , "\~S-' Address I/Ib ~{e""",,,"( 'F:/vdtr.'U\~ City S?F\\ Phone Ca~W;~P~irrigatiOn tr.~ Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial [. 1. LEGAL DESCRIPTION J70~ Z6Lftf 10700 2. Supervisor License Number ,30tJ/5 /0-/- oc.; Jro05orF 7-/--0~ Expiration Date Constr. Confr. Number Expiration Date Signa~upem'ing ........ OWNER INST ALLA TION The instalIation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 3. $50.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. I $ 50.00 $ 69.00 $100.00 $ 43.00 $ 3.00 4~ /r $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~ 4. S-B 30 .j.. z-,o lfOb r-~O . "') ~ '/- .5 ~ I b786 TOTAL 4,-';' 0<) -- ItJ ~Vl 55 Shared Drive(T:)/Building Fo I ,ctrical Permit Application I-03.doc .--- 7% State Surcharge 10% Administrative Fee 'Tb~( IOl.c-;b ]:IS ) CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01060 ISSUED: 08/25/2004 APPLIED: 08/25/2004 EXPIRES: 02/25/2005 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspection Line SITE ADDRESS: 1116 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264410700 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: PROJECT DESCRIPTION: Add 6 circuits Owner: CAL VARY OPEN BIBLE Address: 1116 CENTNENNIAL BLVD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor BURGHARDT & ZHUN INC License 160508 I BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type Water Type: Secondary Construction Type: Range Type: # of Bedrooms: ' . . , ('{.' I' I.Energy Path: ATTE:.1\l : I(Jl J.,-,ii:.'_i'J:, l::.,d . t;~!U\I0~ y v.. ,- . . . fnllnw ruleS adopted by the Oregon util.~pnnkled BUlldmg: n/a NotHication Center. Those rUles rDE~EL()PMENT INFORMATION . in OAR 952-001-0010 through O/Jlr-, ,,- . ,,' . 0090, You may obtain copies of tile rules u, . F~ontyar%~I~t~gCI~ie center. (Note: .t~e telepho~t)verlay Dlst: . S~de 1 s~m:W~er for the Oregon Utility Not!flcatl~,~treet ~rees Rqd. Side 2 Settiack: r.:AntAr is 1 .8nO-~3~-2344). Paved Dnve Rqd: Rearyard Setback:~" . % of Lot Coverage: Solar Setbacks: NOTICE: I PUBLIC IMPROVEMENTS I Street Improvem,mS PERMIT SHALL EXPIRE IF THE WORK Stor~ Sewer A~ai.!MmORIZED UNDER THIS PERMIT IS NOT speclaIInstru~tto'COMMENCED OR IS ABANDONED FOR Notes: ANY 180 DAY PERIOD, Addition Commercial Phone Number: 541-747-7125 Expiration Date 07/01/2006 Phone 541-434-6491 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: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Pal!e 1 of 2 Value Date Calculated . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01060 ISSUED: 08/25/2004 APPLIED: 08/25/2004 EXPIRES: 02/25/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L Fees Paid j Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $5.80 $4.06 $43.00 $15,00 8/25/04 8/25/04 8/25/04 8/25/04 1200400000000001264 1200400000000001264 1200400000000001264 1200400000000001264 Total Amount Paid $67.86 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 Reauired Insoections . 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 of2 225 Fifth Street , '. Springfield, Oregon 97477 541-720-3759 'Phone Job/Journal Number COM2004-0 1060 COM2004-0 1 060 COM2004-0 1 060 COM2004-0 1060 Payments: Type of Payment CreditCard 8/25/2004 . RECEIPT #: ,....~ty of Springfield Official Receipt velopment Services Department Public Works Department 1200400000000001264 Date: 08/25/2004 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Paid By GOOD CONNECTIONS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 45656 In Person Payment Total: Page 1 of 1 2:19:17PM Amount Due 4.06 5.80 43.00 15.00 $67.86 Amount Paid $67.86 $67,86 __~~~G~,I!*it, cniil", .",.,',"". i,., ~.i Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01060 ISSUED: 02/24/2005 APPLIED: 08/25/2004 EXPIRES: 08/24/2005 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: Addition Commercial PROJECT DESCRIPTION: Add 6 circuits. Add 10 additional circuits Owner: CALVARY OPEN BIBLE Address: 1116 CENTNENNIAL BLVD SPRINGFIELD OR 97477 Phone Number: 541-747-7125 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor BURGHARDT & ZHUN INC License 160508 Expiration Date 07/01/2006 Phone 541-434-6491 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I BUILDING INFORMATION' ATTENT/nM. fOllow ~fS'tbrQsegOn law re Lot Size: Notificat er fgfJ~fJlj'h qUires you to Sq Ft 1st Floor: in OAR 9 'k~"~""tThose e I Oregon UW;ry Sq Ft 2nd Floor: 0090. Yo aQ.Q.~,o throu ru es are set forth Sq Ft Basement: calJin 'RIDfg'e lF01AAh Co i gh OAR 952-001_ Sq Ft Garage/Carport nUmb g ~~lbt!htN i ,es of the rUles b Sq Ft Other: er ~rihkIf}}-~61~m;.: !he te/epnlJh Y Occupant Load: r.Qnt'3~' nurll,~, AI_r.. e I DEVELOP~EN~~~OQ REQUIRED PARKING Front yard 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: Street Improvements: Storm Sewer Available: Special Instruction: N \Bl!JBfJIC IMPROVEMENTS THI~ t II . t F TI-1~J^eI~R*Type: AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED ~~~nspouts/Drains: ANY 180 DAY PERIOD. 'Notes: I Valuation Description I , Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Page 1 of2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Total Amount Paid CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01060 ISSUED: 02/24/2005 APPLIED: 08/25/2004 EXPIRES: 08/24/2005 VALUE: Total Value of Project , Fees Paid-t Amount Paid Date Paid Receipt Number $5.80 8/25/04 1200400000000001264 $4.06 8/25/04 1200400000000001264 $43.00 8/25/04 1200400000000001264 $15,00 8/25/04 1200400000000001264 $3.00 2/24/05 1200500000000000246 $2.10 2/24/05 1200500000000000246 $30.00 2/24/05 1200500000000000246 $102,96 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. I Reouired Insnections , 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 Pal!e 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759'Phone Job/Journal Number COM2004-0 1060 COM2004-0 1 060 COM2004-0 1060 Payments: Type of Payment CreditCard 2/24/2005 RECEIPT #: City of Springfield Official Receipt lelopment Services Department Public Works Department 1200500000000000246 Date: 02/24/2005 Description Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By WAYNE SYLLIAASEN Item Total: Check Number Authorization Received By Batch Number Number How Received DJB T70902 In Person Payment Total: Page 1 of 1 10:56:38AM Amount Due 30.00 2.10 3.00 $35.10 Amount Paid $35.10 $35.10