HomeMy WebLinkAboutPermit Electrical 2007-11-15
.,
r
"''!
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION (
City Job Number C6Vf..>\ zco 7 - 617 J
8PR'NGFlIILD
L~
~ '"
.,
ZON ~
INITIALS ~
DATE ~ ,\~~"0'
SOURCE ~
I HS-or
CITY OF SPRINGFIELD, OREGON
Date
1. I LOCATION OF INSTALLATION:
5155 Mcun Smd
LEGAL DESCRIPTI9N: 1:10Z'31tt <{ oc8t'Ch.. I New Residential- Single or Multi-Family per dwelling unit.
A( ~Yl S:. I .sa...Von Phtut'tIJ;...Cj Service Included
JOB DESCRIPTION: ' 1000 sq. ft. or less $117.00
. Each additional 500 sq. ft. or
::W6-~PI ~ oJ s~ns portion thereof
Permits are non-transferable and expire if work is Each Manufact'd 1"lome or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Snspended for 180 days. Feeder
3. I COMPLETE FEE SCHEDULE BELOW
$ 21. 00
$55,00
2. I CONTRACTOR INSTALLATION ONLY I B.I Services or Feeders -Installation, Alterations or Relocation:
Electrical Coutractor E?5>~A. Sl~'(\ ~AlV'lI~ 200 Amps or less $ 70,00
----.l 201 Amps to 400 Amps $ 83,00
Address IdolO Oc.....K p~ Rd 40] Amps to 600 Amps $138,00
601 Amps to 1000 Amps $180,00
Phone L(JSS-552-llo Over 1000 AmpsNolts $413.00
Reconnect Only $ 55,00
City ~JW1 e..
J
Supervisor License Number 305-.s (G-
Info Y
I
Constr. Contr. Number ~<, Lj I n
3-110-23011
c. I Temporary Services or Feeders
Expiration Date
Installation, Alteration or Relocation
200 Amps or less
20] Amps to 400 Amps
401 Amps to 600 Amps
$ 55.00
$ 76.00
$110,00
Expiration Date
\~:t"\I"
- Ii' - -
Owners Name 1M c.(t.e-,v ell:' (" fDS.r '-'1
Address 'Z <{( ( ~ S T
City e-"7A!l..I:!iLA, (.4Phone Pump or irrigation $ 55,00
, SignlOutline Lighting ~ $ 55.00 110.00
OWNER INST ALLA nON Limited EnergylResidential $ 28.00
The instaIlali.\!!j.~ bei\lt',.l"ade on pro~erty I own which Limited Energy/Commercial $ 50.00
is not inten&l:llfij""1l"!'f&Qr8'~, aw requires you.~OMinimum Electric Permit Inspection Fee is $50.00 + Surcharges
follow rules adopted by the Oregon Utility ,n
Owners ~titlJfO!tion Center. Those rules are set forth4. I SUBTOTAL OF ABOVE -', I ,\ \Dv--
In <?!,-R ~52-001-001 0 through OAR 952-001- 8% State Surcharge S 5!D
\/O"j'v" Ivu ".ay UUlalll "VtJ'''~ VllI,e rules by 10% AWG[cf~'we Fee ~\
calling the center. (Note: the telephone 5% T~y 0 . - ')
n~mber for the. Oregon Utility Notification I H M: rMlT SHALL EXPIRE IF TH ''^'~~
Inspection RequeseeyJifl!31jl;~-800-332-2344). TOTAWTHORIZED UNDER THIS PERMIT ~.~
C ~MM ~f\.l€l'tBBe'fli"/ffrmi!{IWUlVIErn:tffl;cat;on 7-07 doc
ANY 180 DAY PERIOD.
Over 600 Amps or 1000 Volts see "B" above,
D. I Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 48,00
L-n.
E. I Miscellaneous (Servicelfeeder not included) -Each Installation I
$ 4.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541- 726-3 769 Inspection Line
SITE ADDRESS: 5755 MAIN ST
ASSESSOR'S PARCEL NO.: 1702334400800
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-0I751
ISSUED: 12/05/2007
APPLIED: 11/30/2007
EXPIRES: 06/05/2008
VALUE: $ 2,500.00
Springfield TYPE OF WORK: Sign
PROJECT DESCRIPTION: Signs - Albertsons and Savon
Owner: MCKENZIE CROSSING PARTNERSHIP L TD
Address: 2811 E ST STE B
EUREKA CA 95501
TYPE OF USE: New
Commercial
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Sign
Contractor
E S & A SIGN CORP
E S & A SIGN CORP
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
License
163470
163470
Expiration Date
03/16/2009
0311612009
Phone
541-485-5546
541-485-5546
BUILDING INFORMATION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I.PUBLIC IMPROVEMENTS I
Pa2e 1 of 3
nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Spriukled Building:
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special1nstructiou:
Notes:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Dowuspouts/Drains:
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01751
ISSUED: 12/05/2007
APPLIED: 11130/2007
EXPIRES: 06/05/2008
VALUE: $ 2,500.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Oescriotion I
Sien
Si2n
Tvpe of Construction
Use Bid Amonnt
Use Bid Amonnt
$ Per Sq Ft
or multiplier
$1.00
$1.00
Square Footage
or Bid Amount
1,500.00
1,000.00
Value
Date Calculated
Description
Total Value of Project
$1,500.00
$1,000.00
$2,500.00
12/05/2007
12/05/2007
Fpp<, ~
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Sign - Outline Lighting Each
Sign 36-60 Square Feet
Sign 61-100 Square Feet
Sign Plan Review
Amount Paid
Date Paid
Receipt Nnmber
$36.00
$18.00
$8.80
$110.00
$110.00
$140.00
$80.00
12/5107
1215107
1215107
1215107
1215107
12/5107
12/5107
2200700000000001775
2200700000000001775
2200700000000001775
2200700000000001775
2200700000000001775
2200700000000001775
2200700000000001775
Total Amount Paid
$502.80
I Plan Reviews I
Si2n Review
12/0512007
1210512007
APP DJB
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.
I Rpflllirp,-l rn~,nections I
Sign Attachment: Method of mounting the sign to a structure or pole. Method of attachment of bolts or welds.
Sign Electrical: After connection is made but prior to energizing.
Sign Final: After all required inspections are conducted and approved and the sign installation is completed.
Pa2e 2 of 3
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: COM2007-01751
ISSUED: 12/05/2007
APPLIED: 11/30/2007
EXPIRES: 06/05/2008
VALUE: $ 2,500.00
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.
Pa2e 3 of 3
1~01
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-017S1
COM2007-017S1
COM2007-017S!
COM2007-017Sl
COM2007-017S1
COM2007-017S1
COM2007-0 17S1
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Description
Sign Plan Review
Sign 36-60 Square Feet
Sign 61-100 Square Feet
Sign - Outline Lighting Each
+ S% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
ES&A
"^P~'!IlmJ!I.c'9"~ffi!ll.!!-m_,i"".,'." ,,'..,,'.
""i " .
~,~,',c,,",
~ ,I','
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200700000000001775
Date: 12/05/2007
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
IIh Sl19 In Person
Payment Total:
Page 1 of 1
I :59:08PM
Amount Due
80,00
110,00
140,00
110.00
18,00
8,80
36,00
$502.80
Amount Paid
$S02,80
$502.80
121S/2007