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Home My WebLink AboutPermit Electrical 2007-3-29 ! ~.,~ 'CITYOFSPRIN;' , ' OREGON'-::-~--~ . ~, " . .. ~ . ...... '.. , . ,.. '" .' !.. . ~ . t "'l' ...' ". .,1 .' '. . . . ~.' ,., ~RINOF1ELD_' . ZON L;D'2,. ; INITIALS N}-r- - ~ DATE '3-2C, -01 ......" SOURCE \'v< <. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I>.726-3753 . FAX: (541)726-3689 ELECTRICAL lffiRMIT APPliCATION 3 ):;)<1/6r City Job Number C 1/ ()(JLJ5)( Date ~.:-:'''_'~, '_~"_' -1....-~..f~:- .' ,,- ---.c', .;....~ "'-""N.:.''''''~'''~'~ ~ r~--.;-'.".\';"o'r",.'-'.-P~""":-- ",'" .,.... .~...' ..':";....,.,.'"... ~ ,,- ',- ~'.-.r~ .,..,;......,~.:. .~.- 1. : LOCATION OF INSTALLATION:" fe' , 3.COMPLErE FEESCHEDULE BELOW., ,,;:;, "-: '__ '-_d..~.._-~.._.~c"''':''Rc''''-'cc.- l:...~...." __,c.~_.,-~._~.. _c"-'-~.c.-" LEG~~E~~T~~ ~ ffi (J ' . =# 7 A. r-N~;~'k~~~~iJi~i'2.'si~~e~W~;i~lii':ji;rK'tiy-~~;,'.d~tii;;;nnit., _..............._ _.- ........-__ _~..,.- _ _ .. .::14 '">_...... .......,.. ~j _'~~~ _ _' , \ 4'02,1 S 4m; ..g I 0"0 Service Included JOB DESCRIPTION: 1000 sq, ft. or less $106.00 0_ . () '^ Each additional 500 sq. ft. or "€..o~ 't'CYlls TO ~()()...b-Q portion thereof $ 19.00 Signature of Supervising Electrician ~~DU oJ. _ TEIl&IA!aaatdnaEeiMJit &J(iJitilE I~ I HI: WURK c.. 5 r ^~M'Vjceror-lieedenRcnniITHIS PEnl"T In ,,$,-3.00 Owners Name J.g G ,02 Ii~ t uQ OL-,UL "UHivn,Ct:u ,mt:h:n. d,;" , 'v ,1U I Address 'bSO tl' S/l'20rJ(,-- (f:rb . fOWfJ;,tlM~rJP{1~~~/?l1~~~fnifdU~e;;);E~Th'ii~f~;laii;~~~ - ArtY1'80'i}AV"'PEji{HJD--'~- ~"---~ ._-,<.,-~.._-~- Ci~ 1 Os.. Phone. Pump or irrigation . $ 50,00 ~ Sign/Outline Lighting $ 50.00 OWNER INST ALLA nON Limited EnergylResidential $ 25.00 The installation is being made on property I own wbich Limited Energy/Commercial $ 45,00 is not intended for sale, lease or rent. . Minimum Electric Permit Inspecti.on Fee is $45.00 + Surcharges 4. psU;jrOTALOfABqVE:i;~~-;B."~7>:').;.~~~'~~:-:~'~' 00 Owners Signature: .. '-_'-'" -.... .. ~"._"."--'~,. .....__........... S b - 8% State Surcharge 0). . 50 10% Administrative Fee -4 - s ~. 5% Technology Fee ~ - 00 t1 u J ' SO Permits are n.on-transferable and expire if w.ork is n.ot started within 180 days .of issuance.or if work is Suspended f.or 180 days. ~::.- roo', .....~.'r,~-..;,:.. :.-"". ,,"\ .;or;;- :-,,--~, -'":- ..-- -,r::---..- . CONTRAcrOR.'lNSiAi.utrON. ONLY ~ 2. t. '-"'.~. ,~.._ ;~A'."':"- . -"::..~l:;;~.\~,.. .::.,.:ir:'>'-f;.:~~;-).;.:.:.c.'Z.':'::"l ElectricalConcractor my cJectl",dl'\JlJ l.....-c. Address '3 C1- '3 I b f..l\ ev {~ . City ~ Phone 7ri-"I-11/Si( Supervisor License Number ,~1I Cf '3 5 Expiration Date ! C9 II / D7 Constr. Contr, Number .1;' 7 ,.,,0 b Expiration Date 11 } 1~) 07 Inspecti.on Request: 726-3769 ~\ Each Manufact'd Home or. Modular Dwelling Service or Feeder $50,00 ....-,--,,~. :,' .-- .~ 7""," -._,.~~.-:.., .... ': ....."-.~.~.. ....--.. _.~, ..... B. >Se;~i~e~or.Feed~;s::' install~li'on,Aiterati.ons .or.Rel~cati.on:" Ll:.....:J.,,;;i,t :-4..:..:..~-:--";;": ;,.~~,_~:,r~:.~UJ.;.d":";"'::';",.,.;.~';;,..;. -. ~.-::.:.~~,,...:':.~,,,, -' .-' ,,::....~ 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75,00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163,00 Ove[11000,:-\mpsNollS . ;, . ~ - _' $375,00 Rep9iinectt<DDly3 &Uop,e:rby ,r~ 'I e>l:,vf"$ 50.00 ~-=; b . )l.olili.caji9!' centG.r. Tho~e fU'ti::> "ue s~' '~'_ . r,c 0,].,._ _'" ~';;.,^,,,,,,,...7UI'i'",<I\>tI1'" "Aft ~2:;;{)'" ',".: C. ..,T~mp.orar.v.Se\'.VIces .or~Feeilers1 ~ I,: . ." ::;".',; . Oci90:Yo~'ma\lijbI8ih"'c-opie$'dftne-rtrtes' _Co .', . , _.._.. "',1 ,t~..+h.:.\ te'''pllone InstaJ~~9,!! Alter>lI1.on:or Rel.ocal1'!n- " '''": ',. . . ." 0 . ~r IJlllll" -''''If.. ",1'\1' 200"Arilp's'oftesP I("l>., [<.(i'-' , _' ':' $-50:00 201 Amps to<4(j()1Am;'~ : .;- ,',',:, <.,.." $ 69.00 40 I Amps to 600 Amps $Ioo.bo Over 600 Amps or 1000 VollS see "B" above, r-;--' ";- _ _ ,.~. . '- ...-, ""._,;",-" ',:"', '. !-": D. " !l~~~5~ C:i~~~!!.ti-~~.," _ ~:~:;~~:..~_~ _' ()~ .....:.....-.....-.-, New Alteration or Extension Per Panel t~9JKt~it $ 43,00 TOTAL Shared Drive(T:)/Building Fonns/Electrical Permit Application S.o6.doc 225 Fift!! Street Svringfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00458 COM2007-00458 COM2007-00458 COM2007-00458 Payments: Type of Payment CreditCard ~ \;'Receiot I RECEIPT #: . ~:;~ Wit < Description Service Reconnect + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By EDWARD M GUIDRY Caof Springfield Official Receipt _Iopment Services Department Public Works Department 2200700000000000424 Date: 03/29/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received njm 01725 In Person Payment Total: Page I of I 1I:51:56AM Amount Due 50,00 2.50 4,00 5.00 $61.50 Amount Paid $61.50 $61.50 3/29/2007 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00458 ISSUED: 03/29/2007 APPLIED: 03/29/2007 EXPIRES: 09/29/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3530 GAME FARM RD SPACE 7 Springfield ASSESSOR'S PARCEL NO.: 1703154003100 TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: reconnect Owner: Address: SGB SPRINGFIELD, LLC 15500 STRONG ROAD SPRINGFIELD OR I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor MY ELECTRICIAN INC License 87506 Expiration Date 11/20/2007 Phone 541-729-1454 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupaucy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure: Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: WaterType:~TTEI\III',JI,.J'''lJv" "Sii Ffil.'s.-riJent: Range Typt>':JIIOW I'UIE::S aJopteJ bYsq'Fi Gfra~ftcarport Energy Pat.h"tification Center. ThO::s1{iit'(jth"'e'r:' S~i , J' Sprinkledi~u.!!~!!lgll52-001-Dla1 0 thrOc~"'p~t,i3o'il&~-n( I, L_!_ ___:............$ ...!,.;,.. r,d~c:' . ... .~.. ....,.. ...., .~.............. - -.- Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INEORMA:r')ONnl~r. (l'lott:: the ~<')'''pl'')ne 1urnb:irior:hc OWi:Jn Utili'" :RJj:QUJJ~EDPARKING . ,.,",- r.'7l'l ')'.....1'\ Overlay Dist: Cemer 'f ,_,-I".. ~ . c ,; "Total: ' # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: Notes: I PUBLIC IMPRO.\fEMENTS I THIS PERMIT SHAL~i<t'i-'YII\'f[f~P~:HE wor" AUTHORIZED UNDED.o"lri~iiqu!~W.t~i...t NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Street Improvements: Storm Sewer Available: Special Instruction: I Valuavion Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Sq uare Footage or Bid Amount Value Date Calculated Paee I of2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00458 ISSUED: 03/29/2007 APPLIED: 03/29/2007 EXPIRES: 09/29/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fp.p.s P'lid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Service Reconnect Amount Paid Date Paid $5.00 $2.50 $4.00 $50.00 3/29/07 3/29/07 3/29/07 3/29/07 Receipt Number 2200700000000000424 2200700000000000424 2200700000000000424 2200700000000000424 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. I Rp'olJirp.d 1"~\l'i~rion~J Electric Service: Approval required prior to utility company energizing service. 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 Pa!!e 2 of 2 -