HomeMy WebLinkAboutPermit Electrical 2004-12-17
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225 FlFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPliCATION
City Job Number ('OWl 7.004 - 01 J ~-S-
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LEGAL DESCRIPTION I
.170.3 z7.b-D ~OZ.5()C:Y
, l10Yl::l:zooicA
61Z, 9?98V
~ _ .,/ New Alteration or Extension Per Panel
/ ~ ~~ One Circuit ATTENTION: OrBQon law ~~@Syouto
" - Each Additiona~@iI1Swtrt?llootbdopted by tne Oregor'iVu"'J
Owners Na;;~ r9A- ~W ^: flU ~ (~'a-~ S;:,i::or::e~~g~~~~~~~~~;9~;;;;~p~~;ii~.~
;:rd .~u. ~~ D E.~::~::I:::~0~~!::;~!1;~~:1.!i~~:;~~~3
, Sign/Outline Lig~tYng Center is 1-Rn~~)o
OWNER INSTALLATION Limited Energy/Residential $ 25.00
Limited Energy/Commercial / $ 45.00
JOB DESCRIPTION
Sp+tJ
. Permits are non-transferable and expire if work is
, not started within 180 days of issuance or if work is
Suspended for 180 days.
FCONiRAcrORfn\iSTAi:MTIONO~~
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Electrical Contractor <3-/_ [If'(' 7€>ct-.-
Address ..:Sit.f );(;;r'6.M;~ "j:s(Q/J.
City Fc..-Ct7NL. Phone 52/-,)851-
v
Supervisor License Number
3*2LEA-
Expiration Date
//')-/- 200,<;-
Constr. Contr, Number / '7&&/!?
Expiration Date y-;f"- O.~
Signature of Supervising Electrician
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Date
{ "'_-"~"'-'''' ,'"~-t""- "<'" p- -. """",",,-,,-."-0' - .....-=.-.'-- . "''', '."i -.;;~- '-. Y\--:'" ..~T '~;;''''--'''' .':":";"::'
A. k_~w~~~n~_~al--~~$~~!~i&Mti:fmi!fp~',~~i(lJ_ng'.~,~i:D:;
Service Included
1000 sq, ft, or less
Each additional 500 sq. ft, or
portion thereof
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. ~~.S~~;'f~F~e'd~;~':;~Ynit~'ll:tl~~~-t~~t:iih~1~-~riJf~~iiti~~'::/~:'~I
. .~ ~ '.~. ___"'.~', .t,'..?.-" '" '}'c~_''':~'"",'_'Ji;,..l',_,_'~'_''''~~-_-:' .,...., -,':.:\""-~ ""',-.,,~
MnT1r.1='
200 AnIjiS'or qei;s" . $ 63.00
201 A~!;a4'&f..t1lJsSHALL EXPIRE IF HI7s\b'olRK
401 Anl'tIiTJ-l600IAlihlsUNDER THI~ PERMfiiSlO'dOT
601 AnlPQW{&f'd~pR IS ABANDONEESfSRJo
Over lob"dU~~~ PERIOD, $375.00
Reconnect Only $ 50.00
~.~~-.'.:-'''''--:''-''-i.;::.' >.",,,,,,".,, '.- .:.>."..r..;-....r: ,...,.,,",...-..-i('."-~~,:,-("". \".!fJ. '~."" ;'tr..._:-"~"':.~~'~.._;~.; : ~\""'~." -_~:-.~
c. -irempor~ry_S,er,Ylc~-",or:.Fee~~!s:~*'~}:~_~iC~;::..r" ,ft:J.~;'Ltl~~.),!!:,'1
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50,00
$ 69.00
$100.00
Over ~OO Am~r~'<>"y~lts se.:: "B" above,_
['IO.:::rert'~--"._,'<; ".-<""""":'<'~;,,;:,j. jt't'.r;>",")f,,:.,""7'.;g' --,'.".40,' ~;f).;;'-<';-:
D. h:Branch"ClrcUlts.~. ..:1/"i ',;>::t~}ti:''iii.i.:2r.;;}'.;';;l1',; :,"";.:_:.:1,' y:y(~;"i"~~'f:r:~'..\1;-'~;';A<'"
8',-,,", ~,_~_.~:':",j,::' ~;L~~~'''-'''''rj~. ".t;'_-.^,f' '~-;-i:.,'
Vi
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. ~w;f;;fAL'6;lBovit'f'~,~!Fi:;C] l{ r
U~~~'J.B1;""""~k:<.i.-~~.,..::;.i~~.':-"";'.0";;;:'i....-sa: ~'
7% State Surcharge 7>/ r
1,1-"':>
10% Administrative Fee 7
TOTAL 5 Z. br
Shared Drive(T:)JBuilding Fonns/Electrical Permit Application I-OJ,doc
.
. CITY OJ ~rJ:Or\jt.-t<lJ!.L1J '
Building/Combination Permit
PERMIT NO: COM2004-0I555
ISSUED: 12/17/2004
APPLIED: 12/17/2004
EXPIRES: 06/17/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54 I -726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1144 GA TEW A Y LP
ASSESSOR'S PARCEL NO,: 1703220002300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION: Low voltage alarm system - suite 220
Owner: GA TEW A Y MALL PARTNERS
Address: 110 N WACKER DR BSC 3-04 ATTN PROP TAX ADMIN CHICAGO IL
Contractor Type
Electrical
I CONTRACTOR INFORMATION I
Contractor \C~: ~?tbicense1t 1N~~~iration Date
SECURETECH IN&\O~ nc~,,^1i S\-l1\~~ ~LJ\\(5~li.~8M\1 \? ~'l\.i '08/08/2005
1'''BiilImING:-Il~FORMA(fIONiNtU rv"
\oAtNvCU ~.
CO~ ~St- 1".1'\:12-100,
N\J ?tlv Vi es.
1\ Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Phone
541-521-2837
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist: UileS 'ioi1"\~tal:
# Street Trees Rqd: On ial/lleq gon \ltmhdicapped:
Paved ~.wefflnOl>t Oleg d b'/ \ne Ole Ie setd'illll),act:
% of I1lt'ellv~f1!ll~:adoP\e ose !\lieS a 95Z-Oof.
;~~~~~:~~~~~~~t~;~\nl~~~~ ~~~e ~~~~~'i
I PUBLIC IM~Iill:;~bta\nf~o\e: \ne \e\~~icatiOn
UU::Iv! c~n\el. \ l.li!lit~tl>lo \
calling \~el \ne OI~i$ll~a2~~l\).
(lUrnbel c~n\el is ,,~Q)nspoutslDrains:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation DescriDtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee10f2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-0I555
ISSUED: 12/17/2004
APPLIED: 12/1712004
EXPIRES: 06/17/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fp.p.~ P3ill I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
Receipt Number
$4,50
$3.15
$45,00
12117/04
12117/04
12/17/04
1200400000000001757
1200400000000001757
1200400000000001757
Totai 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.
I RP.Ouirp.llln~np.ctinnsJ
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
Pa~e 2 of2
~ I 225 Fifth Street
rl Sprhigfi;ld, Oregon 97477
541.:726-3759 Phone
.
~.
~y of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
1200400000000001757
Date: 12/17/2004
11:27:19AM
Job/Journal Number
COM2004-0 1555
COM2004-01555
COM2004-01555
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Payments:
Type of Payment Paid .By
CreditCard SECURETECH INC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 017431 In Person
Payment Total:
Amount Due
3.15
4,50
45.00
$52.65
Amount Paid
$52.65
$52,65
12/17/2004
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