HomeMy WebLinkAboutPermit Electrical 2005-8-1
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54~X7r~68
ELECTRICALPEKMIT APPLICATION 0 /Y'i~tf "
'::ityJobNumberCo-I1Z00.f"-O/C3Z Date ()-I-c.oa--5 Date~,!<Ii .
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-~-[8~, ,r;,470~.~~.q'~-i;.'~
1"'LOCA.'I'10MOE1NSTA.IJE:A.TION~',' ",,"'i;.. 3.' COllffiEETE"FEE SCHEDUEE'8EEOJ1/J:~~~;"".,\'i;~~i~1l'*"
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LEGAL DESCRIPTION A. ~iN~~~R'~1r~i~,C;~~gj*Nf~i~t~ffi~liiifl~ITfl2~~
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no 3"5 LPI t.{ 0 "3 (eYO Service Included
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
Over 1000 AmpsNolts $375,00
Reconnect Only Q\1." $ 50,00
~~es'f '~~
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\o\\o'll1a\l.~R~itJ;\"IO~~s 0\ \":e?"one $ 50,00
~o\i\\C~49j~s~@O'~Ja', \"e~o\i,\...a\iOl\ $ 69,00 '
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New Alteration or Extension Per Pa~el
One Circuit
Each Additional Circuit or with
O "() \ Service or Feeder Permit
Owners Name U ~
\ Q ':> U \ f\ ~~~'~.",~~1P'..::,'?f> '#~~:i?!~~~~~~':r~'~~*~
Address \ <- Cl ~ \ ~ .... d Q r.<" '"' 1\ ~ ~ E. ill.~~J!!i~2R-il(~~lY~'i.~'it!lott~<l\}~)p~~~WJ$
City~O<;t>.,..~ ~1~ Phon.(s41)6'86-770tJ pumporirrigatio!tt\~~~~Ci\ $50,00
...s",\' \\'- o.~\\\
\l ..~' Sign(O!'tline I::igllting'r\ tCl'i\ $ 50,00
no;'\'v~' ,of c.I:'T'~ - ,\\\o.l ,,"':c.v
OWNER INSTALLATION \tv \ \ cn~~' q::imite<!\EnergY.lResidential $ 25,00
-"''01',-,, \i\.l\~~e" t>,'O""- ,
The installation is being made on property I own whicli 1G'i\\1.t: \un0!f.d,Energy/Commerclal $ 45,00
, , ded' I 1 ,,\J\I:' ,.,('X;) -9.\()IJ,
IS not mten lor sa e, ease or rent. f' t\Minimum;Electric Permit Inspection Fee is $45.00 + SurcharO"es
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JOB DESCRIPTION
~~ ~ \~C ~ -rr.-t{; c S: ~",J SPn/ ~(.~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days. ,
2 rff~R:?€XOR!1NSTAEE4if.fON.:ONLX,.,.#
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Electrical Contractor eke,(:) C-:TJ E\o~L..;c
Address \6 ~6<z."d STr-DP\' 0f_
CityS;I \<2_ '113<:)(.Phone(s03)J"I'1-nlJ'1
:upervisor License Number \ 3 CZS ~ -.$
Expiration Date \ a - \ - 0 7
Constr, Contr, Number ~ I G 6 B
"7 - cO - 07
Expiration Date
Signature of Supervising Electrician
'i\~ w\4~
Owners SIgnature:
Inspection Request: 726-3769
1000 sq, ft, or less
Each additicinal500 sq, ft, or
portion thereof
Each Manufac!' d Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19,00
$50,00
. ,
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B "Ql;;.pr-~'~" ;1'U:.,-n,--:wd' .~~~~:~'JM.:."t' II'" t.<t~i'~.?..I.'lt'-"'_"'at..iif;f^'~~5R"'hl"!Kffiti"'-l\l>'I>'-;~
." .:;,..,.~n"Ic;.es~or~!l,ee et::Sr;:!.nS 2 2 1~"U ..eJ; lOnswr" e OC3 on.~,.~~
~~'l?--:-,r;::;;~M'_.",.j;:;;n~'fp.'~";"L~~.t'):, - -"-1E..,.~..:.;~~~y;:.z...-~-""""~b>'';'',t'r''';'.1:I~'fliS
f.:,:j~
$ 43,00
\
OJ'
3'-
$ 3,00
7% State Surcharge
10% Administrative Fee
4~
~~
77~J~
TOTAL
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Shared Drive(T:)/Building FonnslElectrical Pennit Application 1-03.doc
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.
. CITY OF SPRINGFIELD '
Building/Combination Permit
PERMIT NO: COM2005-01032
ISSUED: 08/0112005
APPLIED: 08/0112005
EXPIRES: 02/0112006
VALUE:
Status: Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4215 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1703344403100
Eugene
TYPE OF
Electrical Work Only
TYPE OF USE: Repair
Commercial
PROJECT DESCRIPTION: Replace traffic signal service
Owner: ODOT
Address: 355 CAPITOL ST NE
SALEM OR 97301
Phone Number: 503-726-2552
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
MORROW MEADOWS CORP
License
91668
Expiration Date
07/20/2007
Phone
503-399-7609
I BUILDING INFORMATION.
# of Units:
Primary Occupancy Group:
Secondary Occupancy ,
Primary Construction Type
Secondary Construction
# of Bedrooms:
Frontyard Setback:,
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories: Lot Size:
Height of Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
mNi!'Clf~!l~ law requires you to Sq Ft Basement:
tnow r . ~~ by the Oregon Utility Sq Ft Garage/Carport
No 'f! f ~OOllr!1tlj1nose rules are set forth Sq Ft Otber:
In O~~c: ~~00f~a1 0 through OAR ~~~~~ ~ Occupant Load:
OI-DE~M~lflNFciRMA~IDN~~e ...
U{,{"lJ,,l. !. i ' 'I' t'on
, number for the Oregon Utility NOti lea I
~~Mlwl:PI~00-332,2344).
If Street Trees
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
IPUBLIC IMPROVEMENTS I
Street
Storm Sewer Available:
Special Instruction:
Description
Tvpe of Construction
Sidewalk Type:
DownspoutslDrabtsO t\ ~
. . ,WI- \ ~C)l
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\\Cl~\C~\V\\\ ~'\~\\\\\\S~~~~t.\)~??-> \
_, "c. Pt.\\ .d"' \\~ ,~, r,,\\;>: . ..;.'
'" ~....- \)i"-
I' ~\\\\,W' ,,(,C\) n\\}\)'
Valuation Descri)ltiiin\ -" I't.". _ '
v,,:,'1 \'O\l tl1', " ..
$ Per Sq Ft ~Square Footage
or multipUer or Bid Amount
Value
Date Calculated
Notes:
1 of 2
""lIIIIIl
.
. CITY OF SPRINGFIELD .
Building/Combination Permit
PERMIT NO: COM2005-01032
ISSUED: 08/0112005
APPLIED: 08/01/2005
EXPIRES: 02/01/2006
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
Fees Paid'
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6,60
$4,62
$3,00
$63,00
8/1105
8/1105
8/1105
8/1105
Receipt Nwnber
1200500000000001125
1200500000000001125
1200500000000001125
1200500000000001125
Total Amount
$77.22
I Plan Reviews I
To Request an inspection caD 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. wiD be made the following
work day.
IRp(l~
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
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 wiD be made ofany structure without permission of the Community ServlcesDivision,
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 wiD remain on the site
at all times during constructiolL
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
Springfi~ld, Oregon 97477
541-726-3759 Phone
.
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Job/Journal Number
C,oM2005-0 I 032
COM2005-0 I 032
COM2005,O 1032
COM2005-0 1032
Payments:
TWe of Payment
Check
Change
Job/Journal Number
COM2005-01032
COM2005-0 I 032
COM2005-01032
COM2005-01032
,,'
~ayments:
TWe of Payment
Check
Change
,
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8'112005
RECEIPT #:
;lIIll
,J,i,i.ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
1200500000000001125
Date: 08/01/2005
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
MORROW MEADOWS CORP
MORROW MEADOWS CORP
Received By
djb
djb
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
MORROW MEADOWS CORP
MORROW MEADOWS CORP
Received By
djb
djb
1 of I
Item Total:
Lbeck Number Authorization
Batch N umber Number How Received
18812 In Person
In Person
Payment Total:
Item Total:
(;beck Number Authorization
Batch Number Number How Received
18812 In Person
In Person
Payment Total:
2:50:52PM
AmlXlnt Due
63.00
3.00
4.62
6,60
$77.22
Amount Paid
$77.68
($0.46)
$77.22
AmlXlnt Due
63.00
3.00
4.62 '
6.60
$77.22
Amount Paid
$77,68
($0.46)
$77.22