HomeMy WebLinkAboutPermit Electrical 2004-9-30
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CP~2.006c--o C2..14- Date C)q -)1>0-04,-
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~-c""-""""~_;'~~$~~ ,~"..- ,,-';l~94!<7)~~~~c.-~:.'- ~-'" 'I
l '\ 0 3 ~ 4-- LIe ~ 00 ~ 0 <:) Service Included Q}b. '" ;~., ~ 0'1..
bLLJOBnDElSCRlPvTlpONS IlJYyP4-l1JtA('h;~ 1000 sq. ft. or less ""1.-,.,., ~~ .,,,,.?,,~~OO
Each additional 500 sq. ft. 0 t:' ~ "0'.-,. 70",.
portion thereof ~"'- $ llf.60'''.9
. Permits are non-transferable and expire if work is Each Manufact'd Home or N"'"
, not started within 180 days of issuance or if work is Modular Dwelling Service or ~"ssO,OO
Suspended for 180 days, Feeder "-
2 t~CONTAACTOR -INSTALLATION O~YJJ B. '_;SW~~:'~;;'.F~de;~~:I~~tih~Y6fttAlte.-~iiitit.':S:~lR. ~i~~ati~. ~:~;f 1
~lec:::;::}::~:o~f;~j~::~':\\=r:,,'=:: 200 Am;s or'le::'~ ,",'.m,,~ ""=~~~;:.o~'. ..> """..~
)c h f Ul7 201 Amps to 400 Amps $15.00
Address ) D't..' VJ -,' 401 Amps to 600 Amps $125.00
I, I I \)_ 0 '''If I ,/"W1 "} (l 60 I Amps to 1000 Amps $163.00
~() -'of YV; '1 Phone /'-1{ ~~YI.(/' T Over 1000 AmpsNolts $375.00
~ '\'<';~ ~ Reconnect Only $ 50.00
:::::~ /A&9$;~ C',~:~~~:~~~~:~~:"'!lC~y!"",.1tl
,IV'" '~" .,~)" ,J R1LJ {p 200 Am 1,;}~ ~ $ 50.00
,~"\,o\.~,,\\.'V"),--a',1::S " psorle~tl ~ ~
Constr. GQntr.<NumRCt'" rV\I>. '":<-t.-'t1 . .' 201 Amps ~~~ ~". $ 69.00
'\'0~~~p~k.~ 1 401 Amn~ ~ ~'tn;l:l 'Q~ $100,00
E . . D"" ,.. '/JCJ 't ~O~ -$i <1P '0<0
xplranon ate",,~. ~ . .' O~~~~lb~~~~l&-::~;,~~,~~' . ~."~"f:r... ,"\"~J
19nature Ofsupervlsmjlec~tnClan ~\~~~8~.:~::'1;fu!~.lc~'\,: ~~~;"V'1(; .':~or ,\ -:: .. . .....,:."" .,;?-: ". '".1
o ~~ ,,~v OV. f; n'l ~
I f\ \ 11ft , O~' o~~,Mt~ti&%!'$X~e/t~~ Per Pane~ ( 1;;2.
V,) \IIAUJ _ V "'~'\.0<o~~~utt-C; O,0~$ n,oJ"" I $43.00 :::t-d-
I V-( ~'V~. \~~O~~~~:~6~~~!tor with I $ 3.00 ,3
W., ('~Q 1'~"'<Zl..~'f.r,~f1J!g,:'Z", .""... ., rr, ." '. _""0' .." ~ .,. " ".i1
, n rQ. v'f (ITJ. !:?'.~~~I1~ae\ius (S~~i~~~f~e~!':!Iot incl~d,ed) ;-.E.:i.ch'Ihs't~UaUg!!j
Phone S 4-/7 3 ~.. "31~ ~~p ~-itigation $ 50.00
Sign/Outline Lighting $ 50,00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
OWNER INST ALLA nON
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Inspection Request: 726-3769
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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~' . .~'7''''. ".-,;o~~6'C',h.,.~,'.,~~_. ""o1f .
7% State Surcharge '3- , ~
10% Administrative Fee ~. '00
~ .J .^SJrS:> TOTAL ~~~.~
, Shared Drive(f:)/Building Forms/Electrical Permit Application 1-03.doc
Owners Signature:
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.
. CITY OF SPRtl~hl'l1!,LD
Building/Combination Permit
PERMIT NO: cOM2004-01214
ISSUED: 09/3012004
APPLIED: 09/30/2004
EXPIRES: 03/30/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4197 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1703344300100
Eugene
TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Alteration
Commercial
PROJECT DESCRIPTION: Hook up slurpy machine.
Owner: SHELL OIL PRODUCTS US INC
Address: PO BOX 4369 HOUSTON TX 77210
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor
BURRELL BROS ENTERPRISES INC
License
136446
Expiration Date
08120/2005
Phone
541-747-2724
I BUILDING INFORMATION I
# of Uniis: ~~'#;\~ Stories: Lnt Size:
Primary Occupancy Group: B '\>(..~ S I;IeIght of Structure Sq Ft 1st Floor:
Secondary Occupancy Group: ~~ ~ ~'\ '\ ~)Cpe of Heat: Sq Ft 2nd Floor:
Primary Construction Type {:!.VK'Y.~<:(' '\) <';Water Type: Sq Ft Basement:
Secondary Construction Type: ~'v Y:- '\~S ~\:)~Y'; Range Type: Sq Ft Garage/Carport
# of Bedrooms: . S--(-.~ '1<.-<(- ~'r~ Energy Path: Sq Ft Other:
^~\".J~Q...-.}~ '0~~ ,S ~("\, Sprinkled Building: n/a.,o\} ':~g~~upant Load:
~;~S ~~~~c,~'\) ;'Y.~'<-'~ I DEVELOPMENT INFORMA T19N~~0<- '\)~, ,o~~"
'r'0"'.",-.}Y'; \:)~. ~\- O,J~~0<:i'1l~'l: ~,<A REQUIRED PARKING
-\:)~. 'O~ ,'Ii- >s:--0 0~ ~ ,s-.0
Frontyard Setback: ~-4.. \ Overlay Dist: . ~o~ 'Q--\ ~ \~ O~ 0 \ 0~0 ~otal:
Side 1 Setback.: ~ # Street Tree~&-q'dt~O '<00~0 o\}<!f' 0' ~ 0'0\>'<" v-z:c-9iandicapped:
Side 2 Setback: Paved Dr~tJ!~!llI:\> \,~ ",\ il'" >s:--0 ~_,o>$-' Compact:
Rearyard Setback: % ~l;ofCoVe~l!lle~',,()'() ~ vo 1-.e'~ <*'--\ "" b.rM'
:\ ,v \V'- V ,.'-' -i>' ~o, ,;;'" n~
Solar Setbacks: ~ ~. o~ ,,() ~'" ~ ^ V n'~
_,,0 r~ n~V .,O.",;f... .0'\' n.t?lv
.- .'-n' on.". ....,.. "... ~'CI-'" ~.
I PUBLIC wPB,QYEMEl'(I'S"0 0 ,5b~
\~ ~()'1l(). -&.\~'0 '\ ,0\ '~0':\'" Sidewalk Type:
'-' v'l> ~0 v0~
~\}<0' DownspoutslDrllins:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee10f2
r
,.
.
.
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 Clrc
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$4.60
$3.22
$43.00
$3.00
9/30/04
9/30/04
9/30/04
9/30/04
Total Amount Paid
$53.82
I Plan Reviews I
. CITY OF ~rKll~uNELD
Building/Combination Permit
PERMIT NO: cOM2004-01214
ISSUED: 09/30/2004
APPLIED: 09/30/2004
EXPIRES: 03/30/2005
VALUE:
Receipt Number
2200400000000001221
2200400000000001221
2200400000000001221
2200400000000001221
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.
L.~~r\1:red Insne~tions I
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.
42~,~~~s~.~ tl
Paee 2 of2
Date
,
. 225 Fifth Street
: Springfield, Oregon 97477
,.541-726-3759 Phone
Job/Journal Number
COM2004-012l4
COM2004-0 1214
COM2004-0l2l4
COM2004-0l214
Payments:
Type of Payment
CreditCard
9/30/2004
.
RECEIPT #:
~~.Q."I-~.-~i.
Wit!
.~ I
..' !
-,-_.+ .
aY of Springfield Official Receipt
Wvelopment Services Department
Public Works Department
2200400000000001221
Date: 09/30/2004
Descrlptioa
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
JOSHUA J BURRELL
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
jmp 073951 In Person
Payment Total:
Page I of I
11 :50:34AM
Amount Due
43.00
3.00
3.22
4.60
$53.82
Amonnt Paid
$53,82
$53.82