HomeMy WebLinkAboutPermit Electrical 2007-3-29
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CITY OF SPRI 'iFIELD. OREGON'
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INITIALS I'J yv'
. AL DATE '6'l) U - DL...-O-'
~ SOURCE me:....
22S Flml STREET . SPRINGFIELD, OR 97477 . P1j,(S41)726-37:53 . FAX, (S41)7:z6.3689
ELECTRICAL PERMIT APPLICATION
City Job Number C-om 20-0 7 - 00 'i 72..
CONTRACTOR'INSTALLATION ONLY' -B.-serrices'or Fee()er. -InStallation, Alterations or Relocation: --~
2.
Omlid & Swinney Fire
Electrical Contractor Prnt-prt-i on ;linn C:-ecuri tjiX> Amps or less
201 Amps to 4oo Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
City Springfield Phone(541) 741-1775 OverlOOOAmpsIVolts
Reconnect Only
2oo Amps or less $ 50,00
201 Amps to 400 Amps $ 69,{){)
401 Amps to 600 Amps $Ioo,oo
ExpirationDate 12-15-07 NOlie'!:'
Over 600 Amps or I 000 Volts sex: "B" aooe ~
SignatureofSuperv" Electrician THISD:ErB'rIlJc610MJilf.XPIRE IF I HI: W K
.... ~Uf"~ / AUTHCWe~li~tmlQ~~r1E~I~n~tp~fJll.~~OT
~. A" _ 3UMMOMfcfJduGR IS ABANDDNI: ~UI1 $ 43,{){)
~ ~ - ANY 1 ~~Md!tffilIJU1:cuit or with
.-r:: __ -<TC"' ServIce or Feeder Penmt $ 3,oo
Name ~'/>J VE:6i1'Vtl:::TP-J!';::'_ __"
-Address 601 l;;- 14~ ~ ~ ,n .
City 91J.6f,,~ Phone
!l~ 91401
OWNER INSTALLATION
I. LOCATION OF INSTALLATION:
31'il'D'j(~-\hn1" s,.d.. \\ qiLll3
LEGAL DESCRIPTION: I I
C \ i mo...tt'" r r,n +( 7\ ,
JOB DESCRIPTION:
T\'\~<^.\\ ~('tL{i\-u 511~M
\ I
Permits are noD-transferable and expire if work is
not started within 180 days of issuance or if work is
Su'pended for 180 days.
Address ...l..5.. 7 1'; ~
47...tb 1';j-rppj-
SupeIVisor License Number 51 OLEA
Expiration Date 1 0 / 0 1 / 08
Constr, Contr. Number 62730
The installation is being made on ".~"-..f I own which
is not intended for sale, lease or rent.
Owners Signature:
In.pectioo Request: 726-3769
32.fd7
Date
3 .~q. tJl
3.
COMPLETE FEE SCHEDULE BELOW .M
A. New Residential- Single or Multi-Family per dwe::;r-
Service Included
10oo sq, ft, or less
Each additional 5oo sq, ft, or
portion thereof
Each Marrufacl'd Home or
Modular Dwelling Service or
Feeder
$1<)6.00
$19,oo
$50,00
$63.00
$ 75,00
$125,00
$163,00
$375,oo
$ 50,{){)
C. Temporal)' Sen'ices or Feeders
InstaUation, Alteration or Relocation
E. Miseellaneous (Sen'icelfeeder oot included) -Each Installation
Pwnp or inigation $ 50,oo
Sign/Outline Lighting "." ",l.~..v'" $ 50,oo
, I' , .' .I' ~,\,.. .
CiriUtoo EnergylResidentia1bV lre 'Jre(::or$ 25.oo '
rJrhllod ~~:;.gyt'c~~:;'~-;'i.l)"e rule:1 are$W;,oo'" 4 5 . 0 0
.'nt:fi.....t.;\lrJl ....I~'a...... . .,. . ,- ".....'"....~,., nr
Minimum Electric Pennit,In'peetionlFeeli.$4S:00 +'Sureharges
,~,'}Ar-; ::!.J.c:-u\,J ,"\oJv' ,.' -. ,-. . \
4. SUBTOTAL OF ABOVECOples of troe rules
.Ju~u. 1 "'... .,. " . ~.. (" l-/>.' ttl':~ ~e:Bph,:,r'H::l
8o/"Stat 'S 'h.";; \i Ite.. I ,0 v. - . -.. '
~.." ~. urC,uu6e .w t' '1",/ f".{'''1f',:-'~t....".,
lOOA,Administrative:Fee' ...~.:'~~,. .lUII.r I ~)~ ..........---
1 .,,. ,', .. . ,'" ~ "J"'.j, . :/')
5%Technol_~~.F~ ',:, ',. t.'l':" .......:.,..,..
45.00
3.15
4.50
2.70
TOTAL $ 55.35
Shared Drivc(T;VBuilding FormslElcctrical Permit Application 8-06.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007,00473
COM2007-00473
COM2007-00473
COM2007-00473
Payments:
Type of Payment
Check
cRcceintl
RECEIPT #:
.
'Ibii
~
~ of Springfield Official Receipt
.elopment Services Department
Public Works Department
3200700000000000193
Date: 04/02/2007
Description
Low V ollage - Commercial Indus
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
OMLlD & SWINNEY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 32817 By Mail
Payment Total:
Page I of I
1:52:59PM
Amount Due
45,00
2.25
3,60
4.50
$55.35
Amount Paid
$55.35
$55.35
4/2/2007
-iFjii
. '--- ... .
.
. CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2007-00473
ISSUED: 04/0212007
APPLIED: 04/02/2007
EXPIRES: 10/02/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54 I -726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3780 Kathryn Ave
ASSESSOR'S PARCEL NO.: 1702304306700
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Install Security System
Owner: MTN INVESTMENTS LLc
Address: 59 E 14TH AVE
EUGENE OR 97401
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
OM LID & SWINNEY FIRE SPRINKLER
License
62730
Expiration Date
12/15/2007
Phone
541-741-1775
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
, Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
. Solar Setbacks:
NOTICE:
THIS PERMIT SHALL EXPIRQv,erl,y ~i,st: ,
AUTHORIZED UNDER [~~~ll!.wS1Rqd:
GOMM THIS PaveillDflil'I~M:
ENGEO OR IS ABAN!i~r~f~~t&fverage:
ANY 180 DAY PERIOD. L
,I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Sidewalk Type:
Storm Sewer Available: Downspoutsffirains:
Special Instruction: ATTEN Ilv". ,.,', ,." , ,
- .....,'-'J.
Notes: [o!l?w ~ulE;s o.dople:i b~' ii'e ()regon' :,
~o,!!~<;.a~~~ ?~m~:,Those iU/es are Sf;.l,u,
... -... ...........- ""'..... ....... ......"..... .... ....-....-.
0090. :fou ma~( (ItV~luati(in~:D~sc~iiti.Jn~1
call,mg ~!i:l cer"",. \"'Ul~: me :e:epl1one
Des^r,'pt,'on T f c'lumtoe;t' ~or1llo:l :S Per.LSq Ft'i!ilv ':o.Square,Footage
... vpeo ODS rue Ion ..;, -. -4> . j~ 1.11,:,"';1'1' Value
. l,;ent6r tEri"!l!~tipl!~r; -:'!...-i.t}4)?f BidJ\mount
Date Calculated
Paee I of2
.
. CITY OF ~rK11'lu1'lJ'.,LlJ
Building/Combination Permit
PERMIT NO: COM2007-00473
ISSUED: 04/02/2007
APPLIED: 04/02/2007
EXPIRES: 10/02/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54 I -726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees ~
Fee Description
Amount Paid.
Date Paid
Receipt Number
Total Amount Paid
$0.00
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.
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 ofthe 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
/
Paee 2 of2