HomeMy WebLinkAboutPermit Electrical 2004-12-14
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225 FI;';:ji{;sm,";"ET(r':~~SP.'R,';IN"""GmEtD. OR 97477 . PH:(541)726.3753 .. FAX(Y<41)72G<a~'}.o ',:,1', ;, ~':":";"<~M;;~' ,.."
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ELECTRlCA.'I!/PERMFrAPPUCATION "i~; G ~ oG~,,"G~ ,,;,.i,;> ..1 .'
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City Job Numberc.o.."Zo 04 _ O/5'J / Date ( 2-/ I..{-O '-f "'G "" ,~ ~v.
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1.:,L0C4 -n01'l;OF.,INSTAI::1ATION,ut't~14,~'j
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1000 sq. ft. or less
Each additional 500 sq. fl. or
portion thereof
35,lO ~AT€WA.V &..V~
LEGALDESCRlPTION /703/.0-33
f,IU'JF /4C. ' O/l(OQ
JOB DESCRIPTION
/l-;()flI'.,[ ~ v..,/CAM EMi.f)I/)(L Co.vrll.oL
;'F;~i1I":'';' ,'~:'.~'~""'-"~;'IF;""'-':",";.'~~' .t' ,- ,
A. H~",~,Riisid~!!1i~I'~~ing,le;;r ~Iu"
Service Included
$19.00
Permits are non-transferable and expire if work Is Each Manufact'd Home or
not started wllhln'I80'days of issuance or If work Is Modular Dwelling Scrvice or
Suspended fod80 days. Feeder
~!l:OiBfltiPt1{RfN~Tl6fioNi~~ B. ,t.(1,~~,',;,~,".~',',-i,<~,~,',":~,',:t4:,J;,:+I,',ee~,:~d,_,~;."~,..'~.:-",:.','.'l',,',n.";,s~,,~~,,'.',',i~,h,'~,~~,:;,',>,-^,'l~.e,"~,'a,',;~,i,,',;,.~,;;'~.,~~,
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Electrical Contractor A11T <: F r L' P-. frY 200 Amps or less ",,\leS "oU to $ 63.00
.--^ la'" I'll" U\\I"l
~ 201~ 'ellY!l'^mpshe Olegon . ,,'" $ 75.00
Address t.f(,f.(J MAIJJ sr. ~l(y) ~~ m";'~~~~st 1"\esa(ese\':::~',,.$125.00
~\nl!I ~,e" ~ :t~ose p. ';j","'~'
'0 :()UI\(h'R~ltCI\AAlO mP&\Jgh 0;": ,~C 0\$163.00
City SPIlIAJI. F/~LD Phone 5Lt/. 7~ t - L{7'73NO\i'lf~9~1!!1I:1~9r}l0 g:opies 01 t, '" ':~"" $375.00
\n ~o~B'If\'ll@p1P\a\n,~o\e', \he \e'''':''_~.;"r$ 50.00
009 . gentel. \ \ \IN \-Iu''''--
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(I cen\el IS
Installation, Alteration or Relocation
$50.00
Supervisor License Number
'=?~ 7/ LJ:A_
1010 "
Constr. Contr. Number r:;9 q 'I tf
- ~0~t~
Expiration Date
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps,
Over 600 Amps or 1000 Volts see "B" above.
D. ~'(i~a'ritb?Cir~~ib;)":\~r/:?: . ~':..: ..., ':". II:',"':',,:'.
.;._".' '/I.,,' ,,' ,~".".. r .."; h".. " "",.. ',.. .... ...r:
$ 50.00
$ 69.00
$100.00
Expiration Date
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.......,..
'o' ..'
Signature pfsupervisi~g ~trician
-~ ~.f/ _..:/
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OwnersName ~oc.o /?h~tI.;"
Address ? ~ a <,t< ,<::'7 "':> I
Ci~S ~ t2.9 k ,Phone
CA
OVVNERINSTALLATlON
The installation is being,made on r..r":J I own which
is not intended for sa1e~-lease or rent
New Alteration or Extension Per Panel
One circiJ}OTICE: $ 43.00
Eaeh Addi1\ona)JGircuitjor.widl L EXPIRE IF T\'C" '''ORK
Serviceo}F.~det~~it ..Jilt'lL $13WOV
I\U I HuRILtU UNDER I HI::> I"ttiMITIS NOT
E. )MI~~~{i~~~~~W~'~~~j1Yk~~Af.;t.l~~I'Ji,~y:ri;;~d~stall'lI~n'
,'" ANY'1tiO'DAYPERfOD': ' ' ' '
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergyfResidential $ 25.00
Limited Energy/Commercial >< $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surch.rge.
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4. :.'SUBTOtAL OF ABOVEo;",,<,, ' .
~t;.:.},::f;":-~-~;;":.. ..... .... .,;'~.::-~ ,.:~: ',,-. ,,',
OwnerS Signature:
Inspection Request:
n~'~~~~
, ~ -:\.\r
~ UOSP1ARij gJR~
7% Slate Surcharge
10% Administrative Fee
.I5.;t...< .)
TOTAL
Shared Drive{T:)lBuilding FonnsIElcctric::l1 Permit Applic:Jlion I-OJ.doc
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.
. Lll i' OF SPRINGFIELD
Building/Combination Permit
225 Fifth Street, Springfield, OR
541-726.3753 Phone
541-726.3676 Fax
541.726.3769 Inspection Line
PERMIT NO: COM2004-01531
ISSUED: 12/14/2004
APPLIED: 12/14/2004
EXPIRES: 06/14/2005
VALUE:
Status
Issued
SITE ADDRESS: 3520 GA TEW A Y ST
ASSESSOR'S PARCEL NO.: 1703153301400
Springfield TYPE OF WORK: Electrical Work Only
_, It: 'tlCl~~
I PUBLIC IMPROVEMENTS I ',::is'\'?--';;. \~'?--~\\ \S \W '
..~. '1,1 \. ,'C?t: ,n rCl'?--
..\"~\\..I\.' "\1 s"rSidewaIIi'Typ'c;c-v
\'\.1 \ ';;.,?--\'" ~\)'c." 'I'.\>.~\)".
I\\\S 'i' ~\1'C.'i) \\ Cli'~}y~spoutsfDrains:
\>.\l\\\C\ x..~\,';;.'i) ';;.,?--\C\'i) ,
\,Cl\J\W\ C\ 'i)\>.'l 'i'
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TYPE OF USE:
PROJECT DESCRIPTION: low voltage
Owner: CONOCOPHILLlPS CO INC-RETAIL
Address: PO BOX 1539 PASO ROBLES CA 93447
I CONTRACTOR INFORMATION I
u\O
Contractor Type Contractor \Ie'" '10\yS\I\'l License
Electrical ADT SECURITY SE~~~)~!:p\\ . ~\ \O\\~ 59944
, ~ 0Ie~O~"BLfii'jj1NG^~FORiVIA'fION I
<fJ~\O ~609\<' ~'lIobJ \ :r,u; X\e 1\)'- e
# of Units: p.~ ~ 1\)\0'" \\\01. 0 \'lI'lPll?S!ori~s:\e'?'(\O\\ 0\\
Primary Occupancy Grou~\\O p>'i.\ofl ~O\..oO\ 'fI dIfigIJ:l).of,Sfructur~
Secondary Occupancy Gr~\~\C ~ 9,:>'1..0 11 0'c\P>1 ~'i1'~~ll~e'iiP:~, '
, Primary Construction Typ\(\ 01'1 '(o\l ((\'(1: C0(\\0I. ,~~f",1IYP?Jo
Secondary Construction Typs\)90.~\(\~ \'lIe \'lI0 Ole~'!ilg~lype:
# of Bedrooms: c~ :001 \01 :\,0\ \S \Energy Path:
t-\)<S' ' c,ef:\ Sprinkled Building: nla
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer A vanable:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project
Pa2e 1 of2
New
Commercial
Expiration Date
05/07/2005
Phone
541-736-4973
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Value
Date Calculated
.
. Lu i' OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01531
ISSUED: 12/14/2004
APPLIED: 12/14/2004
EXPIRES: 06/14/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541.726-3753 Phone
541-726-3676 Fax
541-726.3769 Inspection Line
I ';fv\lf P,;!ill I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage. Commercial Indus
Amount Paid
Date Paid
Receipt Numher
$4.50
$3.15
$45.00
12114/04
12114/04
12/14/04
1200400000000001743
1200400000000001743
1200400000000001743
Total Amount Paid
$52.65
I Plan Reviews I
To Request an inspection calI the 24 hour recording at 726-3769. AIl 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 ' R.'W'J"relllnsnections I
.1.I,rllll
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 he 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 therront ofthe property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.-'
.
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~_~ 1
IiiiJ.y of Springfield Official Receipt
Wvelopment Services Department
Public Works Department
RECEIPT #:
1200400000000001743
Date: 12/14/2004
1 :51 :49PM
Job/Journal Number
COM2004.0153 I
COM2004.0 1531
COM2004.0153 I
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage. Commercial Indus
Payments:
Type of Payment
Check
Paid By
TYCO
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
3.15
4.50
45.00
$52.65
Amount Paid
djb
31554
In Person
Payment Total:
$52.65
$52.65
12/14/2004
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