HomeMy WebLinkAboutPermit Electrical 2005-6-17
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22 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(54I)726-3753 ',Fl'V\.; ~1)n6-36
ELECTRICAL PERMIT APPLICATION :~~:}J'\ 1,0"\"'"
City Job Number ColM tooS'-D<::l 7 ~ -...( Date b-( 7 -6 ~-
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1. ';~LOtAII0N OF INSTAiLAII0NWS"':;CA~H
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LEGAL DESCRIPTION 17o~' 533 01700
m[fDESCRlPTlON' .. . -- .
SV " 'OA.Ii~ -.:.t;.:, C'J) f0-U vY('(hiVI
rv-~~"./ \'- . -:"'-j
.. ~Illlll:!lan~ non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
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'"CONiiiACTORINStAiiATIOi'iONLV,0
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Electrical Contractor
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Address
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City
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Phone 9J[ ~~ - G">'1 ("
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Supervisor License Number ~,.S) j
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Expiration Date
Constr. Contr. Number
Expiration Date
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Owners Name \LO~, \L& P 1=
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City bJ.-~e:( Phone bYb - bbs-g
Address
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Nlk
Inspcction Request: 726-3769
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A. t~~~:}~e"~~id~.~ti.al j~~l~ng1-e~r ~'!ul,~-.~a)p~ly:pe(d~~'elljng ~n~t~!tl
Service Included
1000 sq. ft. or less
_ Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
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B. ~"Servl~~~;.oriF ee9~rs'~:zJ~stallat~of!;~"~lte.ra tjons .or Relo.en tiQn :~';':l
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200 Amps or less
201 Amps to 400 Amps
40 1 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
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C. . Temporarv_:Services.'or;Feeders;,;.:ttt16.-;i~Jj~~t:r!wj!:.:.:~,~~~.~~ ~~,",,".
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Installation, Alteration or Relocation
200 Amps or less $ 50.00
20.1. Amps to 400 Amps $ 69.00
N.lol ~'tn~s~0600 AmpsEXPIRE IF THE Wll~roo.oo
THIS I"tr\l \I~ ~~:n,::: ~'j'C: DI=8'^IT IS NOT
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D.... ': Brancl!IG1.rCU)ts/t~, ~;~y:~.~:W\J.:'I'.~:~J:, ~~;~:~,,~~:!~~~i~~~~si:~r;' ~i
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iNew Alteration or Extension Per Panel
One Circuit
Each Additiona] Circuit or with
Service or Feeder.Pennit law r-"' ,ir"" yilil6100
ATTENTIUN: u,egon -, Utility
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E. ,l\P~cce~I~!l~pu~' (Service/feed~&, l\2tti!l,ltid~i1)~Elrm! Ips ~alla t!~J!, 1
l.oNo1111CaI1011,(;enter, .".,.IU, . .&,. ,..", ""fi '952"001:" .' ..."'-,~."
~'. r-. O""-!)O; -00; 0 through OA _ h
Pump orJImgatlon . copinc ('If the 1iJ5l);Q"y
S. n/0"'f' v""., "'li ClV obtain ..~. \ "--CO"'" II( D, iJV
.g 'UIlDe Ltg llOg (Notp' .t'c> Ie el~".'>V \;;>
--lIinn the r.8nter. T '\"0
Limited-Energv/Residentialagon IltililV Notl ~f1.t1cr
1:\' "nbe'r lor llle u' 4)
Limited Energyc,t:;R\'(lBi<;Sci,,1800-332-234 '$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
$ 43.00
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4. [SUBTOTALOFABOVE;f,;:}NU''''f,,,t',r.A';,
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7% State Surcharge
10% Administrative Fee
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TOTAL
Shared Drive(T:)/Building Fonns/Eleclrical Pennit Applicalion t"(}3.doc
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00754
ISSUED: 06/17/2005
APPLIED: 06/17/2005
EXPIRES: 12/17/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3550 GATEWAY ST
ASSESSOR'S PARCEL NO.: 1703153301700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Sign lighting for existing signs - Quality inn
Commercial
Owner: ROD KEMPF
. Address: 2121 FRANKLIN BLVD
EUGENE OR 97403
Phone Number: 541-686-6658
Contractor Type
Electrical
Contractor
SIGN GROUP LLC
I CONTRACTOR INFORM~TI0N't Oregon law requires you\to
,UIIUVV 'u,,,,, adopted by the Oregon Ut'lty
N t'." ,'-- "enttE n'M", "'I'"" '1'A s~;'?rth
o '..lIcense' 'xp!rallon uale' ,'5:Acme
in Oi4S7S5,-001-001 Oci~jj'oifoo~:'H_ 95$~1~~~5_5546
'.""'" V'IU IIIOY UULo.", .......................... ...,- ''-'~~ ~
BUILDING INFORMATION I the center. (Note: the telephone
, number for the Orf'qon, Utility Notification
# of Stories: Ct' 1LO;~~1Ze:2 2344)
Height of Structure en er IS s~'i1'jj~t Floor: .
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Patb: Sq Ft Otber:
Sprinkled Building: n/a Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
" Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist: NOTr"!:' Total:
# Street Trees Rqd: u, Handicapped:
Paved Drive Rqd: fHIS PERMIT SHALL EXPC6".rtpa'HiE WORK
% of Lot Coverage:,\UTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
A".l" ..,'of" "'." ___,__
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I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descrintion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2elof2
I,
.
. CITY OF ~rK11~uFIELD
Building/Combination Permit
PERMIT NO: COM200S-00754
ISSUED: 06/17/2005
APPLIED: 06/17/2005
EXPIRES: 12/17/2005
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
Fl'l'S VIIWJ
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Sign - Outline Lighting Each
Amount Paid
Date Paid
$15.00
510.50
$150.00
6/17/05
6/17/05
6117/05
Receipt Number
2200500000000000791
2200500000000000791
2200500000000000791
Total Amount Paid
$175.50
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.
Sign Electrical: After connection is made but prior to energizing
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information bereon 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 wllI be used on this project.
1 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 wllI remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Paee 2 of2
225 Fifjh Street
Springfield, Oregon 97477
541-7?/i-3759 Phone
Job/Journal Number
COM2005-00754
COM2005-00754
COM2005-00754
Payments:
Type of Payment
CreditCard
':
"
.6/17/2005
.
RECEIPT #:
~
~
....". '
2200500000000000791
Description
Sign - Outline Lighting Each
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
KRISTEN LOCHEN
Received By
djb
Check Number
Balch Number
Page I of I
..."S5.ity of Springfield Official Receipt
.velopment Services Department
Public Works Department
Date: 06/17/2005
Item Total:
Authorization
Number How Received
017613 In Person
Payment Total:
1 :25:57PM
Amount Due
150.00
10.50
15.00
$175.50
Amount PaId
$175.50
$175.50