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Home My WebLink AboutPermit Electrical 2003-5-20 '0 CITY OF S:'-o/JNGFIELD, OREGON U ' 1. I LOCATION OF INSTALLA1'IOIV . 3hZO ~T~vrA'1' 5/Z0/l)3 I 3. I COMPLETE FEE SCHEDULE BELOW ~.03 ~~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number 'Co"", ZOO J - 00 I '7 I Date LEGAL DESCRIPTION )70'3:, /533 00300 A. I New Residential- Single or Multi-Family p<r dwelling unit. 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 JOB DESCRIPTION 7 L..{(2.<..J..\.lrs $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $50.00 2. I CONTRACTOR INSTALLATIONONLY I B. r Services or Feeders :....instailatiou; Alterations or Relocation: Electrical Contractor ~.~ {' [)({X)("CLJ-( 0 'r) 200 Amps or less $ 63.00 ("), 1\ L 201 Amps to 400 Amps $ 75.00 Address nqC\'llt ~)Cl~\ CU"IL 401 Amps to 600 Amps $125.00" G 601 Amps to 1000 Amps $163.00 City -l,..U./'\' t l. t Phone ~9iQ.-OqOs Over 1000 AmpsNolts $375.00 I Reconnect Only $ 50.00 ISlP B S I D,'" - D4 ,;:,,0 Installation, Alteration or Relocation ,10 .~~" . L 0~ ~ \)~ JOO Amps or less $ 50.00 Constr.Contr.Number ,)L\t..\b' ..(\~,~ ....o~ ~0'~ioi'AmPst0400Amps $69.00 cJ ".... ~v:J 0 t'....'l:v '("i'l q 1>~ 0 'If.- Q)'J 40 hAmps to 600 Amps $100.00 E . . D - '2 ""~ 1('00 0~ ~ ~'u 0 XplratlOn ate ~UJ . I' ." . ~ o'?' 0 ~Ov& 600 Amps or 1000 Valls see "B" above 0,0"<) l;\)' S0' ~ ~..:s< i)'~" ...~: .. . . , Signature of Supervising Electrici'!li' R" .<,,~o ~o\j. SO ,<1>" '!lranch c.rcmts . .. . ' ~ ,,0 c:P~. 'S' R,0 1('00 _,0 ~. . ,_ ,,0' <>~,0 R),<:l.^c,o .0:'1.:I.,,\-N.e~ Alteration or Extension Per Panel ~~ .. ," '/?,Q:>'. RS 7f;" _,0' 'i:$;' n.'" , . ,,~\j , .. 'v~"" _","" \.\- "oJ (1;'):.-One Circuit ~ ~.OO ,~v. (,1>"- SL:" 1>" - 10,0'" 0~0'R)~'5 Each Additional Circuit or with",,<- \~ ':k.,f;l 'I <7 O~ ~C?) ,;:,~ (,0 O~ !Qel Service or Feeder Permit ,<-i-~\\> _~\lIP'~~3.00 .,., Owners Name ",()'?',,4,O :,,'S':.,~0;~" "."..... ~~)\.. \\~C;Y.~~~r\) Address '3 sS- G~I.~~~~'Sr E. L!\'~~!,~,l'9.~~e~~'rillcluded) -Each Installation I ,;:,~. ~1'i:.\)\J~\';)~ City 5/tl.RJv'l Pho~ pu~~~\r~"t.\) ~ T.~\'V\). $ 50.00 Sig~~~~~ft,~~ ~ $ 50.00 OWNER INSTALLATION LimiteliP~rg.~esidential $ 25.00 Limited ~nergy/Commercial $ 45.00 Supervisor License Number c. LTeniporar)' Sen~ices' orF~.e~ers' Expiration Date LfJ The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: 4. ~ SuBTOTAL OF ABOvE I bl lfZ7 /.:,10 71 J7 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:YBuilding FormslElectrical Permit Application l-Q3.doc Building/Combination Permit PERMIT NO: COM2003-00191 ISSUED: 03/1912003 APPLIED: 03/1912003 EXPIRES: 11/2012003 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3620 GA TEW A Y ST ASSESSOR'S PARCEL NO,: 1703153300300 . CITY OF ~rKll'luNJ!,LD Springfield TYPE OF WORK: Heating System # of Stories: Height of Structure Type of Heat: Water Type: \*ange Type: ,,0'" . Et(ergy Path: S' \)~" ~, A",,~0 _(\<:- n\ \0_", ,.... ..,,-. - - - -~ ._~ \'l>~ 0UI DEVEcOPMENT INFORMATION I SETBACKS 0'V>0<:- 'O~'S' ~.s.- o'?" 0'- 0<:-'" o~ 00 S0 ~ ~ 'S' o~ ,,0<:- Frontyard Setback: O~' o~~ ~,<:-O ~o"'~ S 0 \9v~R,l!y'Dist: Total: Side I Setback: ~-0~ ,_'l>~ .0~' .'\)'S' O~,0 \,<:-0 #~treet Trees Rqd: Handicapped: X'- ~0'" <:-' Rl' G " ., .' Side 2 Setback:~ '~\) (JZ ,1'5 iP _'0\0' :i.\\~P!,yed Drive Rqd: ColllDlW: 'i" .'O~ \0<:- Rl'\) ~"" ~~ oS flP ~ ~U~'K Rearyard Setba~k:.!i.'v'l>'II ~'l: 'l>~ 0 ~,0~' ~o<:- ~~1.% of Lot Coverage: \If ,\VI ~ ~~ Solar Setbacks:~o\\ ~<(. ~ 0'" ~ 0 v0 O~0 ,<o'\)'\) ""'!;\~'t. t1,~~ '\ '\~ n -l .'<'1 ,~0 " \,...." _ n~" _ ,,, ,,~'\)~v~,~~~\o' ~,0~ ~- I PUBLIC IMPROVEM~lV.TS~ C;,y.?-~'t.~ -{y..':..~~\;)~'f,t. v 1"'0 eg.. " l~ '" ~." ~I" Street Improvements: <:-\) ,,~\C;, \>\:.~'~'t.\;) '~~ Type: \~, v.\;)~ x.\;) ,a.\~' ,,~\ ~'t.~~ ~\)'Jrspoutsmrains: . 'V\;)~ \'O~ '\)~ ,,~'{ TYPE OF USE: PROJECT DESCRIPTION: Replace 7 rooftop heat pump units and gas supply lines Owner: OREGON DEPT OF TRANS HWY COMMISSION Address: 355 CAPITOL ST RM 119 SALEM OR 97310 I CONTRACTOR INFORMATION. Contractor Type Electrical Mechanical Owner Contractor License ROSE CORPORATION 54431 COMMERCIAL AIR INC 110075 OREGON DEPT OF TRANS HWY COMMISS I BUILDING INFORMATION I # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN Storm Sewer Available: Special Instruction: Notes: Paeelof3 Repair Commercial Expiration Date 09/30/2004 12/18/2005 Phone 541-686-0905 541-461-4821 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING . . Ll1 f OF SrKll'lut<lJ!,LU Status Issued Building/Combination Permit PERMIT NO: COM2003-00191 ISSUED: 03/19/2003 APPLIED: 03/19/2003 EXPIRES: 11/20/2003 VALUE: . 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft Square Footaee Value Date Calculated Total Value of Project I Fpp< tiWIJ Fee Description Amount Paid Date Paid Receipt Number -Mechanical Issuance Fee- $10,00 3/19/03 1200200000000000853 + 10% Administrative Fee $9,10 3/19/03 1200200000000000853 + 7% State Surcharge $6,37 3/19/03 1200200000000000853 Gas Outlets 1-4 $4.00 3/19/03 1200200000000000853 Gas Outlets 4+ $3.00 3/19/03 1200200000000000853 Heat Pump $84,00 3/19/03 1200200000000000853 + 10% Administrative Fee $6,10 5/20/03 1200200000000001258 + 7% State Surcharge $4.27 5/20/03 1200200000000001258 Add, Alter, Extend Circ $43.00 5/20/03 1200200000000001258 Add, Alter, Extend Circ Ea Add $18.00 5/20/03 1200200000000001258 Total Amount Paid $187.84 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. I Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 2 Final Gas: When all gas work is complete. 3 Rough Mechanical: Prior to Cover 4 Final Mechanical: When all mechanical work is complete, 5 Rough Electric: Prior to Cover 6 Final Electric: When all electrical work is complete, Paee 2 of3 . . CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2003-00191 ISSUED: 03/19/2003 APPLIED: 03/19/2003 EXPIRES: 11120/2003 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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, Owner or Contractors Signature Date Page 3 of3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone JoblJournal Number COM2003-00191 C0M2003-00 191 COM2003-00191 COM2003-00191 Payments: Type of Payment CreditCard 5/20/2003 Paid By ROSE CORP 9:33:46AM City of Springfield Development Services Department Public Works Department Official Receipt Receipt #: 1200200000000001258 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Received Hy djb Date: OS/20/2003 Amount Paid Item Total: 43.00 18.00 4.27 6.10 $71.37 Check Number Confirm No . How Received In Person Payment Total: Amount Paid 000073 020358 71.37 $71.37 . Page 1 ofl cReceipt.rpl