HomeMy WebLinkAboutPermit Electrical 2005-12-21
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proJecl as su , the following
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54I)726-361r.r,ng L~:;)~r:l1 .e.~~~"J '.
ELECTRICAL PERMIT APPLICATION Dele E',:",,<:,'~ ~I '"-l
City Job Number 'CJ:>/M ZOO- r - 0 (7 b <::::> . Dat~urr'c/'~ ~~f~
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LEGAL DESCRIPTION - A. ~~~R':~\~en'!i.i:;'~ingi~;~':lMrilti,faiiiilY;per;d'.elling~lijt, fir,l
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Permits are non-tralsferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or $5000
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Electrical Contractor )/lt1f".t- t: fo('dnl.. tnC'o\lC2llo,Jl:WP~l9illels ''''(OUgh 01\ ",\~<;' $ 63, ,00
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Otl 261 Amp~to\400 Ampso,,\eS 0 ,_'" - $ 75,00
?l//),t'a/ r /....4 l/J O,.o'd'Oc ,~,':\\nV Y y., \I:;:\'-'t'
Address 7 Ill' ~ '>Pa.tL'!:Y 7' ',/. \n o40\i'6'8n!l\oJ6~~~ml(f-l0\e', \\ ,8 IW'", $ 125,00
oO'6ln Al)lP.s\to';I000'Amps;\ \J\I\I\'I ,,' $163,00
.o.ft'" _ FA (> ~ ('~\\I"Y' ."'''' c)(";;~ 3223...
Phone:.J ) 71J L/ ,:,ve,ro\.9.0():AmpSfV~~~OO-3' $375,00
lR\Pconnost;.0illy IS $ 50,00
Service Included
JOB DESCRIPTION
1000 sq, 1\, or less
Each additional 500 sq, 1\, or
portion thereof
$106,00
$ 19,00
City' ~."nt'
Supervisor License Number c:; /J/" tJ ~
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Expiration Date
IO-r-:Joo?
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volls see "B" above.
D. ~;$.:r.~~~'h~QI:~c_ll.'i!~;,:1;~,:i,i::~~:~'t~~:~~':~\~}S~;:,:,~:~~'~:~;:,'.!~:~:.:~':~ '~I':.~~;~:.,' ~~.J
$ 50,00
$ 69,00
$100,00
Constr, Contr, Number -LSAflf>1'
New Alteration or Extension Per Panel ~
<JiiOCirCUlt ~ ~~at,OO 'I.. 3
Each AddltlOnal CIrcuit 'll'.l'ti\~~\t ~d'\~ \\0 {r ----
sef\\~'e!.Fe~\~~~\~ y,:Q.ti}> ~~~ 3,00 )
~~~~~\)Q~" ,'.' "n.:l
E. tW" ." el'l"""~" nul i~~) ,Each ,lnS!all~i~ '
p~~~~y~\Q\)' $ 50,00
Si~tft,\\lhting $ 50.00
Limiled EnergylResidential $ 25,00
Limited Energy/Commercial $ 45,00
Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
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The installation is being made on property [ own which
. is not intended for sale, lease or rent.
Owners Signature:
I"'" ',',""..0' ' ".' ",' '-"'. ""', c'" ", I
4.,'.sl!BTOTA:JiQE;~PVE'"~>,':,'';;~,;c', ,- :
:..,...l>+i;.'<.."-".,..#...,.."".........'_..'~.. ....., .',. ..l, ~'.it.~ .1 ,.,,~.,
, .
7% State Surcharge
10% Administrative Fee
<:;8
1.(06
~80
b7~
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)fBuilding Forms/Electrical Permit Application l-03.doc
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CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01760
ISSUED: 12/21/2005
APPLIED: 12/21/2005
EXPIRES: 06/21/2006
VALUE:
Status: Issued
225 F1fth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 528 Harlow Rd
ASSESSOR'S PARCEL NO.: 1703220002607
Springfield TYPE OF
Electrical Work Only
PROJECT DESCRIPTION: Add 6 branch circuits
TYPE OF USE: Addition
Commercial
.. Owner:
- Address:
DlENS REV LVG TR
42130 SE 149TH PL
NORfH BEND W A 98045
Contractor Type
Electrical
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...nr\ \a'l\l . - r"\l'P.QO\\ .... '- '^f\.'n
l{\IOW,foNTRAmORJNFORMATION I
f'.-r~'C leS a,uvr l'r1oS"'" Of'.t' "~:\ s '0'1
Contrllf:.for~ l~on een\el. '\0 \'rIloug'rl 0\ \'rIe 1':I~icense
SUNS&:rcEtE1;r~GJ'N~:.~i{\ c09,e:",,, \ele9\i~8~~.'"
. Ut'" -" ~.- ...""... _.~.,,'~
In gO '{ou I' BUIl:DING'INFO~TlON'
00 \'\in9 \.'- "'e U''''''- "'2>'2.'<-'" .
ca \Ol~' a~O'~
('(\'oel \ *C/! StOries:
nU eel' ~eight of
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled
~ #ofUnits:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
nla
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Expiration Date
02127/2006
Phone
541-915-4883
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:
IPUBLlC IMPROVEMENTS I 1\\i. ~O\\~
t~ ~\.\. t#i\\\i. :~t1ftAl~*pe:
"()~ \'t.~\1I\1 ~Ot.\\ 1\\\;~o~utslDrainS
1\\~il\\0\\\tt.O 0\\ \~ ~~ftol
f>.U ~\1It.~Ct.~ 'ii.\\\OO.
t~t.N ,&0 ~
. Street
Storm Sewer Available:
Special Instruction:
Notes:
,
,
I Valuation Descriotion I
Description
Tvpe of Construction
$PerSqFt
or multiplier
Square Footage
or Bid Amount
1 of 2
Value
Date Calculated
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Building/Combination Permit
PERMIT NO: COM2005-01760
ISSUED: 12/21/2005
APPLIED: 12/21/2005
EXPIRES: 06/2112006
VALUE:
Total Value of Project
Fees tiWU
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Clrc Ea Add
Amount Paid
Date Paid
$5.80
$4.06
$43,00
$15,00
12/21/05
12/21105
12/21105
12/21/05
Receipt Number
1200500000000001846
1200500000000001846
1200500000000001846
1200500000000001846
Total Amount
$67,86
I Plan Reviews I
To Request an inspection caD 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. wiD be made the following
work day.
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 wID 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 _ 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 wID remain on the site
at all times during constructiolL
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
Springiield, Oregon 97477
;541-726-3759 Phone
Job/Journal Number
"
COM2005-0 1760
COM2005-0 1760
COM2005-0 1760
COM2005-0 1760
Payments:
Type of Payment
CreditCard
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12/2112005
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RECEIPT #:
8I!~,
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.ty of Springfield Official Receipt
Wevelopment Services Department
Public Works Department
1200500000000001846
Description
Add. Alter. Extend Circ
Add. Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
SUNSET ELECTRIC INC
Received By
djb
1 of I
Date: 12/21/2005
Item Total:
Lbeck Number Aulborizatlon
Batch Number Number How Received
053311 In Person
Payment Total:
8:07:41AM
Amount Due
43,00
15,00
4,06
5,80
$67.86
Amount Paid
$67,86
$67.86