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Home My WebLink AboutPermit Electrical 2004-7-16 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541'f%~%'~. o '~ ~ ELECTRJCALPERMIT APPLICATION () "~~ "O':.o~o.' Lr; 'I (' Ol..-( '~1. 0$"$ CityJobNumberLOI<<ZOOl\ - CDBb, Date (- "'" -1~" $, ~.,/ ...,0"1.... . ' >or.." "0 /l'r. oS',,- 3. W:COft:ipfjffE)'ifE:Wi~T,'""~ ""'EL6~~(1fS~ ~.~~~w.'fi~~~~~ ~,l,.ito.)..: ~~,. ~ ~J~il..O'L~~~;P2~ ""., " '" .~ C:9/v. 9(1...';'-:, \$',.... ....6 "(I '''9 A. rM~~m~t~%li~~~~~~~'~''''l,~~F.~~ ,,~!~ftffil~~~ ~$""."":"'~""""c.w"\Ui;r- . ~-, ~.o.;o;;r~"" '~':=Q,..: - .:..~ ~r..~9t:'Ti:.f~ Service Included, 0 1000 sq. ft. or less .00 Each additional 500 sq. ft. or """ ' portion thereof $ ~O L !4,pcA:i'ioN:0F.i1NS'TAiiii4:riIM'ltlm ," _~,,~J,~~~':O::, '.....,..;;.trrr~-" I DDl HI'rIL../ all (Vv.x LEGAL DESCRIPTION 1703203 JOB DESCRIPTION" 00 C{ 00 -:Jub CUI.sole I ~Of.Ld or :,<& P100K- Permits are non-transfe~able 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 Suspended for 180 days: Feeder ~~"'''-"''''~''~-~''''~-'''''''''''\'!''!r.''m _,,",~1ll'''.,r,~'I'l~~'!*l'\'%''''''''.Il"~'~''''_''''~ 2 -e01'!ITRA(3l!ORiINsfAEHArroJ.ioNr;Y;, B. ~\Ser.vices;or{Feeders ,:;;i,illslalla tion;"Altera tionslor"Relocll tio',n :" , . ....., --,- _ ..,~~~'.t'<<.~'~.r,:~n:'w~~'d'd'~~~ n~~0..~~'"l\m:!:lU'ill;~-*''''''Y~~:~':io't~~. Electrical Contractor thlUsr.fM~"" el~ 200 Amps or less $63.00 201 Amps to 400 Amps $ 75.00 r3vYJ,..J f) "-I ~ 401 Amps to 600 Amps $125.00 I 're 11_1lT1&....~~~P~~.,.", $163.00 Phone lP AO 'l,P ~~~~UtIIIlr $375.00 fMlJllI.~..fRe'onn~ndaarel8l~ $ 50.00 InQAR, ~ri-~~~~~~~ tllI!lO. ,,",~'1Ii""""].ii3""'~1ilfj.W~~~~~ caHIn8.....M ,..tIle~phonl ....~~pP~~~tion:. ...,. "QO~I'G~ 201 Amps to 400 Amps 40 I Amps to 600 Amps $50.00 Address )~ r City ~I h.J } Supervisor License Number 31)~ s /rlJtlO~ Expiration Date v $ 50.00 $ 69.00 $100.00 , .' . Over 600 Amps or 1000 Volts see "B" above. !i.~~_"'" . '~.. ,~ "' 'm' ~~ D. ~:L~~~jtij&n~cuits. ',,.,. '.~', ~ .' , .". '. ~." _: ..., ~t-.....~"~,,,.~~.--,;-_' -~ --'---~-- New Alteration or Extension Per Panel One Circuit / $ 43.00 <{ 3. Db I Each Additional Circuit or with ,;)- Owners Name kJ'III~M~!Ic VlW. teJW1!E~ ;erviceor~B~iF:it, ~~~:~~~~~... Address 011,' Will ~ 'Sf ,S1.6~~I~D.~~~l}1}2~;!~~t;;;~~~..s,t:'JL'l!.L".1 City -VA) If,U... Phone '& 1'& ~, I Y1JcOMMENCE~Q~JBM~~R~NED fOR U ".. ANY 180 D~i~YIiK Llghtmg .' OWNER INSTALLATION 'l~ ,'1 C, ; 0/ I) b'/ Constr. Contr. Number Expiration Date Sigj::upe~;2~ec~cian The installation is being made on property I own which is not intended for sale, lease or rent. Limited EnergylResideniial Lim,ited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Owners Signature: Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.~T,',.3~E~OVE1f~{jJ'~~i!im ~.,'''''''''''~~~ I{q.OO 3. l{ 3 L/,e, D 51. j3 ,0_. 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:YBuilding FonnslElectrical Permit Application 1-03.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00869 ISSUED: 07/19/2004 APPLIED: 07/1312004 EXPIRES: 01120/2005 VALUE: $ 5,400.00 SITE ADDRESS: 1007 HARLOW RD ASSESSOR'S PARCEL NO.: 1703223300400 TYPE OF WORK: MedicalOmce TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Add 90 minute door with mag hold open. Owner: WILLAMETTE MEDICAL CENTER LLC Address: 541 WILLAMETTE ST #106 EUGENE OR 97401 I CONTRACTOR INFORMATION I Contractor UI!Eh~"si? MElLI CONsM~=~on la~re6!e~'ti\ilit'{ CHRISTENS~~:- ,"-~ bY__ ~.\.." Bl~e\ lonh . N~ti~~~Gi~i@~~lJ~~i:~~vb~ In 0"" If:) - .. h1aln COpIes I , -. one no9O. YOU lllAlt~rlOrirIie No\e: the \elep" t' on n-Ga\ling thBAgIlllb'c l'ftl\~ Notlllca I I-1.2I1Umb9I't~o 0_332-2344). VNSpr ~A'. Range Type: Energy Path: Sprinkled Building: Contractor Type General Electrical # oC Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # oC Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Expiration Date 02/12/2006 05/0112007 Phone 541-485-1417 541-688-6121 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: -.. ~, I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact:~ % of Lot Coverage: f 1\\t. '-NQ~ ",n't\t~.. .;)'1 ~"~\.\. t.~1''!'~~P.M\1 \S HQ1 I PUBLIC IMPRO""')~i';iQ \l~QE\'\ ~~~~OO~tO tun . ~~~~E~CEQ ~~~. Type: , f>..~'1 '\~O O~'1 DownspoutslDrains: I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Description Type of Construction Value Date Calculated Pa2e 1 00 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Bid Amount Use Bid Amount Fee Description Plan Review CommlInd/Public + 10% Administrative Fee + 7% State Surcharge Building Permit Plan Review Fire & Life Safety + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Fire Department Review 07/14/2004 Initial Review Structural Review 07/14/2004 07/14/2004 $1.00 Total Value of Project Fpp< tlWLI Amount Paid Date Paid . U 1 l' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00869 ISSUED: 07/19/2004 APPLIED: 07/13/2004 EXPIRES: 01120/2005 VALUE: $ 5,400.00 5,400.00 $5,400.00 $5,400.00 07/15/2004 $49.53 $7.62 $5.33 $76.20 $30.48 $4.90 $3.43 $43.00 $6.00 7/13/04 7/19/04 7/19/04 7/19/04 7/19/04 7/20/04 7/20/04 7/20/04 7/20/04 Receipt Number 2200400000000000915 2200400000000000943 2200400000000000943 2200400000000000943 2200400000000000943 1200400000000001105 1200400000000001105 1200400000000001105 1200400000000001105 GRG Plan Review: Addition of 90 minute fire rated door to 2 hour area separation wall. Job #COM2004-00869. $226.49 I Plan Reviews I 07/1612004 OK Provide magnetic door holder and listed smoke detectors as part of hold-open assembly meeting NFP A 72-19992-10.6 or NFPA 72-2002 5.14.6. 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. 07/14/2004 07115/2004 OK RJB APP JMP Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building Is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. IRp~ Paee 2 00 " Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . \...11 l' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00869 ISSUED: 07/1912004 APPLIED: 07/13/2004 EXPIRES: 01120/2005 VALUE: $ 5,400.00 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 oCany 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 Page 3 of3 Date 225 Fifth Street , Springfield, Oregon 97477 541-726-3759 Phone . 8~ ~~" ~. Jiii.Y of Springfield Official Receipt "elopment Services Department Public Works Department RECEIPT #: 1200400000000001105 Date: 07/20/2004 9:09:17AM Job/Journal Number COM2004.00869 COM2004.00869 COM2004-00869 COM2004-00869 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Payments: Type of Payment Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 3.43 4.90 43.00 6.00 $57.33 Amount Paid Check CHRISTENSON ELECTRIC djb 1047 In Person Payment Total: $57.33 $57.33 712012004 Page 1 of 1