HomeMy WebLinkAboutPermit Electrical 2007-4-5
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number L. 0,,,,,, ZOO 7- 00 S ( g
Date
1. I LOCATION OF INSTALLATION
o \0\ -:!>SilQ.''''lf~I=O
1040 I'lA-RUl"-J i2-ill SOf\""~'i,1 i:>11.
3. I COMPLETE FEE SCHEDULE BELOW
LEGAL DESCRIPTION ;703 z zOO
D~S '''C.0ll-\.T\! OZ.30.s- Service Included
JOB DESCRIPTION 1000 ~.ft. of/less" .
;L 7001..{ -/0 ~ I....,. .~.. c.JE~c'h';,dJil;'.;nal\500sq:;ft. or
...1!.J.l.Ul> I.Ps<;. Se.(...Jn~ l"-%;I\~-\:.!,,^,NJo~~eojpo}h:J~tih~:~f;;~s(;tlv'.
. I \9H"!l,lv.,....-.,... Th03erU\a~~..~...r_"""
Permits are n.oD~traDsferable ~Dd e~R~~fll~~~.t:k'I~~9~ter. ~~f,~j~~~f.!~t~a'Hom~..o~O,
not started w.thm 180 days of.ssuance.orl:,\'!,oJ~'OOl.00i~M~~A~\:~wJ'I'!?g~S~rylce,or $5000
Suspended for 180 days. n Uf '.I U m?lJ obt3lFeeder; . , ohone .
','Jot'..O " _ ",y....'..... UU1.A:I"r1'
2. I CONTRAcroRINSTALLATiglll"'@1Y.i~Y\;I~,,,n~t\..~~rvic~S!'!r!Fee.Ms!!..rnsl'll.lion, Alteratious or Relocation:
, 'J"' ~. 'I '. III ..... i .' -, ""..l."' 'l'
.,..~;11tJ." ..... . _ 'c '_Q('r...~3'"".",~,'.J'I- ,.
Electrical Contractor 5 AurM l"-1.e6J'1~,nll\l,-\e.r '. , 200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
40 I Amps to 600 Amps $125.00
60 I Amps to 1000 Amps $163.00
Over 1000 AmpsIVolts $375.00
N01Reeol\lleet Only $ 50.00
It..I:. ~rlf1E "TI4i= WORK
TlitSIPfJi\J!Wa~bltc~~r'eeg~~!IT I~ N01
AUTHORIZl:lJ UNucn T t' \.
GotM~~tap,'I.I~e. ~~erntiOIM/I~f.R..fOR
AN.;oartf'Jlll\,/,~~~IOO.
20 I Amps to 400 Amps
40 I Amps to 600 Amps
A. r New Residential- Single or Multi-Famil}' per dwelling unil.
$106.00
$19.00
Address ~ 0 ?"O'l< 11.7 B'1
City .$A.I Vi"\
Phone <\o3'~~'i,'IS'bb
Supervisor License Number YD 11- L~A
Expiration Date
Ib~I'O'3
Expiration Date
ID - 12..-0'7
$ 50.00
$ 69.00
$100.00
Consfr. Confr. Number 7 /, 8 SY
Over 600 Amps or 1000 Voltssee "B" above.
D. LBranch Circuits
New Alteration or Extension Per Panel
One Circuit
(I [(~ Each Additional Circuit or with
/! .A ( ,'~ ^ I ( .,,.... Service or Feeder Permit
Owners Name l:,..-,,1C-vv-I', Iiv,,..... "t:~
Address ? 0 I.! 0/ ~f -7 '70 \" . E. , Miscellaneous (Service/feeder not iucluded) -Each 'nstallaliou I
cityd.c..fl-r. p:]:( Phone Pump or irrigafion $50.00
~ .
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00 I.\~, 00
$ 43.00
$ 3.00
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
1-
Minimum Electric PermilInspeelion Fee is 545.00 + Surcharges
Owners Signature:
4.1 SUBTOTAL OF ABOVE
Inspection Request: 726-3769
8% State Surcharge
10% Administrative Fee
f'dfAL ic.:H- (~C
4(.00
~.ho ,
l..\ ,50 /? Z>
~E:- /.J \~
..ss -." . ,
Shared Drive(T:)/Building Forms/Electrical Pennit Application l-Q6.doc
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.ITY OF SPRIN\.JI'lJ'.,LD'
Building/Combination Permit
PERMIT NO: COM2007-00518
ISSUED: 04/09/2007
APPLIED: 04/09/2007
EXPIRES: 10/09/2007
VALUE:
Status
Issued
225 Fiflh Slreel. Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769Inspeclion Line
SITE ADDRESS: 1040 HARLOW RD
ASSESSOR'S PARCEL NO.: 1703220002305
Springfield
TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Wireless security system
Owner:
Address:
GATEWAY MALL PARTNERS
PO BOX 617905
CHICAGO IL 60661-7905
..,..u'd:ll-; .
I ~...... I . :,,\
....,.~,v~\ .' -.. e('lreClon ., '.
, . _". \, ~'JO;:;~e1 b~' ,r are <,.r;\ .".
. C.," ",leS ,,' -, h"3e rules -~-2 00
~O\I . - _ ,.....,,~p.!...... . 1'"'\" Q Q=-, -
."liI\,::a\lVP :." NY\O lI'.luV~" -, i'. e rules \
I CON'fRAGTOR INEORMNflOWI 1.~~pl1One
'JO'dO. --:ou 1.1:....'Untt;r. ~\~~oye.~..~~:~ ~7 .~f~~i~~')..~
Contractor ca\\:l,g \~:'" ~.~~. ')r-e\~l;.lcensell :~~xPlrahon Date
SALEM FIRE ALARM IN<;:,.1;',: ~;::I.''''.l.~ . _;.,r?,688olZ.121'I'<,. 10/1212007
Phone
503-364-4566
Contractor Type
Low Voltage Electrical
BUlLDING.INFORMA TlON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Coustruction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
Height of Structure: Sq Ftlst Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: NO'iICE: S1\ FLBV~'l\'i!'INOR\<.
Range Type: PERMIT SHALL E'Sqll?ttdarPIW<i'S'Wlrf
Energy Path: THIS lINDER Wi,ttll5IhW.
Sprinkled Bui\4lhW.\ORIIEO nfaR IS ^&~I'l\9[1ilill1i.P.R
_. ....~I"Cf'\ n t\
I DEVELOPMENT m~Yr~Aii"~.N' 'tRIOO.
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa!!e I of2
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.CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00518
ISSUED: 04/09/2007
APPLIED: 04/09/2007
EXPIRES: 10/09/2007
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
Fees ~
Fee Descriptiou
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
$4.50
$2.25
$3.60
$45.00
4/9/07
4/9/07
4/9/07
4/9/07
Receipt Number
1200700000000000378
1200700000000000378
1200700000000000378
1200700000000000378
Total Amount Paid
$55.35
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
L.Renuired Insnect~
Low Voltage: Prior to cover.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and [ 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 wiII be made ofany structure without permission of the Community Services Division, Building Safety.
[ further certify that only contractors and employees who are in compliance with ORS 701.005 wiII 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 wiII remain on the site at all
times during construction.
Owner or Cont.ractors Signature
Date
Pa~e 2 of2
225 -Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-00518
COM2007-00518
COM2007-00518
COM2007-00518
Payments:
Type of Payment
Check
cReceinl1
RECEIPT #:
~"IIU>
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Cwf Springfield Official Receipt
~opment Services Department
Public Works Department
1200700000000000378
Date: 04/09/2007
Description
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
SALEM FIRE ALARM
Item Total:
(;heck Number Authorization
Received By Batch Number Number How Received
djb
10827
In Person
Payment Total:
Page I of I
1:16:40PM
Amount Due
45.00
2.25
3.60
4.50
$55.35
Amount Paid
$55.35
$55,35
4/912007