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HomeMy WebLinkAboutPermit Electrical 2005-3-8 ~ -,. ~ CITY OF SPRINGFIELD, OREGON \....) .. [~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3~89 ~ ~ ~ ELECTRICAL PERMIT APPLICATION ~0,,1)&,01t. ~ City Job Number COM ZOO 5' - 00 I r'7 Date ~..%~ tJ4,l- o I "I ' CYo,;.'?t~ I. I LOCATION OF INSTALLATION 1 3. I COMPLETE FEE S.f-!1tiDULlhJl,EL(j~f.:'~~~<) !'\.. ,r. c. ffOSv-~,,4-j-'o~./>-1 "", ~o",~ P, &9"1""';' VdGd-lC. ..Y'U 'al? ' <>&c.........." '& ~ ~O'I) J LEGAL DESCRIPTION 170,3 15'40 OOloD A.I New ReSidential-Singleo'~J)i- -. mil. .er.d ' ~~~i.- -- 1\ 1\.11 ""6.... ql):O~ r-I"t\~t-:hi'n/ I 'i"~ Add Service Included ~ ~ 0'" o",~ I <::r....... <5'6 :.9 J08 DESCRIPTION 1000 sq. ft. or less 7"'-- , r I. . / Each additional 500 sq. ft. 0' Lol-J V 0/ ~'7 f!" c-c.,(V portion thereof Permits are non.transferable and expire if work is nol started wilhln 180 days ofissuance or if work is Snspended for 180 days. 2. I CON'rRACTOR INSTALLATION ONLY I Electrical Contracto, 'Se..\ec.tn::.n, \ rL , Address 72'2. 'S SW ~"-k K d City Ph(,+\'dnd DR Phone '5Do-I.:.?i=lB:f8' Supervisor License Number "3 by S L.-f A Expiration Date I c. I I I '1..DoS' I , tpI..l3<.1\ Jhlo)o8' Constr. Contr. Number Expiration Date Signature of Supervising Electrician ~~ ./:/ ~;? e-- -=~, ~ - Owners Name PN.i,.[; L.. 'it ~!) rAL /tSs"O <-. Add,ess lID \n!em~+;m'\.,j \rJC>f City 'Spr'h"5~~Jd-':"" Phone .")A-n-WtW-~ --- OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signatu,e: Inspection Reqnest: 726-3769 Each Manufact'd Home 0' Modular Dwelling Service or . l-feede'FION: Oregon law requires VOU to $50.00 f'" "":"_ 2Qopted.by_the_a'egon.UtiIi1'1 : _B:I! _ ~~.r'\"ife~~!!l~.edMred~I"llD tioO,S\1ldortlbn, "r RelneDti"n: i~ C:AH 952-001-0010 thrDugh OA1f952:001;;- G09300a}lPPM'y \s~tain copies of the rules bt63,OO cJ~lh{)'TIP,e tee\Q!l~"1Note: the teleohone $ 75,00 nu1P.b~m~ 'l?1~.o!M.rgP.ll1 Utility Notilication$125.00 60 I A(j)(!$I\Q:rHlllQ ,.oops332-2344). $163.00 Ove, 1000 AmpsNolts $375.00 Reconnect Only $ 50,00 c. I Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 40 I Amps to 600 Amps $100.00 ""TII'E' Over 600:A~g~ I 000 Volts-t-E-x~iR~fl\''-nH;-W08 Ii D. I B'n;rR\<iircult~rS~~R_THI&-PfRMIT.I&.NOJ nUl t;\UIiILru ul~UL New Altera\iODorrExlenSIOD(Pe'tJ~laneIONEO FOR f(\MMtl~utU un Iv" ,..~ , One CI f~1!, j an nAY PERIOD $ 43,00 Each AdditiomiI' eircuii 0' witli . Service 0' Feeder Pennit $ 3,00 E./ I\'liscellaneous (Service/feeder not included) -El1Ch Installation 1 Pump or inigation Sign/Outline Lighting Limited Ene,gy/Residential Limited Energy/Commercial $ 50,00 $ 50.00 $ 25.00 $ 45,00 1-1'5,00 Minimum Eleclric Permit Inspeclion Fee is $45.00 + Surcharges 4.1 SUBTOTAL OFABOVE '>.6 l..\ ,'Sl:> 7% State Su,charge 10% Administrative Fee TOTAL '5'2,(..C::; Shared Drive(T:)IBuilding Forms/Electrical Permit Application I-03.doc . . CITY. OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00189 ' ISSUED: 03/0112005 APPLIED: 02/16/2005 EXPIRES: 09/0112005 ' VALUE: Status Issued 225 Fifth Slreet, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspeclion Line SITE ADDRESS: 110 INTERNATIONAL WAY ASSESSOR'S PARCEL NO.: 1703154000100 Springfield TYPE OF WORK: Eleclrical Work Only TYPE OF USE: New Commercial PROJECT DESCRIPTION: Low voltage cclv Owner: PACIFIC HOSPITAL ASSOCIATION Address: PO BOX 7068 EUGENE OR 97401 Contractor Type Elcctrical Contractor SELECTRON INC ,. requll"" y~~ H -'r'J.J),-"f.'(1.'l caw 'I'ty , C(,)NTRACTORJNFORMAlfll(i)1'i~On Uti I TOIIU" ,~.~. - . h se rules Are set forth Notilication ce~t~~1~ t~Q\il1SilAR ~~i9ltlition Date in OAR 952-0?, -_h.""n ~Jttl3 of the ru\est~)2112005 "u~.... ..~....~.~-~ tnelelt::}JIIV".... BUILDING.'IN~RM'A1'I('JN'.. Notilication - - r for the u'e~ull \.~hty q,.U'P~:;'l'!~'ter is 1-800-332-2344). Lol Size: Height Of Structure ,Sq Ft 1st Floor: Type of Heal: Sq Ft 2nd Floor: Water Type: Sq Ft Basemenl: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Olher: Sprinkled Building: nla Occupant Load: Phone 503-245-9988 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Sethack: Side I Sethack: Side 2 Setback: Rearyard Setback: Solar Selhacks: Overlay Disl: Tolal: # Strl~[T1-tt~R9d: HALL EXPIRE IF THE VlHanlticapped: pavedIMy{~_~~~1T S . R THIS PERMIT ISC?,(n'ipact: % ofli\oJ~,?~erage:J UNDE NOON ED FOR COMMENCED OR IS ABA _ ... .......nl("'\f"\ Street'lmprovemenls: Slorm Sewer Availahle: SpeclallnSlruction: I PUBLIC IMPROVEME~TS" ., - . Sidewalk Type: DownspoutslDrains: Noles: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Foolage or Bid Amount Value Dale Calculated Page I of2 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00I89 ISSUED: 03/0112005 APPLIED: 02/1612005 EXPIRES: 09/01/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspeclion Line Total Value of Project L.F"'" Pairf I Fee Description + 10% Administralive Fee + 7% State Surcharge Low Voltage - Commercial Indus Amounl Paid Date Paid $4.50 $3.15 $45,00 3/1/05 3/1105 3/1/05 Receipt Number 1200500000000000267 1200500000000000267 1200500000000000267 Tolal Amount Paid $52.65 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. R"ouir"rf In'l""rtion,' Low Voltage: Prior to cover. By signature, I slale and agree, Ihall have carefully examined the completed application and do hereby certify Ihat all informalion hereon is true and correct, and I furlher certify that any and all work performed shall be done in accordance with Ihe Ordinances of the City of Springfield and the Laws of Ihe State of Oregon pertaining to Ihe work described herein, and Ihal NO OCCUPANCY will be made ofany slructure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance wilh ORS 701.005 will be used on this project. I further agree to ensure that all required inspeclions are requested at Ihe proper time, that each address is readable from the street, thaI 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 Signa lure ' Dale Pa2e 2 of2 ,225 Fifth Street , " 'Springfield, Oregon 97477 541-726-3759 Phone JoblJournal Number COM2005-00 189 COM2005-00 189 COM2005-00 189 Payments: Type of Payment Check ~ . 'r I' 3/1/2005 . RECEIPT #: ....iiaAl_1lLO . 1It...:'..._"~ '-,.- '--, 1:'; j ,. ~ '''--.'' '.. j, ,;.' " ";"'C':"" ,.:' j;lty of Springfield Official Receipt .elopment Services Department Public Works Department 1200500000000000267 Date: 03/0112005 Description + 7% State Surcharge + 10% Administralive Fee Low Voltage - Commercial Indus Paid By , SELECTRON Item Total: Check Number Authorization Received By Batch Number Number How Received djb 55234 In Pe,son Payment Tolal: Page lofl 7:51:35AM Amount Due 3.15 4.50 45.00 $52.65 Amount Paid $52.65 $52.65