HomeMy WebLinkAboutPermit Electrical 2005-3-8
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CITY OF SPRINGFIELD, OREGON \....)
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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.:'~~~<)
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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 .
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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