HomeMy WebLinkAboutPermit Electrical 2008-11-6
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225 FIFI'H STREET. SPRINGFIELD, OR 97477 . PH:(S4t)726-37S3 . FAX: (S4t)726-3689
ELECTRICAL PERMIT APPLICATION/
City Job Number COWl L-.CO 0 -0 ( 6z..o
200 Amps or less $ 70,00
201 Amps to 400 "Amps $ 83.00
401 Amps to 600 Amps $138,00
601 Amps to 1000 Amps $180.00
Over 1000 AmpsNolts $413,00
Reconnect Only $ 55.00
uires yOU .to
'19 tV S / 6- '''' O'f"~."<'iffi.\a'ticJe@."":';;;;n';!'\t\\ltd\(~_~~~'~"?'~&""'~'lI~'
v TrNT\O d.. empOl:3f"\1:.lO::eJi\'lCesnr::-Fee e.rs - ""~"?\ .'"~-m;~ "'""'" If,~.ji,f',,,,,,,,"_-r~rJ.o.~<"~_
,^ T r, 'c\opteo uy"',,,<:e,, ,,-, , e' setlOI 'i1~,,,~_..,,\,.,,)i~"..;tr.;..,,,",,,,,! ,"',,"'~""
10\\OW rules a \ r ThOse rules ~l 95~Op1'
10 -(- 20 I / "',,Iilication CfI'il~m~,tW!!~~~ifn oru~qsytion
in OAR 95Z~~Q,~'0Il~ ~ ~:\~phone. $ 55,00
0090,. '10Utne e\!h~p!Jt\9~~~DmS'ti\iCation $ 76,00
calling A\m!il'?A" \l~ T<v)
number iO~~\S 1~BO\)-' $110,00
Ce'l:JVer 600 Amps or 1000 Volts see "B" above,
D i'B~i~ci'-'~~1jitfi~~~~kW~i~~~~~~~~?~~~l~~!i~~';:
Signature of Supervising Electrician . t'~l,4;l'r!i'<~'''''~'?-*"'r;-'~.'\'''''.'''''Y,,,.%~-S:f6~!~F'''''<,,~~''';'"#*;1%1<i~'Th:;;~\;;;t~~t4';t':..;~:*:,:;a:.*;:-;,;:;~::.::.....?;,,;....,:;::l
.4 / I New Alteration or Extension Per Panel
/4/L. .A One Circuit $ 48.00
: \ Each Additional Circuit or with
::~~sN",:; D~~~)' _.~R-( (~~E' S;~~;;;~;~'fJ~r~~*~W~;[~f~~1fi~ffim~,
_f II "::!.'L.J!.-O'f '- "'<".<~."""""'-"'<."""""''''''''''.'''~''''~.'''''=-'''''''''H'''''''''''''''''''''~~'....."""
Citf--J'\ 'c.,). c.. 0. -/--( Phone Pump or irrigation 100
Sign/Outline Lighting :t i~ 'N ,00 57
OWNER INSTALLATION "I~i~ '~nergy/Rest'e~?\?t \M'1' \S t! ,00
The installation is being made on property I own which Wihli ~~~~\~.~~n r()~ 50,00
is not intended for sale, lease or rent ~n~:~ tm!1i!e~~~,~:~~~:~~~urChargeS
Owners Signature: ' 1i>.~~25~~~~w.~~.,j!f~ l J'-f
I~Administrative Fee 570
5% Technology Fee 'W,
7Z~
r~~'W'-~'9-r~!!;;~.r,!"''ia'ol~~~;~~~uo;$(J:"~~~~;r\'~:;;:;~'tP"''.\}~1;
1. :rJ/LOeATIONOEINSTALIfATIONi~~..,*
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LEGAL DESCRIPTION: t
/70:3 '2z0-0 a Z:3"O(:)
JOB DESCRlPTION:
IN f\::,'I'10v'-
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. l~~1i~!!~m:mr~~&{f)
Electrical Contractor
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City
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Address
Phone
Lf &Lf /I,{9> v
Supervisor License Number
Expiration Date
Constr. Contr. Number
IIAI.3JJ
9/Dd/b
Expiration Date
Inspection Request: 726-3769
Date
:!iW,~~""~o:;<~,,,'~"':n>,,~~,if;,.'tJ.t'~~"~~""1It'.~/~.f:~~j.'Y?!!iffl!~'i'Z;iIJ;,f/{;;:p..~!$J:}J:1lll
. 3. !]eOMPLETRFEESeHEDUEE'BELOW:<'''''''';~'\lA~;c'iii\'~?!!>''
,;....-.....!">""""-"'"".;.u....~~'..,f'"<"";.;:'i'_,~~~~;;';"'T,'~,""'_'~;..,...,.+,,~,~..,.,,_~~~-.....~~~~:.i;t~.ii.::;~;,<;~~<i'~~ '
r'6~i;J~e}.f-d;f:~~'\t~~~_;~~..g...,."""_~....,~;..~-.m:~~;~1;;.T..wf",~fl.."'""'~~Jt.S~
A, ~]'\/e"','Residential"",Siirale'orcMiilti;FamiIYme~:dwelliiJg,unit~~
~,~~1',$t,~.,::-.."''''"W;..''''4'''!W~_~'-,:"..,>,,.',',..l:o..-;l,Jl4,<(;O'~.i-''-'"'':.''.'::;>.:""'~-:;;..w..\'"~;.;':;"'""_.;;,;,.._ '''''''V''"l'U'~;:<;-~'I' ;..,~";:;,,,,~.;;;l,~
Service Inclnded
1000 sq, it, or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$117,00
$21.00
$55.00
. .
~~'1?;"'$'#~{:'I~~~A,:~~;;C;;1',"~1'Ji"W-frW~~tj?~~~i?Jhf:)'~f:~'ff;~~-di~~~~~1;f1l
B. ~~~$~~~e~~~;1{..~t~~U.:~~-~gt~~~~~~~J:.~
TOTAL
Shared Dri~e(T;)lBuilding ForrnslElectrical Permit Application I-08.doc
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2008-01626
ISSUED: 11/05/2008
APPLIED: .11/05/2008
EXPIRES: 05/05/2009
VALUE:
225 Fifth Street, Springfield; OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3000 GATEWAY ST SPACE 916
ASSESSOR'S PARCEL NO,: 1703220002300
Springfield TYPE: OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Sign lighting - Burrito Amigos
Owner:
Address:
GA TEW A Y MALL PARTNERS
110 N WACKER DR BSC 3-04 ATTN PROP TAX ADMIN
CHICAGO IL 60606
Contractor. Type
Electrical
I CONTRACTOR INFORMATION I
. o.u\leS ~U~U'\i\\''1 ' ..
Contractor oli \a'i'J Ie Qle4nIC ,,~\n ExpIratIOn Date
IMAGE KING IN~".,.\ott Q1e.?oo \)~ \"e.,\oS ~6~.:l.J\0\' . 09/01/2010
/'.\ ,,,. . - ....-, _~~_u ~"\n~'.. sp~
\ 'lo~II8UlLDIN6-INEORM\\.TIONl\lle
0\ , . '3.\.\""" _vv' - ' ~~.;> - l~ona
l-\o\\\\C 957.,00\ ",aili co? , \"e \ele?, a,\iol\
\Ii Oi'-I' ~N12.~tO~~s: \I-\o\e;, .\~ ~o\\\\C
0090, .'<0\ItRigj1tfOf'~~r~~\I\_2'344). .
call\li9fWl<\'iltl Rc~!~oo''3'32.
\1u(\\'oe\6\!,\lltllfyPe: ,;
Range Type:
Energy Path:
Sprinkled Building:
Phone
541-484-1482
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
!I
, n/a
II
Lol Size:
Sq Ft 1st Floor:
S9 Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I. DEVELOPMENT INFORMATION I
Front yard Setback:
Side I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
"
"
Overlay Dist: ,''tJQ?~
# Stretl,Trees Rqd: \,\~f. \f i\-lf. ~Q"
"~1ri,-iv~~\.\. fY:. 't.~\'J\11 \S
"~~~~nern~'t.? "\-I\S.? Q~E\) fO?
I:>.\\I\-IO?IIE\)r\ ()~ IS r-.~r-.~\) .
I PUBLWIMjl~~;.'sf
~\...,
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Availahle:
Special Instruction:
, Sidewalk Type:
:: Downspouts/Drains:
il .
':
Notes:
I ,valuation Descrip,tion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footag~
or Bid Amount
Value
Date Calculated
Paee I of 2
Status
Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Sign - Outline Lighting Each
Total Amount Paid
Amount Paid
$5.70
$6.84
$2.85
$57.00
$72.39
Total Value of Project
Fees Paid I
Date Paid,
I Plan Reviews I
11/5/08
11 /5/08
11/5/08
11/5/08
CITY OF SPRINGFIELD
. Building/Combination Permit
PERMIT NO: COM2008-01626
ISSUED: 11/05/2008
APPLIED: 11/05/2008
EXPIRES: 05/05/2009
VALUE:
Receipt Numher
1200800000000001110
1200800000000001110
1200800000000001110
1200800000000001110
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.
I Reouired Insuections I
Sign Electrical: After connection is made hut prior to energizing
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 he 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 he 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 he used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readahle 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 2 01'2
Date
22~ Fifth Street
Springfj.eld, Oregon 97 477
541-726-3759 Phone
Job/Journal Number
COM2008-0 1626
COM2008-0 1626
COM2008-0 1626
COM2008-0 1626 '
Payments:
Type of Payment
Check
cReceiotl
" City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
120080000000000 III 0
Date: 11105/2008
Description
Sign - Outline Lighting Each
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
IMAGE KING INC
Received By
djb
Page I of I
I:
Item Total:
Check Number Authorization
Batch Number I Number How Received
11909 !
In Person
Payment Total:
10:42:IOAM
Amount Due
57.00
2.85
6.84
5.70
$72.39
Amount Paid
$72.39
$72,39
11/512008