HomeMy WebLinkAboutPermit Electrical 2008-12-19
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225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)7~6-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ,l"n.v1 'LOO ~ -0 I bIg
Date.
,
12-/'-0%
I. ffiti:JCA:1J.fijNYi!JBmSi~(iTiiXTifjNr~'r;~'WJtI!
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LEGAL DESCRIPTION: ,702 34 ~Z
~(i\A O\A~(,^
JOB DESCRIfbA {> fA--~___
3.
10@i;%lli1l"'R0%'27.'P'1llii"$"''''='''G$'''1!l?'s='''-''''",,'1''~''''~'M"'' _ "''' '" '"' _de,," .," "'M 0 "
A. "Ne*~ResiilentialfE'!'Sin'"le$or'Mulli'Famil"z'c'F'uwclliii ,uDit:~~
001 00 hh~_'C.._,. ....,....._"l\~"k.;!......."..$.~......):tIL&.y$..... g...
Permits are non-transferable and expire if work is
Dot started within 180 days of issuance or if work is
Suspended for 180 days.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$]21.00
$ 22.00
$57.00
2.
B.
Electrical Contractor
SS'b ~ ('1
."
Address
\'i:'fD
10
-.,,'...., 200 Amps or less
. t. O,VO
i:> " ;, ~ ""'L'S . rGt~1 Amps to 400 Amps
~( 1.. '" f :.'.: '1/0., C qdoPI~&17 Al1>Pj to 600 Amps
~09D. ~o""2'00 eli)oler. 60]6x.rii~.~gliirOlg Amps
r {( f' . 0 'fOs V( YOU
Phone '1*'-1'1//(;. ,0,5"liqy 06 70~e/100Q,s\Jlpst,y~>> to $426.00
~"Iber f~'''' cenle IEilnP,ec'ifnnl5ctoIDy Set /Ity $ 57.00
C I Ihe 0 r. (AI uP/es o~fj 9$::;.n~rtl)
f5 enter,s reg,€-I)i]"'[tii!l-~-.e'liJTM~~~~i'F'!IlJ?.:',j"~Nlljiil,TD'i t .'WJtI!!iil\'~~I1fuIl"
, 7 8 . ~tcm q .-vise or", ~"CUersjWb -~- 705iL ~ ~***"
- 00-33;IIfT%tJ!"a/); !Y~"~ ~ . ..-
Insta'iJ1a~, ~iltt~ion or Relocation
200 Amps or less
20 I Amps to 400 Amps
40' Amps to 600 Amps
$ 73.00
$ 86.00
$143.00
$186.00
City 'S, rO"l...., '\',1:\ \)
Supervisor License Number
10'7 !>
id'lolD
Expiration Date
Constr. Contr. Number
$ 57.00
$ 79.00
$1]4.00
Expiration Date
Over 600 Amps or 1000 Volts see "B"
D.
Signature of Supervising Electrician
NorICE' _ --
Tl:!l.~ Q~,,' One Circuit _ $ 50.00 '::>c
IJUT/-fO ~/"fMIT SH Each ~?ditional Circuit or with
~.~\) J:~~~d~D.0'Ll~~_~~~~8~;\iii~;;;~;~f&M~~~~~;;~;~~~'fii1lIiififut.
\ 7; Q() N. -'--r :-i:mo ,., "'ND'!f!fIVfI)WIS~"ZY""~7~"''''''''"''~"-~~-~''. . ..
City <; f' ~ oJ';' Phone I"H '4- G,17> D. puYflJ.,F'@frpalIol $ 57.00
Sign/Outline Lighting $ 57.00
Limited EnergylResidential $ 29.00
Liniited Energy/Commercial ~$ 52.
Minimum Electric Permit
New Alteration or Extension Per Panel
I"l. rn~
~
OWNER INST ALLA nON
The installation is being made on "'V"",j I own which
is not intended for sale, lease or rent.
] 2% State Surcharge
10% Administrative Fee
5%'Technology Fee
rcharges
'-'52
_b-z:t:f
_'~5i-o
- 7f.=
.=
4.
Inspec Ion Request: 726-3769
-01"""-'.-
TOTAL --bt 0'-1
Shared Drive(T:)lBuilding FormsfElectrical Pennit APplication 7-08.doc
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01618
ISSUED: 11/05/2008
APPLIED: 11/04/2008
EXPIRES: 06/1712009
VALUE: $ 5,200.00
2i5 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
. 541-726-3769 Inspection Line
SITE ADDRESS: 333 58TH ST
ASSESSOR'S PARCEL NO.: 1702343200100
. Springfield TYPE OF WORK: School
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Remodel of bathroom to accessible standards
Public
Owner: SPRINGFIELD SCHOOL DISTRICT 19
Address: 525 MILL ST
SPRINGFIELD OR 97477
Contractor Type
Electrical
Plumbing
Contractor
OWNER
OWNER
I CONTRACTOR I~FORMATlON'
fOlio' ""iflIO
lvotifJ;'" rilles /1;,. Or"License Expiration Date Phone
;1) O-'1,/J' E1fiOI)C E1doIJ/;Of7 IElw
090. .".!S::'Of7:l)ter. 7"~ by fA!:eqllirc_
Burubl&G' rNfORMATIONT rllle~rego/~tll to
!! fOr -'life \, Co '9h O}re Set illty
. I'~ the r. (IV. 'PIes "1Fy 9 f,f;,'
# of S"'''''I1<1r . Ore Ote: t Of the :'iJ-IJ ;>.Ze:
Height of Str~tJ;%OI) !.JtlZ' 'he tele rll/~K,! 1st Floor:
Type of Heat: 0'88:::; lvotifholf1fJ'Yt 2nd Floor:
Water Type: :344). CEitio5A Ft Basement:
Range Type: - Sq Ft GaragelCarport
Energy Path: Sq Ft Other: '
Sprinkled Building: nla Occupant Load:
# of V nits:
Primary Occupancy Group: E
Secondary Occupancy Group:
Primary Coustruction Type VB
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION ,
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback: .
Solar Setbacks:
N Overlay Dist: .
r. OnCE.. # Street Trees Rqd:
HIS PI:.' Paved Drive Rqd:
AUTHOR RMlr"8f!1A Lot Coverage:
COM IZeD u il fXp
1,',,~ l%~~;~::;!fr~WOBI(
-~ I/OD. vU1VeD FOR NOSidewalk Type:
Downspouts/Drains:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Speciallnstructiou:
Notes:
Pae:e I of 3
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2008-01618
ISSUED: 11/05/2008
APPLIED: 11/04/2008
EXPIRES: 06/17/2009
VALUE: $ 5,200.00
225 Fifth Street, Springtield, OR
541-726-3753 Phone
5;11-726-3676 Fax
541-726-3769 Inspection Line
I Vat., ''[ion Descrip,tion I
_nlll ,
Description Tvpe of Construction
Bid Amount Use Bid Amount
$ Per Sq Ft
or multiplier
$1.00
Square Footage
. or Ilid AlIlount
5,200.00
Value
Date Calculated
Total Value of Project
$5,200.00
$5,200.00
11/04/2008
Frp< PllW
Fee Description
+ 10% Administrative Fee
+ 12% Stat~ Surcharge
+ 5% Technology Fee.
Building Permit
Fixture
Minimum/Adjustment Plumbing
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ _
Minimum/Adjustment Electrical
Amount Paid
Date Paid
Receipt Number
$13.94
$16.73
$6.97
$87.44
$51.00
$1.00
$5.20
$6.24
$2.60
$50.00
$2.00
11/5/08
11/5/08
11/5/08
11/5/08 .
1115/08
11/5/08
12/19/08
12/19/08
12/19/08
12/19/08
12/19/08
2200800000000001611
2200800000000001611 .
2200800000000001611
2200800000000001611
2200800000000001611
2200800000000001611
1200800000000001238
1200800000000001238
1200800000000001238
1200800000000001238
1200800000000001238
Total Amount Paid
$243.12
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections req~ested 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.. pp(!ll!ir~~ 'ns>>ecti>>>>s I
Rough Plumbing: Prior to cover,' and including required testing.
Final Plumbing: When all plumbing work is complete.
Framing Inspection: Prior to cover ~nd after all rough in inspections have been approved.
Final Building: After all niquired inspections have been requested and approved and the building is complete.
Rough Electric: Prior to Cover ,'.
Final Electric: When all electrical work is complete.
Drywall: Prior to taping.
Paee2 of 3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone .
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRlNtjJ:<lEL.p .
Building/Combination Permit
PERMIT NO: COM2008-01618
ISSUED: 11/05/2008
APPLIED: 11/04/2008
EXPIRES: 06/17/2009
VALUE: $ 5,200.00
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 berein, aud
tbat NO OCCUPANCY will be made of any structure Without permission of the Community Services Division, Building Safety.
I furtber certify that only contractors and employees wbo are in compliance with ORS 701.005 will be used on this project.
I fnrther agree to en~ure 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 tbe front of the property, and the approved set of plans will remain on the site at all
times during construction~
Owner or 'Contractors Signature
..'
,.
Paee 3 of3
Date
(
City of Springficld Official Receipt
Development Scrvices Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-01618
COM2008-01618
COM200~-01618
COM2008-0]618
COM2008-01618
Payments:
Type of Payment
Check
Cash
Change
Job/Journal Number
COM2008-0 1618
COM2008-0 1618
COM2008-01618
COM2008-0 16 I 8
COM2008-01618
Payments:
Type of Payment
Check
Cash
Change
Job/Journal Number
COM2008-0 1618
COM2008-01618
COM2008-01618
COM2008-01618
COM2008-01618
Payments:
Type of Payment
Check
Cash
Change
cReceiotl
RECEIPT #:. 1200800000000001238
Date: 12/19/2008 '. 1O:31:42AM
. . Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 5% Technology Fee
. + 12% State Surcharge
+ 10% Administrative Fee
Amount Due
50.00
2.00
2.60
6.24
5.20
$66.04
Item Total;
Check Number Authorization
Paid By. Received By Batch Number Number How Received
SPFD PUBLIC SCHOOLS D1ST djb 70422 In Person
19
SPFD PUBLIC SCHOOLS DlST djb In Person
19.
SPFD PUBLIC SCHOOLS DlST djb ]n Person
19
Amount Paid
$63.50
$3.00
($0.46)
Payment Total:
$66.U4
". Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 5% Technology Fee
'+ 12% State Surcharge
+ 10% Administrative Fee
J ,~. Amount Due
, . 50.00
2.00
2.60
6.24
5.20
$66.U4
Paid By.
SPFD PUBLIC SCHOOI::S DlST
]9
SPFD PUBLIC SCHOOLS DlST
19 .
SPFD PUBLIC SCHOOLS DlST
19
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
70422
In Person
$63.50
djb
djb
In Person
$3.00
djb
In Person
($0.46)
Payment Total:
$66. U4
'Description .
Add, Alter, Extend Circ
Minimum/Adjustmeryt Electrical
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Amount Due
50.00
2.00
2.60
6.24
5.20
$66.U4
Item Total:
Check Number Authorization
Paid By, . Received By Batch Number Number How Received
SPFD PUBLIC SCHOOLS DIST djb 70422 In Person
19
SPFD PUBLIC SCHOOLS DlST djb In Person
19
SPFD PUBLIC SCHOOLS DlST djb In Person
19
Amount Paid
$63.50
$3.00
($0.46)
. Payment Total:
$66.04
,.
Page I of I
12/19/2008