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HomeMy WebLinkAboutPermit Electrical 2008-12-18 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH,(541)726-3753 . FAX, (541)726-3689 ELECTRICAL ~IT APPLIC4T,{ON City Job Number c:. ((' /" D/ % ~ Date 10;?);\~tijmlll'll~L.mm~~.'/""'d"""",,,,'",~.::,y::'''P{Jf'f:~,"'''M''''''~,'.. ~m em 1. jr;oe;'Vr:I()NiOIi'/Ht~~1J:I()N:"r 'f'!? ?()5-Sj~tFM~St:~I5W~-rr . . LE~l'N: ~~ IT) JOB DESCRIPTION: hrci(1Jkir v (-{ oj Of {'f fh-{ rrl I Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspend~d for 180 days. [lf€ONTJMCTORlFC+"ST~JOMONhY'-~ 2 gs""'="~"-""""="P;"'" ,,':;~rr-:':"-'-==i'''.~6~.' ""f!!I'4ij . F~'W"";==&.__",,,,W0';;0g;%lw.'.,", .mA*^'--~ ,-- ..~. ~ ~.. '" .. Electrical Contractor V y r '( II y () 5 . Address POGO-/.. {PCJ7 CityvV f-l/fyv v;l!y Phone 7 ~ 7 :A 7;' tJ Supervisor License Number 4 7 J... J ;5 /0110' /3 &tfy V /DI/D Expiration Date Constr. Contr. Number Expiration Date '.'f City .'. "1 iJV. ..... ",....... -. . . (N t '1" - {""I"" ,~ callin the center, I 0&:. .I.b ,."-:l::,.:'1:'.Jl:'C' OWNE'hLI)\ID'<5\~!:,NJilON'egol1 Utility Notllication Th. II' . nn'l!.er i,,1_RO().332.21~344), h' h ' e msta ahon IS'-()ehq; mane on property own w IC '--_..c___ is not intended for sale, lease or rent. ~....'.........-. "'..,..~ Owners Signature: '# Inspection Request: 3. A, 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 $121.00 $ 22.00 $57.00 B. 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only $ 73.00 $ 86.00 $]43.00 $186.00 $426.00 $ 57.00 c. Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 57.00 $ 79.00 $114.00 NeWf.Altcration or Extension Per Panel iITIPCE' One Circuit , $ 50.00 . Eacir!\lfdiiiifrii\!\~1irc19I,~ITtt Sen!iceTo"IFeederRerm\'t XP/RE IF TI-f$'5v'9(jORi' , . " D, "LCU ul~DER T .)C. L, \ Pump or irrigation sign/ouilin'e'Lighting Limited EnergylResidential Limited Energy/Commercial Minimum Electric Permit $ 57.00 $ 57.00 $ 29.00 $ 52.00 Fee is $52.00 + Surcharges 72 _ o-v .:;:::>.&s: 11-- /1- "7- "< c) 9d- ~! 4. 12% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive(T:)IBuilding FormS/Electrical Permit Application 7-08.doc "j CITY OF SPRIN\JJ<u.LD Building/Combination Permit Status Issued PERMIT NO: COM2008-01783 ISSUED: 12/17/2008 APPLIED: 12/17/2008 EXPIRES: 06/1712009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 205 S 54TH ST ASSESSOR'S PARCEL NO.: 1702330001200 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New PROJECT DESCRIPTION: RV park - (Space J) Bnrrell will be responsible for location Residential Owner: CHALET VILLAGE MHC LLC Address: 450 NEWPORT BEACH DR STE 595 NEWPORT BEACH CA 92660 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor BURRELL BROS ENTERPRISES INC -License 136446 Expiration Date 0812012009 Phone 541-747-2724 . BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: .Energy Path: Sprinkled Building: Lot Size: Sq Fi 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a . :1 ' d. I DEVELOPMENT INFORMATION I . FrontYard Setback: Side I Setback: . Side 2 Setback: ' Rearyard Setback: ' I Solar Setbacks: ' Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Sidewalk Type: Storm Sewer Available: t NOTICiiownspoutslDrains: . . Special Instruction~TH'TION Orec,ofl I"w req',:lres YOlJ~.\Ot THIS PERMIT SHALL EXPIRE IF THE WORK h , .' " i It Y Ih- fj(e':jon 01 Y ER THIS PERMIT IS NOT foilow ru!e5.,8cJoP'I'';b~ c ~ r~d;'s ~r~ :;8( forth AUTHORiZED UNO Notes: Notification Cen\I,[. ,,,",E " '0f fl 052.001- COMMENCED OR is ABANDONED FOR in (JAR 952-001-00 \U tl1roli,9!) ~ f :"........., dCl~ hv .~ ' .J,/,'" r"\ ^" nCDlnn 0090 You may uu,<>'" w~._' - ;1,[.\ ,~v _1\. . - , . (NC\tEI' the teloorIU"" . . calling the center. ~ L ;,XCaluatiomOescrintion I number for the. Oregofl.33?_2344), I , . . Center IS .1 ,SOD $'Per Sq Ft Square Footage Description Type of ConstructIOn It' I' B'd A Value Date Calculated or mu Ip ler or I mount Pa2e I of 2 Status Issued' 225 Fifth Street, ~pringfield, OR . ' ' 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Fee Description + 10% Administrative Fee + 12 % State Surcharge + 5% Technology Fee Perm ServlFdr 200 amps or less.. ....' : ' Total Amount Paid Amount Paid $7.30 $8,76 $3.65 $73.00 $92.71 Total Value of Project F~~s Paid I I Plan Reviews I Date Paid \ .., i ' CITY OF SPRINGFIELD' Building/Com binatiollPermit PERMIT NO: COM2008~01783. ISSUED: 12/17/2008 " '" APPLIED: 12/17/2008' EXPIRES: 06/17/2009 VALUE: 12/17/08 12/17/08 12/17/08 12/17/08 Receipt Number 2200800000000001751 2200800000000001751 2200800000000001751 2200800000000001751 .' ., ; ~.-( 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. '. R.~o,!ire~ Ir:!snections I Electric Service: Approval required prior to utility company energizing service, 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 herein, and that NO OCCUPANCY will be made of any structure without permissiou of the Community Services Division, Building Safety, I further certify that only contractors and employees who are in compliance with ORS 701.005 will 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 will remain on the site at all times during construction. Owner or Contractors Signature Page 2 of2 Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone, . Job/Journal Number COM2008-0 1783 COM2008-0 1783 COM2008-0 1783 COM2008-0 1783 Payments: Type of Payment CreditCard cReceint 1 RECEIPT #:' Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee' Paid By JOSH BURRELL ... City of Springfield Official Receipt Development Services Department Public Works Deuartment 2200800000000001751 Date: 12/17/2008 Item Total: Check Number Authorization Received By Batch Number Number How Received NJM 015738 In Person Payment Total: Page 1 of I 1:17:2IPM Amount Due 73.00 3.65 . 8.76 7.30 $92.71 Amount Paid $92.71 $92.71 12/17/2008