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
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JOB DESCRIPTION:
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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.
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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
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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.
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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
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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
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4.
12% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL
Shared Drive(T:)IBuilding FormS/Electrical Permit Application 7-08.doc
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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
.' .,
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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