HomeMy WebLinkAboutPermit Electrical 2008-12-18
Date
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DATE I., .
SOURCE I L/
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225 FIITH STREET. SPRINGFIELD, OR 97477 ~ PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAl< PERMIT APPLICATION
City Job Number( :ryy, '7 (\/) ,( / 0 \ '7 1($
New Alteration or Extension Per Panel
One Circuit
NO Ti G!!;:;U;b Additional Circuit or witb
THIS PEService,or,Peedet:RemiiF IF THE wnRK $ 5.00
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. 1', c il!Ie,<m~, ""';/Clce ,.,. "'dlat IDC U e ,fj;; ac nsta ahon-
C,9.MiV1EI,l)1 ~MW/'tM"l;tW" ~I:VJJ_-.z " "'.., .
f"i02A'NY 1Bj}~\MifullltiQ, $57.00
Sign/Outline Ligbting $ 57.00
Limited Energy/Residential $ 29.00
Limited Energy/Commercial $ 52.00
Minimum Electric Permit Fee is $52.00 + Surcharges
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42- $, sfI2W/:-H"iLO
LEGAL DESCRIPTION:
\iOL3'2- ~L.- OOSeJ'V
JOB DESCRIPTION:
LO<0 I!OL71'1bE ft,e C1SI/ REG./SIC-n:A.
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.
Electrical Contractor~S<.>N:" h kn2-ic.. INL
Address }'o -&x I n22
City h OiZ..<ENL-E. Pbone <;"'-1.1 '197 qt'f.o
Supervisor License Number
'1103 S
Expiration Date
It> /; tJ
Constr. Contr. Number
1/0'7'2,5;0
11/09
Expiration Date
.
Signature O(~uPervisingllectrician
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~~me ~~'D'I J,t:+rr'<../6,S.
Addres.s ~ 1J.ti:rN F y
city~~d_( n~hone72G-
OWNER INST ALLA nON
The installatioll is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Reques.t: 726.3769
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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 les.s.
201 Amps. to 400 Amps.
401 Amps to 600 Amps.
601 Amps to 1000 Amps
Over 1000 AmpsNolts.
Reconnect Only
$ 73.00
$ 86.00
$143.00
$186.00
$426.00
$ 57.00
c.
l>Jotiflca;,ion CsnlBT. 1 ~10,,'_ i, d: 3 ari:: set
Instalw~i.!!~,;~.~t,e,[atig~'!.r~lJ.~I"ca!i9!Jh Of>,R 952-001-
200 AmpSl6r less.'J may obtain copies of th$ 51160 by
201 (Note: me lel$I7~'Ooe
Oregon ulIiilY i,o$\'f2ij~n
is 1-800-:::;:::;2..Z~";1J' .
Volts see "B" above.
D.
$ 50.00
4.
12% State Surcbarge
10% Administrative Fee
5% Technology Fee
TOTAL
Shared Drive(T:)/Building FormsJElectrical Permit Application 7-08.doc
Status
Iss u ed
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2008-01785
ISSUED: 12/1712008
APPLIED: .12/1712008
EXPIRES: 06/17/2009
VALUE:
225 Fifth Street, Springfield"OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 219 42ND ST
ASSESSOR'S PARCEL NO.: 1702323200500
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPT~ON: Lowvoltage for cash registers!
Owner: R & C 42ND STREET LLC
Address: PO BOX FF
SPRINGFIELD OR 97477
I, CONTRACTOR INFORMATION ~
Contractor Type '!, Contractor
Low Voltage Electrical" PERSONS ELECTRIC
License
167350
Expiration Date
, 12/17/2008
Phone
541-997-9140
, ~mILDING INFORM~ TION I
# of Units:
Primary Occnpancy Gronp:
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 Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occnpant Load:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback: "
Rearyard Setback: ,
Solar Setbacks:
I'.:
9verlay Dist:
# Street Trees Rqd:
Paved Drive'Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Street Improvements:
,., ,'-, Ii. "",;';. _:,:..;, ;;"'; 'C-....i i..;;' yvu tV
I PUBLIC IMPROVEMENiI'S.lvV rules adoptee oj! the Oregon Utility
1~Q[lTIcatlC'Side"~JfirTTh~~e rules are set forth
In OAR 95~-OO1-001(JPhrough OAR 952-001-
0090. YOlD.o,wl'SpoJ!ts(Q~~jn_s; of the rules by
calling the center, (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332'2344).
Storm Sewer Available:
Special I~~@if~t!~: '.
THIS PERMIT SHALL EXPIRE IF THE WOP,K
Notes: AUTHORIZED UNDER THIS PERMIT IS NOT
~N~' '~''i'rn "D Ie: ~R~~lOnNED FOR
VVIVllV'...'.....~- -
ANY 180 DAY PERIOD. I Valuation Descrintion I
Description
Type of Construction
$ Per Sq Ft
o~ mnltiplier
Sqnare Footage
or Bid Amonnt
Valne
Date Calcnlated
Pa2e I of 2
Status
Iss u ed
225 FifthStreet, Springtield, 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
Low Voltage - Commercial Indus
Total Amount Paid
Amount Paid
$5,20
$6,24
$2,60
$52,00
$66,04
Total Value of Project
Fees Paid I
I Plan Reviews I
Date Paid
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01785
ISSUED: 12/17/2008
APPLIED: ]2/]712008 ";:'.
EXPIRES: 06/17/2009
VALUE:
Receipt Number
12/17/08
12/17/08
12/17/08
12/17/08
2200800000000001752
2200800000000001752
2200800000000001752
2200800000000001752
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
Low Voltage: Prior to cover.
--.
I Renuire~ T nsnectinns I
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 [ further certify that any and all work performed shall be done in'accordance with
the Ordinances of the City of Springtield 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 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 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 frorit of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Paee 2 of2
Date
'.' .S
City of Springfield Official Receipt
Development Services Department
Pnblic Works Department
.
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone .
,
, RECEIPT #:
2200800000000001752
Date: 12/17/2008
2:31:07PM
Payments:
Type of Payment
Check
'. ,..-
Item .Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 1523 In Person
Payment Total:
Amount Due
52.00
2.60
6.24
5.20
$66.04
Job/Journal Number. '
COM2008,0 1785
COM2008-0 1785
COM2008-0 1785
COM2008-01785
. Description
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By, . .', ,
PERSONS ELECTRJC INe.
Amount Paid
$66.04
$66.04
cReceiot1
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12/17/2008