HomeMy WebLinkAboutPermit Electrical 2005-1-5
~' 0"9/25/03
THU
12:57 FAX 5417263689
.s 'g.)601-~ -5
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CITY OF SPRINGFIELD
~002
215 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541j716-3753 . Fdr~i?iJ~.t9!l9
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SLECTRICAL PERMIT APPliCATION O~l <;' "s 1J0~~Ss
CityJobNumb1~\"""'?7\OS-ODoII Date '-S-<'G~t$" 0"0", tr"9~6""i"
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LEGAL DE~O~ A.. ~i~~@Il~M7i~i~f.~t;lb)1~:tC~~~:;~"~' ". -~~:2a~~~1~li;~~~I~lfJ
" l ) Ilk ) . Scrvice Included .
HTE~IJION: Oregon law requires yu.' to'
JOB DESCRIPTION 1000 sq. ft.1orless t d bv the C----- I ";I;; 106.00
(S E\iC'ifa'adi'tio"ii'ill~500o~ ft: or -"-"", h
I,,.-%-; r .) \ C h-<l '\ ~ (' 'i ; C.t, W';ti6!,flii~dfenter. 1 nose rUhle; ~~e _s_e~ ~~$ 19.00
\.l in OAR 952-001-0010 throug vn.. ~~~ .;" 1-
PermitS are non-~nsfcrable and expire if work is ~b~11f1i!i.9 8~topies of the rules by .
not slllrted within 180 days of issuance or if work is . ~iPf.~!l'1i:,~g~~fJffie: the telephone $50.00
:~.si~i_ii~l.~l~iml B.F~~wt.lj~JiiiiiI!m!i~l~~!I,l~
EleetticalContractor Ch~qJC;tl fh~-{~c. 2ooAmpsorless $63.00 ~<3~
Address '5 ~G <l. ~ ~ S" (~A S{~ ~~: :~:::~:~: ~17:;~000
, < \ ' I 601 Amps to 1000 Amps $163.00
City 0? ~_ '\'730<. Pbone\O(3) 3'\ "1-7 60 ~ Over 1000 AmpsIVolrs $375.00
Reconne'Htnty,CE: $ 50.00
C ~i)'<illm'~1>-ifur'~"""s. "S~~l"W<!FR;.;"i;;"'d. '1l'''''''''''''!e':'~1it'Ia' '.,~, "~";;;'~::i:,'E'~'"Jg~
. ;!~~:~:'ll~_.,a'!.;J:;!' .em...L~O!,:~ __,e:~" ~p,$:81~;~!"1:::~~: i .:;~. , ..;:1...."t~~~~I2'r-~f;;'QF.:~J
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.. ~u:: ',!'lI~CU UNutR THIS PERMIT IS NOT
InstaUa tio~; 'Altfr'll tiOPJOll :~~!9~'!1!9~JDO N ED FO R
200 Amts~/lJs~O DAY PERIOD. $ 50.00
201 Amps to 400 Amps $ 69.00
40 I Amps to 600 Amps $100.00
Supervisor License Number \ -3 '8 ~ - S
\ Cl-\-O'7
Expiration Date
Consll'. Conll'. Number ~ 1 (, G 3
Expiration Date
T -(()-();:)
Over 600 Amps or 1000 Volts see "B" above.
~""''-~''!.~';:/I;'I:~':'"l-:l~''''~''~-~' .1.....~'I:.~:r.."""''\;~.... ~:!:?"'~.;;>'""",..,;;;rN~'..i1i)~;ll"!liJ..rr<\,,"e'l'.~7.G~~,.
D 'iit~..~~".~, ..~:,.~.,~:..,:..r 1 'il:!'~\i'':''.+ '7'P~:'r! ",.C:.."",,''''~r.r:,!)~:\'!!I\''.;lrlf~:l~'':;'(,:;!n;::-'',:o;:~'!'.i:"''!/!' ,.,' .~l~
. ':,,::Dr.anc '~~r :,l. ",,,:,!;~,;:.!~..,,, '. \~_..".:~-w..:~l.l,""iiHlhl'~~'K'''{\~;.'''''~'~~' ~l\"'.lt.~' i'U'. .!j!:\.':,
",,,,,..,~_m ~:~, ",...~.., .,~n,.:.,~l~,'!I~~~Ii.."""'"""'l~:,>~""~:,,,,""-i!''':-'~'1.:.~~"'I"".~:r.";l':i~.'lU,.~V,i,,"}f~_,,,,,-
.... """ ......:'O..'~-lO'^, ~'''''''. ._......,....al,J(~~~t .""'" 1<:,o.._~_",=..='''"'"1.!.,.. ,~..~w.:,."I: .~~iQ,L..-
Signature of Supervising Electrician
i~w\\~
Owners NamG 4u; b \ <Y-;;O',I ~c::l
Address(621c[C ~J-.,~") 'J
City Phone
New Alteration or ElCtension Per Ponel
One Circuit
Each Additional Circuit or with
Service or Feed<:r Permit
,
$ 43.00
$ 3.00
'::J'
i3~
E. ,~~~!~!~I!~!~d}~Jmgl?~li~!l;~
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Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidentiat
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00.
$ 45.00
OWNER INSTALLATION.
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
4. .~~m~!IB~~lj~il~llff~J~,
/
7% Stare Surcharge
10% Administrative Fcc
(.. (, ~"'-
'1 6 <'.
'T,06_ 1o.(plJ
17 ~-n .?-/-
Inspection Req uest: 716-3769
TOTAL
Shared DriVc(T;)/Buildi~g FonnslElfl:trienl PtntUt AppJic:nion l-03.doc JJ~ (t..
.
. CITY OF ~rttlNGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00017
ISSUED: 01105/2005
APPLIED: 01105/2005
EXPIRES: 07/05/2005
VALUE:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541.726-3676 Fax
541-726-3769Inspedion Line
SITE ADDRESS: 1900 MARcOLA RD ~ringfiel<brEi!J19.IEoOHiW.oJ:mi:Y('Eii~rlcal Work Only
ASSESSOR'S PARCEL NO.: 1703251300400 , ATT N I ;vl~dopied by the Oregon U~II y
IoH?~;.~ es ,eDt l'ff~;QJhl:lSE!3.re sRJ.wlP_ Public
PROJECT DESCRIPTION: Service for traffic signal att19th,.&IM'a~'1l'laag'l'lJllhrOU9h OAR 952-5cii.
in OAR 952-0_. -_h'~;n r.noies of the rules by
uv"u. .vu ,..-, 'the teleplIU""
Owner: TRI-W GROUP LTD PARTNERSHIP ~Hin.n1he center. (Note... T fan
Address: 100 SE CRYSTAL LAKE DR CORVALLIS OR ~&ibr the Oregon Utlhly Notllca I
num " r is 1_800-332-2344).
Owner: CARL'S JR RESTAURANT Cente
Address: 686 E BROADWAY EUGENE OR 97401
I CONTRACTOR INFORMATION I
Contractor Type
Eledrical
Contractor
MORROW MEADOWS CORP
License
91668
Expiration Date
07/20/2005
Phone
503-399-7609
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I BUILDING INFORMATION I
#ofStorles/ ' '~I:"IiT Sh:U EXrig[:s'fteTHE WORK
Height ofSt~~t~~edllED UNCER TH:sqrtftfHiElooriWT
Type of He.ftiJlVliViENCEO OR IS ABASjjJI:)'7M flY"':
Water Type:,NY 180 DAY PERIOD. Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: . Sq Ft Other:
Sprinkled Building: nla Occupant Load:
'DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer A vaihible:
Special Instruction:
Sidewalk Type:
Downspoutsffirains:
Notes:
Pal!e I of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-000I7
ISSUED: 0110512005
APPLIED: 01105/2005
EXPIRES: 07/05/2005
VALUE:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Type of Construction
I Valuation Descrintion I
. $ Per Sq Ft Square Footage
or multiplier or Bid Amount
Value
Date Calculated
Total Value of Project
Fp.p.s Pair! I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.60
$4.62
$3.00
$63.00
1/5/05
1/5105
1/5/05
1/5/05
Receipt Number
2200500000000000015
2200500000000000015
2200500000000000015
2200500000000000015
Total Amount Paid
$77.22
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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.
Electric Service: Approval required prior to utility company energizing service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, 1 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 ofany 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
strcet, 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
ti~i\u:;n::;ct~ ~ 1 _ S ~ 0:)
Owner or Contractors Signature
Date
Paee 2 of2
~..;.
.1 225 Fifth Street
SpriKgfield; Oregon 97477
541-726-3759 Phone
.
~~~AI!'I.'!".'!!--"'___._..:_,.
Wit.A6< i
'\'II!!IIr t
.__._.___.._. _ r
liiilY of Springfield Official Receipt
"elopment Services Department
Public Works Department
Job/Journal Number
COM2005-000 17
cOM2005-000 17
cOM2005-000 17
COM2005-000 17
Payments:
Type of Payment
Check
,t
1/5/2005
RECEIPT #:
2200500000000000015
Date: 01/05/2005
Description
Penn Serv/Fdr 200 amps or less
Add, Alter, Extend circ
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
MORROW-MEADOWS CORP
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 1015/182 In Person
Payment Total:
Page I of I
2:49:57PM
Amount Due
63.00
3.00
4.62
6.60
$77.22
Amount Paid
$77.22
$77.11