HomeMy WebLinkAboutPermit Electrical 2005-7-27
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225 FIFTH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ,,~0~~~", - """" '~
ELECTRICAL PERMIT APPliCATION \e.~~\)~~0 <>9,;i!t~~,\,. .
City Job Number Co N\ z.tx::>'5 ~ Oe>">b ~ Date ~7 Izt; /_~t-O\ \0 . .'
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LEGAL DESCRIPTION A. ~R,~id!.nt~aI7.~i!f ..c~~~,!ti:f~mily.p':e[_dW!I!-i,;'g,u!lit,' ~
II 07- '?~ <\-l 0 '3> ( 00 ~ervice Included v',.,F"\'"
JOB DESCRlPTIONlf-l;Sf:! I.s .l-I"("I>'" [:)1S\1l~ 1000sq.ft.orless
/ / . Each additional 500 sq. ft. or
/ ~uJ lIt'} b-A-G;. 71ATA tAt} 1~11J C portion thereof
~':~<!,:"i..''-!:' :':1;:"'C""I'+,~iO' F~r "~n:T6" FIE'W"';';TO''-RE: ' 'G' 0" N' ':::":;i-""''t.,~''/,l,
1..1 '_ ~., T"I,"> h.... J."\..J..l~ , ~- \ \..
".~~;.f.,J _ '-.. _I......J:... .-.t.:"~:::-,,",.:. "_ '. "t;..,'''-:':1"l~_I''!~- .....
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsIV oils
ReconnectChUy ,0
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c. ~.JiP"'tl;:i~J#~~r!Wedel's'\'
r':--':~I!l . r-.r-.: -- - ~~_. - -,> , .
~ \""-- O\e '/J>e <:1>":>'); 'O~
lnstdilatiOn, AJieraoo!,\~cation
,,0', '()~' \V' 0" e 0 11-
0\'20~Ni1!#,r J~'" 0' ~ }.e~"(;' ~O $ 50,00
,O~' c2al~m;;t.9400~\~,0\},G $ 69.00
_,,' '1> ''', .c,' _d;2jlV,'I:- ,- "-
~~"" ~ec,CJdOI,4.lDP~t.O'O .~ _t>.t>,' $100.00
,;5.' . \V ;:."Vv =\.'8' ~ '-':l~, rt::r' " "
. ~,,~ ~o <-.');OVer ~~~-'~l!9O'Volls ~e~..B ~bove.
'Oo~,G <>. 'llD" ~iiii<clt-:GIl:",uar;tii~-;;t\~'~"~\J;'\' lV'1J,';;::,.
~ O~~~ov~~fQ~~~-~;'~~~----- -:"~~ _h",,"_..f - ~--
'-$' Rl~\)' \<!,!ew,~tteiifon or ExtenSIOn Per Panel
\:j ~-:S r;o.!!\ p;--<".
CiJ" wue -creU1t
<,~<'Each Additional Circuit or with
Service or Feeder Permit
. 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. ~fQ&M?#()~!!y~.T,.Y!;:{tiok()~;Jl;~
Electrical Contractor 7J A V I,(J tJ t. Lc<;/;~ ,S '<i'
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Address J ':'{:2. c;., ~fI-P~~~ <(~5J
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:.?1J <,' ~SY'-,~~~.y-,?~~c "I)'!
City c" '-Rffi\v'.,,~' Phone ,~'...l ,3-Y '- 1
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,\~,,\{:..\:j .0"'-'V ,~~--:;
SupeIVisor LicenS~~~bC:::--6" '12 7 - U 3 00
t/I6J~ .
Constr. Contr. Number ,7 JS I Cj
Expiration Date.f /2..1 / 0 ~
S;~:51jM
Expiration Date
Owners Name ?-IJPA.fflu,OVI./< /'Z"ZA
Address ~L;"'7:l7 MA-IAl.(r
City .t(ftxullr;hi:l" Phoneel'7)~../_qH"J
~~
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent
Owners Signature:
Inspection Request: 726-3769
'ollo&bQ6.00
"so
$ 19.00
Each Manufact'd Home or
Modular Dwelling SeIVice or
Feeder
$50.00
B. t,:s~~i~es~6/E~~d~f's~~~lh~i~'(I~i~h~;Alter'atikfi~~r,iie'lo~ati6n, ~./;~ '.t
~"'~!1" ,'U.O. ~~~';' -<Co"',- ''',,,,,,,8- ""~';;i"'.~r,' ,~T!l-~!'~ ~'.' ....J';;. :'l;:-fj 1I.~"'" ~I.~ ',tli
$ 63,00
$ 75,00
$125.00
$163.00
$375.00
$ 50,00
~" ,I
';'1
$ 43.00
$ 3.00
r:""~"1"':." "'~,':~'::< "'~>:"C~':"~"i".''''T.>';'':'<::::''';';;r:,''''''i;:-'~':-....''''-'c"'" "-. '..'.'. "'-,"-1
E. 11.M!S1ln.aJl~'!%;(~~bi~~(!~~d..r,5joLin~@~~d) ,;;.J<::,i!~~JpJt~!!~ tiiin,J
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
'\..{C!,..r--
J
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
p_;';'" ~_ -,.\: ""'~~'~,>~_, y_ ....~.... ~,.' H-.~~;:-";-.:.}:..;~\~:i~> ~
4. p'SUBTOTAL OF-:ABOVE'r""~ '~'.' ,"~.'
i.~_-p..." '-1::; :,;:<1."<, ,~:<"~'_' "p.. ':-_ ~fi: ~,;j::t',~,;,.'lV.\l;e~ k,,*~,~
j
4-S ,eJO
"?.IS
&--' SO
S'Z.. iO~
7% State Surcharge
10% Administnitive Fee
TOTAL
Shared Drive(T:)IBuilding Fonns/Electrical Pennit Application 1-o3.doc
.
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
CITY OF SPRIl'iuN~LU
Building/Combination Permit
PERMIT NO: COM2005-00969
ISSUED: 07/26/2005
APPLIED: 07/26/2005
EXPIRES: 01126/2006
VALUE:
SITE ADDRESS: 5727 MAIN ST
ASSESSOR'S PARCEL NO.: 1702334103100
PROJECT DESCRIPTION: Data cabling.
Owner: PAPA MURPHY'S PIZZA
Address: 5727 MAIN STREET
SPRINGFIELD OR 97477
Contractor Type
Electrical
Contractor
DAVID WELCH
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Tvpe of Construction
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration Commercial
, .' l ~:\?:HE :F TI1E~I~~~
Il'~' ' .- \ H\:::' r.i-nr~1l1 1'-' t~'-"
, '11.UllILeU url'"", Phone Number: 317-816-6900
ole. . 01 UI--\ IS r\tlt\NUUI~CU rv"
ClJ\VIIVIlN\,lv
u,,,y 1thi l!t\Y f'tKluD.
I CONTRACTOR INFORMATION I
License
73519
BUILDING INFORMATION I
Expiration Date
04/29/2006
Phone
503-393-4144
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: nla Occupant Load:
--~- ._"-="1. ;:--''':':1Ii:1W 1t;4U~P."'" ,.....:3
, DEVELOPMENT INFORMATION toy the Oregon Utility
'VooV" ,~,~- "-', ~qJ,REDPARKING
Nntification Center. Those rules are .:-:~ 'n' .
Overlay"PN~n 952-001-0010 through OAR 9:r~~~1-
# Streetl~~~~ I}lIg:may ohtain copies of the rHa~diCl.pped:
~aved Drive Rqd,: '.'. _. C'ln'er. (Note: the tele\=Cior,npact:
Vo of Lot Coverage: ',' n'egon Utility Notification
1 ;1 t,t .
.. .. I ~CO'J32.2344).
L. I.J ....
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
DownspoutslDrains:
I Valuation Descriotion ,
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee'lof2
.
.
CITY OF ~r1Ul'lt.FIELD:
Status
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00969
ISSUED: 07/26/2005
APPLIED: 07/26/2005
EXPIRES: 01126/2006
VALUE:
Total Value of Project
~
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commerclallndus
Amount Paid
Date Paid
$4.50
$3.15
$45.00
7/26/05
7/26/05
7/26/05
Receipt Number
2200500000000000977
2200500000000000977
2200500000000000977
Total Amount Paid
$52.65
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.
I R..ouir..d Tnsnections I
Low Voltage: Prior to cover.
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 permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are In compliance with ORS 701.005 wlll 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 wlll remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Page 2 of2
. 225 Fifth Street
Springfield, Oregon 97477
. 5411'-726-3759 Phone
Job/Journal Number
COM2005-00969
COM2005-00969
COM2005-00969
Payments:
Type of Paymeut
Cash
.,
'1
'I
7/26/2005
.
RECEIPT #:
Wira"""'~,."-,,,..... '-,,' '\
--'~ i
'WJTr i
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
2200500000000000977
Date: 07/26/2005
8:56:4IAM
Description
Low Voltage - Commercial Indus
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
DAVID WELCH
,
Amount Due
45.00
3.15
4.50
$52.65
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
jmp In Person
Payment Total:
Amount Paid
$52.65 .
$52.65
Page I of I