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Home My WebLink AboutPermit Electrical 2004-8-5 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . F4'/)[. (g 72'ij>~.9.89 '""'T?o :9 ELECTRICAL PERMIT APPLICATION "<'..0' City Job NumberCqM toOl( -00 q 6z Date 1. 'ifi7oCA1iON:OR;1NSf~TI~~~ ~..N:tI~'it.ii.l.'It:,,~e;;:l:r.m.l..'::~...~-..;Jt~'-j~~~~ 6"'1 N 1i\ ~ ')~ 1000 sq. ft. or less Each additional 500 sq. ft. or PEOal1chiOMn antheur:aOcft'd Home or $ 19.00 ~', ',' PermitS are non-transferable and expire if work is" . . not started within 180 days of issuance or if work is Modutar Dwelling Service or $50.00 susiii~;;~:1NST~TI6,N!ONEY:1 RF~~~:lr-TF-"~f~ififtjffifti,~, n:,rxiW;ilii,'\'i~6'itR~m~~ 2. ,', ,.." .. ""'-~"""~":\.'~~..di:~17",.-.",,,:,,,,"r.t~u=.EI !:~~;f,~,.'!~~.~,,..,<w.:r;...~~.'w,, Electrical Contractor (J ALM <; \ ~ f If'" gec.O<.<--. 200 Amps,or1iess $ 63.00 -::os,"" .\',~'1 , 20'I~Amp's to:400 Amps $ 75.00 13vrh t-I 'i)u v-c.. n \'3->/1 \~OII'A\i,~~ to,'6'00 Amps $125.00 0" \\\" - '3-,'0 c" ~Olel,le6 'Oi 60:1rkmps,iO-IOOO Nnps $163.00 ~ ~n' ?Y ese' """"' (\) Phone ~W{': ~'Jl. ~'I' /(.J~r l~p?'l\mp.slVolts $375.00 ~$)'Il ~, c,ef<<" 0\ Q \'1' Reconnec\.9ri1y.- ..j" $ 50.00 ~'O. Cg.\IO(\ 00\''0 ~i\(\CO~t.\\\e .\0"\' J S . L' N b -::l l.1i9'!>'2.......'3-i 0'O"el.C~"1~"p(ff.r~~~~rfg.(fr~F:e'fdi!f~~'5.'!~'.;;;':'!"',.~~W~jt,&"f$i.%l upervlsor lcense urn er _ ,.) ~ W ..~ \\' f\\: \.7'~ f"..oY ~:...;~~\...~, ~~..-~ _ - ". ~,~~. ".~ ,~X!..~~~~ I \\\ -~O.""- \~eve Ole~ ()_~?i/. 1 0 1 j, ~ ,..~~\(\g.. \0\ \\\e \~ \.IltstaUation, Alteration or Relocation , ,^v3 . <:-\0\ , 5'~\" c,e 200 Amps or less .' . Constr. Contr. Number . erG '?L( - c- 201 Amps to 400 Amps J I 401 Amps to 600 Amps' J () I 0 '1 Over 600 Amps or 1000 Volts see "B" above. S7~"';fr"" D~~;=:~~~~ . 7 O"tJb ()o/~f)6J Each Additional Circuit or with ~~;#~\Sn. 57 aO ) ,/" A fJ (l. Service or Feeder Permit \..c.~\.. ~~ ~~"".OO . Owners Nam, r V'~{JV\. V VlL-!lI.A o...v Gv "lJ.1? ., \ v":(;\;J ^'t\.'C..v -0.0 ' Ic:l (t- " v - r E. ~;~@~ ~~~~~-fu~~~~t~ifiiW~~~ Address T '.I 0 . -W:~~~{~?~""~."'~"""""_-4_"'_'- City ~ IM,..L Phone ~ Y;' Y ~ DO pumP'!'f~lin8?liM~ x.$ \)'?- ~\)\). $ 50.00 1 ~ SignlO~~~$~~~ '?~ $ 50.00 Limited tin~~~tR'e~idential $ 25.00 Limited En~y/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges i?, _:o.';&Orll.:m.,~i,...;';~<'f<l!",W.~l:-~ ,,"j~~~~,,"~~p~f~..r:J~ 4'~~~~~f~~~ JOO.oQ J()..... 7% State Surcharge IDO ",,,~~~'CY 10% Administrative Fee 10.DO ~"tJ? TOTAL --1-1 7. ~ () ~~ Vr/;)~~ Shared Drive(T:YBuilding FonnslElectricnl Pennil Applicnlion 1-03.doc LEGAL DESCRIPTION v I ? C? Z:. >"5 'tl , " JOB DESCRIPTION' Ij)OwWk Lc1l-h";'.., ~oJM f1.t floW i~",-+ :'O~!b? City I)-~ 1 ~~ Address ExpiratiOll Dale Expiration Date OWNER INSTALLATION The instaUation is being made on propeJty I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Service Included $106.00 $ 50.00 $ 69.00 $100.00 . . CITY OF SPRINul'1~LU Building/Combination Permit PERMIT NO: COM2004-00962 ISSUED: 08/04/2004 APPLIED: 08/04/2004 EXPIRES: 02104/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5781 MAIN ST ASSESSOR'S PARCEL NO.: 1702334103500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Power and lighting for new tenant Owner: OREGON MEDICAL GROUP Address: PO BOX 1648 EUGENE OR 97401 Phone Number: 541-687-4900 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor CHRISTENSON ELECTRIC INC License 458 Expiration Date 05/0112007 Phone 541-688-6121 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I BUILDING INFORMATION' # of Stories: !l ,*0\1 \Il Lot Size: Height of Struc\~~ teo,U\tO 01' U\i\IW Sq Ft Ist Floor: _ :!.'{Ae ~ \ne Ote9 'Illill\ \1l\\\'Isq Ft 2nd Floor: ~~W w.ed '0'1 Se tU1e& Il-t, eoi,\}\}\.~q Ft Basement: Pi ~ tuiii~~~: 1"0 ou9n Op.~ a lyl1l3 \lSq Ft Garage/Carport \0 . I~Qn~a~~~ 0 \nt les oH'\-.., \!\l!,\@SqFtOther: tlO\1f! ~rsnT~d Qtllng~? \'fIa \'iiJa9\. c,,\\9<,>ccupant Load: ,_C'\n"v-'- _.,,\1 ,....\n\6. "'\i"'i\.U'"'::t~ , I i:mJv;hJ)IH~tJ!lN'l'lN1i(:)irnATiON,fI')' 1.."- el '01 \"-. \ _~Vv - t\U~'o l'.en\Elt IS Overlay-Ulst: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: OI'-l<. ~.\Cc:. DownspoutsIDl'\\1!i:lf 1\1E ~ M01 ~O, ~. ,. S\1r..\..\.. t/'- El'-t1I\1 I" " 1\11S ~OE~~~O \l~OER 1~~~~0~EO fOR r..\l1\1 0 OR IS ~l> ,..nMt1IE~CE'l rCQ\{)O. i \~U v'" I Valuation Descriotiol'l Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paeelof2 e. . CITY OF SPRIr~tJt<U,LU Building/Combination Permit PERMIT NO: COM2004-00962 ISSUED: 08/04/2004 APPLIED: 08/04/2004 EXPIRES: 02/04/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fp.p.~ Pllirl' Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Clrc Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Numher $10.00 $7.00 $43.00 $57.00 8/4/04 8/4/04 8/4/04 8/4/04 1200400000000001182 1200400000000001182 1200400000000001182 1200400000000001182 Total Amount Paid $117.00 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 Re"uh~Jn~np."tion'l Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all information hereon is true and correct, and J further certify that any and all work performed shall he 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. 1 further certify that only contractors and employees who are In compliance with ORS 701.005 wlll he 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 Pal1e 2 of2 . .r~A""'!."""'.' ....-..... ',. WiL' : '.,-- ' , . I -- --"-- 225 Fift" Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00962 COM2004-00962 COM2004-00962 COM2004-00962 Payments: Type of Payment Check 8/4/2004 RECEIPT #: JIIY of Springfield Official Receipt "elopment Services Department Public Works Department 1200400000000001182 Date: 08/04/2004 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By Received By CHRISTENSON ELECTRICAL djb Page 1 of 1 Item Total, Check Number Authorization Batch Number Number How Received 1062 In Person Payment Total: 9:50:58AM Amount Due 43.00 57.00 7.00 10.00 $117.00 Amount Paid $117.00 $117.00