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Home My WebLink AboutPermit Electrical 2005-8-3 f ~ ~ S~~~~Ol_~' ~'O"'~~ . 225 FIFfHSTREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 'FAX:(541)72~~68f~~~~~"\<'" ;H~ ELECTRICAL PERMIT APPLICATION . .:~'1."'~66oe .~.. ' City Job Number C9M. z.ros - CJ ~ 040 . Date---fJ!~x~$.C;~c';'''''' /' . . I. ~f6.€ATI6N6F'iN..siAtMTioN:it!,,1i'!;""Y::. 3. 1''COMii[ETlfFifEs''t1iED'r.JI;E1i ;":eUii~i~-'f^-:'~~>!t',l('7~\ ," .... ..,.,-..~..:;.~... .... ..'."'...,......''"'',._.' ,~'l:",.."''''"~".il4',,1\;tr~ .. .,.'~.'-',~"',.,.."...,,,..'".'-.- "',.,..'F~ .n.,.,'.>.2:::~~'t;~.~"'~ >;"",,},'j'\~~~'~.t.:tLt l}f(5 Mn# fs1: ,0\' ,C '~nt::':'~1.7(,"~7;r"-:5i'F~~,t{i'~~'--"'-'!~";;-'~"':~~~:?;-""-~#";'~'ff~'-' A.l~l).S,~!!~!\~!~Jl!!gl.e;Qr.iM.,U1.tiJK~mny,.p,~"'-.1~~g\~~jf1.~~' Service Included * 1000 sq, ft. or less $106,00. Each additional 500 sq, ft, .or portion thereof $ 19,00 ~ '" ~,. l,'~~~""" A' 'I~l.". .., ~/""I .... . h \: ,. ~~....~'~. ,.- v". ~- ...... .,.....,')'". - .' ',;.'.' ~:,,;. ,'.. ":"C"IWT. OF'~ ) ThTRFTi:::rr',TvIO:nT::-G'O' N''':;'''';J'' ,.,: ~"!' {,t.t.~,..'i'" "\:;..1-1 '\~ .\...1..l"lU J:.ca~.JLI,'" r~ 14..\"1 ~,,' ''':1, "~"t'. .~.,.\".;:- "'~', ',.":'''; ~~1' ~'-', !. .... ','.:-f~:". ,~"":,,,,""',,,. A.)' :,.... 200 Amps or less I $ 63,00 ZOI Amps to 400 Amps $ 75,00 Address P-O '{?OJe (//3q 401 Amps to 600 Amps $125,00 , c/y? .:(-.i:' 601 Amps to 1000 Amps $163.00 City PVhrtJr:: Phone pJ'f'-o -(7 ip),,:.::> Over 1000 AmpslVolts $375,00 I ,\\^'''' ,,,:> " Reconnect Only $ 50,00 ? \" cd~~'(:."~ \\:/' C titnT"'''''''''''''''''%!-S'''''''''.''''~F"r~''d'n"..-.w;_'frl!Ui''~~- Supervisor License Number :>). <,y:./,.. Sv .s.<....'V . ~"~mp.qtaryf .~r:..~~,~19_r:.; . ~~^~r:sr~F>"';':F~t:~V.i'~:,;\~\t~;i::JJJ:;~:~ \. v X'-'v ~,V Expiration Date J V / () ~S'~ i:v'0 "\",~if Installation, Alteration or Relocation ~,,' . ",. ,"~' "\":) 0'::' -~" ,,' ,;' i'> ,,'V "c ~10' 200Ampsorless ro~ \)~ (is' Constr, Contr, Number'~ ,<'-5q.'l.\)'7-'cg~ ZOI Amps to 400 Amj;~'" ,..,0<:0 ",,,,,-'~ ,..,'0" , , \"~' )..\.)' ,,,- _, , . " "'''' '" 'v '\l' "'f;0:"" ~y)' ,,~' 401 Ampst060<!.'II>J;'Pll" i' C!J~'~'" $100,00 E 11 D t ' , {)U", " v ^,'I> ",-'" ,,,,? ,ff:- ,'0' ,,'0 xpira 'on a e',' " "u.>." Over 600 Amps or"'IOOO'V6Its see "B'{,"abow., {\J~.i' ".= .,." ~rJ- ~, l;~~11. --'::h"'C" :.i-N.~~ -~':.f~ ~~ "....,.;.\9~ ~.u.\,;~'!;tt. 'I'~~,a~1''k~ ~'~ r.,' J Signamre of Supervising Electrician D. f<"B~~~~'e~t~~,~~~1< ' ~~,"':l'l; ".~:~.f'1'l,: "ij.r~t';':'J 1 ~~ ~ Ne~ A1te<'?aticli!,o? txd~sio;fPer Panel y.~ ,Q;" rO...... ~v ':-.\' 0....- ~'_. r~"" , <' One:c~uii\:l" ':!:J''I> ~ 1.:--0 ~'l,; $ 43,00 .... E" h' ''"'dd''''ti' nal"C' _Ln 'tli"''S \ 'C " ac \'n. I 0 lJ'CUltOr, WI '1 _ /' A ~~~~fvic86; F&d~{P~~it ~'O~~ Owners Name (()!JJt;;S/ c..o#1ML//f/IC4fr/OAI;}:i-r-.'?"..J."O'v ,,<:-"'<s-'" ,.",' Address -z,(;150 Ai, ~ E.r~.y~~~~~;r;~(~~I1!~~r~~!frKi,~J.i~~~i\1i!lJ City 1:5./ t. t:/}Ug ?t.tJ; R7 () I '103 Pump ol-'~gation ' $ 50,00 Sign/Outline Lighting $ 50,00 Limited EnergyfResidential $ 25,00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. rSUBTO:fAL'OFAB~VEi~'i.~;c~t~;:Z,i~ ~I' ~ ~ t.:":c"-b.!~2<':"';:f~..:,;..;~:b,..: '''?;'J;'"~~",~~':df;:)~41""",,,,;,,~~._ ,..:-,~ lQ. "'-"-" 4,4-1 f,,-SO 1'3> ,( ( LEGAL DESCRIPTION \l O'L- 3~ &;'- o~'"?,.oc JOB DESCRIPTION {1u f::15T 11 W (/1t. Ib t) /015 /1)t-t t' ) Permits are non-transferable and expire if work is ~ not started within 180 days of issuance or if work is Suspended for 180 days. ~CaNTAAcrORrrNSTAN!ATI6N:ONiflil 2. .'.-.' ""~'" ~,,,......-.' .... .' " .""" . ~..-K"---:'_':>" Electrical Contractor L.; rr::: ~ ~ OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signamre: ....,~'"" R.,~" n,-"" @~ tP Each Manufact'd Home or Modular Dwelling Service or Feeder $50,00 !:~~r'i'O' ~l'(':~:""1. .~- :r:'h;,!\C,-" '':tJ~,''1:p'D>>'l<;o'''. h""t!1;t ->it- 'A-::-,;$~'~::~~P~-N",}l B. ~~~c!it~~l.~~:~er'~;~\,,~~~.I!~J!~~i.^l~I~!~~~~~~~.g21ti~~Iif:~ 05~ $ 50,00 $ 69.00 $ 3,00 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)IBuilding FonnslElectrical Pennit Application 1-o3.doc , -iir- . " CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-01040 ISSUED: 08/02/2005 APPLIED: 08/0212005 EXPIRES: 02/02/2006 VALUE: Status Issued 225 Fifth Street, Springfield, QR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 5415 MAIN ST ASSESSQR'S PARCEL NQ.: 1702334203300 Springfield TYPE QF WQRK: Electrical Work Qnly PRQJECT DESCRIPTIQN: Add 200 amp service. TYPE QF USE: Alteration ~S Commercial Qwner: SAFEWAYSTQRE#311INC ~I\ Q V"'- Address: % CPTS 1371 QAKLAND BLVD STE #200 ) \ \ }.. 1l' \ ~ ' WALNUT CREEK CA 94596 ~& ~ \j\J , "K\ - \ I co. ~ CTQRIN lORMATIQN' ,,,-- - V Contractor . ,,\0"'+- License rl'p~ratiOIl(~ Phone LITE ELECTRIC S~RXICF; \'-\.\)\ < <-:.l..tW {\, Jj \ 541-68~~6 1.\'\\''<- '(<BuiLDING INFQRMATIQN f\ \ {J ~" \ \ \~:\~.U.../ \-\.. \:: '0\''' \' 1\\\;"v ~W ~U ' # of Units: $'~. 0. '0\\1' :;;.\' '\ ",'i';$\) # of Stories: lze:' Primary Qccu~a,t~y~~O"~(\) \j'i';\) \S \>0'0 Height of Structu e q Ft Ist Floor: Secondary Qccu~~!1C~,C;;f<<<!up:<.\) \)\' ,,-\\)\) , Type ofHeat: Sq Ft 2nd Floor: Primary ConstructloDlTYJle,\J\.. " \,x.\' Water Type: ,0 q Ft Basement: S d C I>.vI "TV '\\'-' R >> ~ econ ary onstructsn. YES:" ange Type: ,,\0 'f# ~v;:.. q Ft Garage/Carport # of Bedrooms: \.; ,,'i';"{ '\ Energy Path: ;j-e"o ~ -\:j ~ ,0 ~V Sq Ft Qther: r Sprinkled Build.m'lt:.~e~O e "oeG..nt~ '0"\ Qccupant Load: ....~ \..) ~ Q:J ...G:J . . ,- ~'l.- ....- ~;f' -J.' '0 I DEVELQPMENT 1NFORMNJlION~ ,~o~, 0<::- IY e- o. ~'" O' ""'~ # -~, o"~ '\"" .0 n"o ,e ,~, .{\'<" i'I ,'( K" ',,,, e 0' AtJverlay D&t:,<.::> '" o~ ,'S' ~ "'. ~~~ it-St~'*eJt.~ee\~Qd~o'e.;)~'\~ ~ ~o~~~y~n~, R~~, (:>.,0<:0 ~ro'l; ,0 i$-\o/~r.L~t;eo'(,efli~:e <.o<.::>r::J ~o 0'" ~o '/;'e '/;'e ~ ~ '\' '<\.. :'(\. .,.....0.. _!..n~ ,,<.." I PUBLic lMW{Q~ENTS I v Contractor Type Electrical REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: SoJar Setbacks: Total: Handicapped: Compact: Street Improvements: Sidewalk Type: Storm Sewer Available: Special Instruction: DownspoutslDralns: Notes: , Valuation Descriotion I Description Type of Construction S PerSq Ft or multiplier Square Footage or Bid Amount Value Date CalcuJated Paee 1 of2 '.' . . CITY VI< ~rK11~uN~L1J . Building/Combination Permit PERMIT NO: COM2005-01040 ISSUED: 08/02/2005 APPLIED: 08/02/2005 EXPIRES: 02102/2006 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fpp~ P",id I Fee Description + 10% AdminIstrative Fee + 7% State Surcharge Perm ServlFdr 200 amps or less Amount Paid Date Paid $6.30 $4.41 $63.00 8/2/05 812105 812/05 Receipt Number 2200500000000001029 2200500000000001029 2200500000000001029 Total Amount Paid $73.71 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 Rpllllirpd upctioll~ I Rough Electric: Prior to Cover Final EJectrlc: When all eJectrical work is complete. 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 furtber 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. q--, ~/ r02-;;' S- Date Owner or ce;ltract~rs Signature Paee 2 of2 . .225 Fifth Street Springfield, Oregon 97477 ,/541-726-3759 Phone . ~~~9~~.:. ~'6&: : f4III't, "..,,~. '"' .. .:' . ~y of Springfield Official Receipt WVelopment Services Department Public Works Department RECEIPT #: 2200500000000001029 Date: 08/02/2005 1:45:21PM Job/Journal Nnmber COM200S-0 I 040 COM200S-0 1040 COM200S-0 1040 Description Penn ServlFdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Payments: Type of Payment Check Paid By LITE ELECTRIC SERVJCE Item Total: Check Number Authorization Received By Batcb Number Number How Received jmp 6828 Jn Person Payment Total: Amount Due 63,00 4.41 6.30 $73.71 Amount Paid $73,71 $73.71 8/2/200S Page I ofl . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01040 ISSUED: 08/02/2005 APPLIED: 08/02/2005 EXPIRES: 02/02/2006 VALUE: . Status Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5415 MAIN ST ASSESSOR'S PARCEL NO.: 1702334203300 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Qwest Power Pedestal 100 amps TYPE OF USE: Alteration Commercial Owner: QWEST Address: 3050 N DELTA EUGENE OR 97402 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor LITE ELECTRIC SERVICE BUILDING INFORMATION I License # of Units: # of Stories: Primary Occupancy Group: Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type Water Type: Secondary Construction Type: Range Type: # of BedVeWii'!fC E: Energy Path: THIS P~RMIT SHALL EXPIRE IF THE W~~kled Building: nla AutHORIZED UNDER 1 HI~ I't:I'~~t;';':'U~MENT INFORMATION I COMMENCED OR IS ABANDONL~, ~, FrontyarlliS\!t1IMdJAY PERIOD. Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Phone Number: 541-870-1403 Expiration Date Phone 541-688-8996 Lot Size: Sq Ft IsI Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROY..E.M.ENJ;'s"lquires you to f~li~;'r~ie~ adopted by the OreSI(ieM:i~~y'pe: . . , ' C t Those rUleS1fe set fordi Notification en er, OWl!sl!o'!1slDrains: in OAR 952-001-0010 through 0 n ';j;;)~-V . 0090, You may obtain copies 01 the rules b_ calling the center, (Note: the tel~~ho~e n' .mhM for the Oregon Utility Notllicallon ~ . 1...... -J jL.t:.v""t~/. I V aluati'j;~' D~;;riDtio-n -I Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Paeelof2 Value Date Calculated . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01040 ISSUED: 08/02/2005 APPLIED: 08/02/2005 EXPIRES: 02/02/2006 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project 1~'\f!o(fI:~ P~;d II If, ..... Fee Description + 100/0 Administrative Fee + 7% State Surcbarge Perm ServlFdr 200 amps or less Amount Paid Date Paid $6.30 $4.41 $63.00 8/2105 8/2/05 8/2/05 Receipt Number 2200500000000001029 2200500000000001029 2200500000000001029 Total Amount Paid $73.71 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. L..~~I1Jw;n..~tion'l 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 witbout permission of the Community Services Division, Building Safety. I further certify that only contractors and employees wbo are in compliance with ORS 701.005 will be used on tbis project. J further agree to ensure that all required inspections are requested at the proper time, that each address is readable from tbe street, that the permit card is located at tbe front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Paee 2 of2