HomeMy WebLinkAboutPermit Electrical 2005-11-21
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The following prOject as su. p cHic land use
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689
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ELECTRI~PERMITAPPUCAT10N '/ l' ,,,,"MOO 519
City Job Numbef CO~"2':' c> c;- - 0 I b 23 Date I' 21 0 C
I
1, ~jfoCATf6N;,OFliNST7i.j;r~TiOMt,,'lt;!;,J!t'~, 3, ttfcoM]>[;f;'iiXFE'E'SCHEDi'J'iE'liEECJ'ffi' ,:t
~""'_.~"'~""''--~~I.'~''''_'''';pO -., .~_.~ ~"'''''''.fTV~f.~'~''''''''''''''''' ~~""""'''fn.:J.~___=''''1,",':r!~~'' ~-..:/!.'
~70 I M ,A-(N "5>'1
LEGAL DESCRIPTION
170 Z. 3"3.4 I
b 31 0 (
61il?"'\'''"'C'--' "'"~~~"'.<\\,'~'~ wlli '
A. ~~IR..~idejf!1.~~in.~~~1l}'!~!!!iEa!!illy",Pk.d,{r?!pj1~!!.i~."~f,
Service Included
JOB DESCRIPTION 1000 sq. ft. or less
r c Each additional 500 sq. ft. Of
UIAA. (? ,?"......6'L ~ ~... '> ;-r'l..tP@ionthereof .
Permits are non-transferable and expire if work Is . W +- Each Manufacfd Home or
;, not started within 180 days of Issuance or if work Is Modular Dwelling Service Of
Suspended for 180 days. Feeder
$106.00
$ 19.00
$50.00
'2 ~~Q~crOR~TjT!Ztw@@yjl ,B. ~~~'tlF,~'€f~fIfi~~iliti~;cr;1'iftfu~~lI'tRB~fu~'\l
. ~~~o<<~i<lM~,t<>:l_~~<t;.lt\-:.4':"'\,*,",,\~'-"'~"-''''''''''''i}:';;,~ ~"_]fi.~,..~'UP.\~!f"~~~-Q(.,~_._,.~-,,._-.~_~A"'~,~"",vV;l.":'- ,~-~
Electrical Contractor ~/ "'7 6/..-//#, WTEN-n?9~S orless. "$ 63.00
" 1261 Amt;gSiOb~A1J3J1U1re5 you to ' $ 75.00
Po IS )( 2.9 follow ru,,,,,, aoopted nil M Oregon Utility
Address 0 / tJ . . ~lotificatio1Pt~m.tor~1W5e rJ1~s are set TUrin $125.00
. In,OAR 95@!J~~ ~1.9g2.1WPbAR 952-:;:;- $163.00
Phone (/1f9 '..if7ac~. YOl.()y,eryIQQQ<A'PP.~~\lsofthe ruler L $375.00
, , ". calling t1l,"-"Q~~JP~~l.'ote: the telepho:'_-' $ 50.00 .
number ffJr tho n,.o')^[' j "'1",/ "-""u.!il ..
M~""''''~''''='''''''''~ ,- ..~' "'..1\"-..>....~.,)!;.l'''..'p~!t!jf:'::,j
G;~~Il.'!t!!:Y;j,~E!i'jc~~'f~f!!~:t~J"',i.."'~ ~~,;..!),1:ifl>:'~-G;'...,..; -C,"',i\ -::-:-::
. h j"./"""" ..,
City ~~
Supervisor License Number
5io3
s
Expiration Date / tJ - ,/ - ;L 0 0 7 '
Constr. Contr. Numbef
/~17i-/<j
Installation, Alteration or Relocati?n
200 Amps or less I
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D,~:r~Wsgillr!!ll~)~,~;,~~~~1$..-i~",~~~'i\,'iiit~~
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit Of with
Service or Feeder Permit
$ 50.00
$ 69.00
$100.00
S-C>:
Expiration Date /0- I;).. :... 2. 0 0 ~
Signature of Supervising Electrician
1M1>~-'
owners:am: WL~~!.' Tk~~L
Address "2 <? ~ b C V to Sc.t:">-o- -I- /tJ
t:;-u.(--cH t!
$ 43.00
$ 3.00
E. ~~lliffif8'f1s~""~~e1~d#;1fi:t'lii~iifdr.l)"'';E''a~li'i~jjti'':Aii
,_,~!<,~~__~__"i-. ....,,-""_~_.,~.......-- ,,,,-;__,.;cn'.>'\1>=,",,_R~~-~)"'>,,'.;,>-"_"~"'-,,*~
7% State Surcharge
10% Administrative Fee
? S'..
50,,",
Inspection Request: 726-3769
TOTAL
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Shared Drive(T:)lBuilding FonnslElectrical Pennit Application l-Q3.doc
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U 1 't' OF SPRINGFIELD'
Status Issued
! 225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Building/Combination Permit
PERMIT NO: COM2005-01623
ISSUED: 11/21/2005
APPLIED: 11/21/2005
EXPIRES: OS/21/2006
VALUE:
SITE ADDRESS: 5701 MAIN ST
,ASSESSOR'S PARCEL NO,: 1702334103101
Springfield TYPE OF WORK: Use Initials
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Temp power for xmas tree lot
Owner: MCDONALD'S-THURSTON
Address: 2896 CRESCENT AVE STE 105
EUGENE OR 97408
Contractor Type
Electrical
I CONTRACTOR INFORMATION I
C t t NOTICE: ~.Ii'x - t- D t
on rac or IT SHALL EXPIR MWOM-Plra Ion a e
MICHAEL DA V~2 '1~~~~r> TU'C: Hllr Ie MnT 10/12/2006
COkl.....lUu...,.... ""\r.vMAo\>jMI~"1J FOR
AH't 189 ~Yo~OD.
Phone
541-689-4708
,.
, # of Units:
Primary Occupancy Group:
, Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
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 GaragelCarport
Sq Ft Other:
Occupant Load:
nla
, DEVELOPMENT INFORMATION I
Front yard 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:
Notes:
. es "oU to
._.., ..onlllf y
-... '- l)1t::~v,' .-- n Ul\lllY
I PUBLIC IMPn,<J,v<Jj,lnl!,ln I> I opted by the Orego set lorth
10\\U"''' \....-- -~ f"\~p rU\P.S are
'r tion Center. Sidewalk ~~e~ 952-001-
Notl,\ca 1 0010 ttlroug r" \ by
. OAR 952-00 - DowDsnnutsJDf'ahWes
\n bta\ll '-v",'''' e
0090. You may 0 Note: the telephon
calling the cente~'e (on Utility Notification
number lor the01_ioo_33Z-Z344),
, r.enter IS
I Valuation Descrintion I
:
Street Improvements:
Storm Sewer Available:
. Special InstructIon:
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pallelof2
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2005~01623
ISSUED: 11121/2005
APPLIED: 11/21/2005
EXPIRES: OS/21/2006
VALUE:
=
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fpp" P3id I
Fee DescrIption
+ 100/0 Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
Amount Paid
$5,00
$3.50
$50.00
Date Paid
1I/21/05
1I/2II05
1I/21/05
Receipt Number
2200500000000001602
2200500000000001602
2200500000000001602
Total Amount Paid
$58.50
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.
~uirpd~
Temporary Electric: Approval required prior to Utility Company energizing pole.
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 berein, 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 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
Pal!e 2 of2
2i5 Fifth Street
'Springfield, Oregon 97477
541-726-3759 Phone
.
~
aty of Springfield Official Receipt
.evelopment Services Department
Public Works Department
RECEIPT #:
2200500000000001602
Date: 11/2112005
8:13:06AM
Job/Journal Number
, COM2005-0 1623
iCOM2005-01623
. COM2005-01623
;
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Temp Power 200 amps or less
Payments:
: Type of Payment Paid By
:CreditCard FINLEY ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 011251 In Person
Payment Total:
Amount Due
3.50
5.00
50.00
$58,50
Amount Paid
$58.50
$58.50
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ll/21/2005
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