HomeMy WebLinkAboutPermit Miscellaneous 2005-6-1
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:'25 F1FrH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number COVl'\z..OO\'-\:)<::> bsb Date (/1 ~r.o S
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LEGAL DESCRIPTION 1 70 Z. ;, Z4 Z
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JOB DESCRIPTION
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Service Included
1000 sq. fl or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Permits are non-transferable and expire if work is Each Maoufact'd Home or
~ not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder
2 I;CONrkAcroR''rNsTXLBt. "rloN'O&iy) B. ris~t~fiiG,3F{,q'.l~~~)inst~?ti;;n, Altei-ati~iisoiR~lo~ititn;'til"
. . .. ^ "'C^'" ." c~o '...,'..... .'0. '~. OlegOl\ ~':o,'ego~fo~ft'~"""" ,. ',",' '. .' ," .' .' '.
Electrical Contractor (/) 1'- 'B,\e~O .~do~ted:lO'bs~Wl!lO~~9?Z-OO\' $ 63.00 Io~D'>>-
\~"0'l4 tU11l"cel\tel. 1261 ~ latllro ~ '0'1 $ 75.00
Address fo l>M L:>II-:'-'~ifICa.tiO'~')O\.oO\14o~l~tO\~~~e $125.00
"1\ O,,~ "'~~~~~'<\t~~~~~\~I\ $163.00
City 'T1'1~ Phon$0310go~-;~~bl(tOt\OO'liX~.0Ils $375.00
ca.'"'' \01 the OR~{'JIP~:ohW~I' $ 50.00
Supervisor License Number 4- ~;, I.{ Sfll\1:l1l1 cel\tel ~ ~iljnpoi-afy.s.e'n1c~ ~~F~(ie!s':.
Expiration Date
I 0 ~ b \ -"l...Do'7
Constr. Contr. Number ,y. 9 S C, 'L .
Expiration Date ~ ~ l S -0 (p
"t::"ij2'~~~
Owners Name ~ v' fr1v .-/-r.A L
Address Z7 f(~ Qv'(:;{L"'" A.. I ~ Ll
City t1A G-cr./e- Phone
$50.00
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volls see "B" above.
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E. f{~~qap:~'!~r:(S~;:Yi~~i~:~~~)I.~t,lilf!!fded),~E~.~h!Ii~t,;I!ati~J
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
OWNER INSTALLATION MQi\CE: Limited EnergylResideiltiailORIZ $ 25.00
I~ . c'.l~.1 \ I'~\"" It: "- ::..,. '" 1'401
The installation is being made on property I own.whichPtRMllhllmted Energy((;;,9,'!1merclal $ 45.00
. . ',"~ ."~n \ INDI'\'\ I l1\u ~,'~r\ ~(')P,
IS not mtended for sale, lease or rent. fl,C\.l0~3~~m(j'm,Jj~.,,,!;).~ ~\~~:~~:i,t~.I:S:~c,t:::..F.,,~e. \is. 545.0 0 ~.1' Surcharges
Owners Signature: 4: . SUBT(!)TAL'OP:ABOVEi"')"''':,,~,. ,- I ~'<'~
. fl,N'l '\'00 '" " ''''.''..'n.'~''"''c'''' "'"r.. """"'""'"4 ' .':. LV";>
7% State Surcharge Lf l( I
b'70
10% Administrative Fee -
"7 -. 71
TOTAL ~
Inspection Request: 726-3769
Shared Drive(T:)lBuilding FonnslElectrical Permit Application 1-o3.doc
. CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2005-00656
ISSUED: 06/01/2005
APPLIED: 06/01/2005
EXPIRES: 12/01/2005
VALUE:
-
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4684 MAIN ST
ASSESSOR'S PARCEL NO.: 1702324200103
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: 100amp service for Clearwire cell site
TYPE OF USE: Addition
Commercial
Owner: HOWAN INC
Address: 2783 RIVERW ALK LP
EUGENE OR 97401 .
1 CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor License
OK BROTHERS ELECTRICAL CONSTRUCT49562
I BUILDING INFORMATION I
# of Units: \a."" (9O.Vi\t~~t~;"
Primary Occupancy Grnup: \,\.OtagOll \'(Ia ~ii'rU~llnure
Secondary OccupanctB"eliP~O . dO?\ed 'o'j a (U\WY~d'9J~\.
Primary Constructio'!J~ tuleS ~ (\\et. 1'(105 ou't)IWilh'r'f~ '0'1
Secondary Constructi\ffi\l\~Rtl.::JlI ce \-O()\O \'(It ?i~dgl;"~lIe
# of Bedrooms: ~ol\ ~I'o 95'2.-()() a'ola.ill CO \e~\l.erl!Y~i4aiO(\
i(\ 0 () 'IoU tl\a.'j (\\at. ~O . \~",~li''BUilding: n/a
nn". .._n r.,e -;[''' v ~n^A\.
ca.\I\~~:\ot \'(Ia J.~ijj.MENT INFORMATION I
(\utl\ cell\et I.
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Disl:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
NOTICE: XPIRE IF THE WOKl\
TH\S PERMIT SH~~~ ;\1IS PERMIT IS NOT
AUTr\ORIZ~D UONR IS ABANDONED FOR
COMMENCED
ANY lBO DAY PERIOD
Expiration Date
09/15/2006
Phone
503-780-5524
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Pal!e 1 of2
Value
Date Calculated
*
. CITY OF SrlOl'\itJNl'.,LlJ
Building/Combination Permit
PERMIT NO: COM2005-00656
ISSUED: 06/01/2005
APPLIED: 06/01/2005
EXPIRES: 12/01/2005
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
FP~f p~
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$6.30
$4.41
$63.00
6/1105
611/05
611/05
Receipt Number
1200500000000000715
1200500000000000715
1200500000000000715
Total Amount Paid
$73.71
I Plan Reviews ,
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.
lJeouire~ In~n~~tinn~ I
Electric Service: Approval required prior to utility company energizing service.
By signature, I state and agree, that I have carefnlly 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 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 ofthe 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
225 Fifth Street
Springfi~ld, Oregon 97477
541-726-3759 Phone
.'
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Jl,tty of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200500000000000715
Date: 06/0112005
3:35:02PM
JI;b/Journal Number
COM2005-00656
COM2005-00656
COM2005-00656
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Perm ServlFdr 200 amps or less
Payments:
Type of Payment
Check
Paid By Reeeived By
OK BROTHERS ELECTRICAL djb
Item Total:
Check Number Authorization
Batch Number Number How Received
Amount Due
4.41
6.30
63.00
$73.71
Amount Paid
1511 In Person
Payment Total:
$73.71
$73.71
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6/1/2005
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