HomeMy WebLinkAboutPermit Electrical 2004-9-29
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SPRINOPIIILD r-""~
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225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION Clh . /
City Job Number (OJf'l ZoO If- ()' Z I \ Date f 2- ~/ 0 l(
1. I ,'COCATIOS: o'F,'INSiXLiAtio'/t; ,',;;i 3, ~~Q"M ..p,.-~f.E...:',i,'b,"FE,)l";sC,'HEijiJ, ,LE",,' 'Hj{t.p'lv.,,<..r,~ =,'; ":"'" ' "
~ftT~q~".miW' "\~f~ ,... ~~ ~=~,~y"r"~-c-~-~~;~:--'~~'~~ '"r -~.,
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JOB DESCRlPTION 1000 sq, It or less ' ~G", '9. O/~G~6,OO
l'.l Each addItional 500 sq, ft, or 15'~ "\. 9",~ ~i..
Cif L U ; ], portion thereof "",~ , "\. f\o~~
Inf <.. "':'(9 c;:: &C'*~..r~
, Permits are uou-transfera e aud expi ' 0 i J' Each Manufac!' d Home or ~':l "\ ~ '::\
" not started witbin 180 days of issuance or if work is Modular Dwelling Service or "~$ 00 ~.,::~""
Suspeuded for 180 days. Feeder , <, 'G" 'i>
2. ~SQNwH:.?;~~'lli#@.ti~?~f.t""l B, ~iyi~~(~_~~F~eder~;;;~'h~~I!~ti?!,Ji Aii~~,~~, '~\.R~~.t!9!': .',1
~ ~ "~,,.
Eleclrical Coutractor 200 Amps or less $ 63,0
PI 017 201 Amps to 400 Amps $75,00
Address 0 '0 y. lP ~ I 401 Amps to 6oo9'tmps $125,00
. '" 'l'l\l""
IILU "'n L1 ,J 601~'Wi\S~6~~'t.mps $163,00
City ~~~V 111l Phone 7 7\J~ :\7~~~;;:~':?J~VOlffi " " ~357g~~
Supervisor License Number ~t m.~~~~~~~J~jDP\l~:iiY.~se:r'ice~6:':)'~~!lej:s; ,"J~i7,;"".:'~i
Expiration Date ~/ D - 0 7 I'Ir,\l~~;(\ ~~i '? Installation, Alteration or Relocation
Constr, Contr, Number /3' ~ LJ 'f~ ,~ ~~~ :~: ~: ~~~ Amps
, I 40 I Amps to 600 Amps
Expiration Date I ^ (1 "-f
-J-.t,' - ../---.j Over 600 Amps or 1000 Volffi see "B" above,
ignature of Supervising Electrician D. Fi(f~IJ:c~~~i-f.cmts.;>"t'l: ':" ~:;r '-.,,~,;: : ~;.... :~~~.;'<"
[)htAiLJ 'h\~
ers NameqA fed ( rr /
Address ? 0 a. ~ li 'S h '7
City ,11-0"" \-..-.()CPhone
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$ 50,00
$ 69,00
$100,00
'"..\
' ,
Inspection Request: 726-3769
New Alteration or Exteusiou Per Pau'i!, \~
One ClrcUlt ~t"" 'l1'~;~~~3,OO
Each Additional Circuit or W\\!p.\) r:o;2 ~~o~~ '
Service or Feed~ ~rg\\t\~:\~0 ~~; ~ ~ .~~~O
E, r'~i~,~~~~g~~s~~~'~h:l,nst~ll.ti~d
PIiiit>l~e~I~\"~~ i\~ cO~\('.. \~0 ~~~ 50,00
Sig\gQutllft\" n..I:t,ntZ 0'0'-' , ~o \ \'i.~\'I.~r;.~ 50,00
~o" ~ ~~<>~ ~0" o~ -- .--
LilIDtemergy>Ks..'iidl!ll'tli!,b\0g f:)~!~.g; $ 25,00
Lim~~.;r~~'&~i~ \"~ $ 45,00
c:<>' 0\ '1.0\
Minimum Elec~~rm~spectiou Fee is $45,00 + Surcharges
4. tW~:tql1PjF~<<;i~~;::t, _,:,:'S,,,~~j LIb
7% State Surcharge '5 Z <
~ ~ ~~:~::ministrative Fee )~b:Z
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OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
.
· CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01211
ISSUED: 09/29/2004
APPLIED: 09/29/2004
EXPIRES: 03/29/2005
VALUE:
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4124 MAIN ST
ASSESSOR'S PARCEL NO,: 1702323201200
Springfield TYPE OF WORK: Electrical Work Ouly
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION: Add 2 circuits
Owner: SHELL OIL PRODUCTS US INC
Address: PO BOX 4369 HOUSTON TX 77210
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
BURRELL BROS ENTERPRISES INC
License
136446
Expiration Date
08/20/2005
Phone
541-747-2724
BUILDING INFORMATION I
# ofUolts:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
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 Garage/Carport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENTlNFORMATION I
Frontyard 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:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pal!e I of2
.
.
-
Lu r OF SPRI1'thHI!,LD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2004-0121I
ISSUED: 09/29/2004
APPLIED: 09/29/2004
EXPIRES: 03/29/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726.3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
I F....~ tiLilU
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Receipt Number
$4.60
$3.22
$43.00
$3,00
9/29/04
9/29/04
9/29/04
9/29/04
1200400000000001413
1200400000000001413
1200400000000001413
1200400000000001413
Total Amount Paid
$53.82
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.R..olJir..tI \iI,.o..~tjon~ I
Rougb Electric: Prior to Cover
Final Electric: Wben all electrical work is complete.
By signature, I state and agree, that I have carefully examined tbe completed application and do hereby certify tbat all
information bereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
tbe Ordinances of tbe City of Springfieid and the Laws of tbe State of Oregon pertaining to the work described berein, and
tbat NO OCCUPANCY will be made orany structure witbout permission oftbe Community Services Division, Building Safety,
I furtber certify tbat only coutractors aud employees wbo are iu compliance with ORS 701.005 will be used on this project.
I furtber agree to ensure tbat all required inspections are requested at tbe proper time, that eacb address is readable from tbe
street, that tbe permit card is located at tbe front of the property, and the approved set of plans will remain on tbe site at all
times during construction.
Owner or Contractors Signature
Date
Pal!e 2 of2
.
225 Fifth Street
SjJringfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-01211
COM2004-01211
COM2004-0 1211
COM2004-01211
Paymeuts:
Type of Payment
CreditCard
9/29/2004
RECEIPT #:
ir~
1200400000000001413
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
JOSHUA BURRELL
Received By
djb
Check Number
Batch Number
Page I of I
.. of Springfield Official Receipt
~elopment Services Department
Public Works Department
Date: 09/29/2004
Item Total:
Authorization
Number How Received
099629 In Person
Payment Total:
3:14:48PM
Amoun~ Due
43,00
3,00
3,22
4,60
$53.82
Amount Paid
$53.82
$53,82