HomeMy WebLinkAboutPermit Electrical 2004-10-20
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125 FIITH STREET. SPRINGFIELD, OR 97477 . PJ.I:(S41)726-3753 . FA-X: (541rn6-3689
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ELECTRICAL PERMIT APPLICATION ./71 7 . OAvl&::,-?/4'O",-" 10 -I a.o-(
City Job Number CoIA<z.ool.\- 0 12.8"7 Date /0//'7/ 01../ o~../""O':9.o... fJ
I J U . Q'a g,19
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LEGAL DESCRIPTION - A. ,'i~c~,~gl;j~~if~i,y,sif~@:::' ::ij;~f.f4~;~~~~;riF1I.:
17 0 L 31 L{ z.. 0 0 ~ 6 0 Servi~e 'n~luded ". 1&"",' /0 ~ ~":o< ,.
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JOB DESCRIPTION 1000 sq, ft. or less S::l$ 00
Each additional 500 sq, ft, or ~. .~, '0::;' , &:9
;1l"l1. MAli') ;S. S.oI:l'Nla""f'~ portion thereof ~
Pecmlts are nun-tran.'lifel"2ble Alld e:rpire if work is Eac.h MMUfaa'd H.ome or
not started withill 180 days of ilSuance or if wo.-k i.. Modular Dwelling Service or
Suspended'for 180 d.y.. Feeder
SSO.OO
2. If,~q~~fi.~~~~!t;~ii~~~t.ltj
,Electrical Contrnctor 51" Lu Q \ 1'''' A ~ ~raP
B. ~t~~;~~~l~?B~$ii~~i~:~i:~\{i~t~~~~?}~~(~.~j~~11~k~i
Expitalion Dmc
(0- oS
200 AmI'S or Ie.., . S 63,00
201 Amps to 400 Amps $ 75.00
401 Amp' to 600 Amp. S125.00 i\
6OJAmpstnlOOOAmps. S16ioo ~~
Pbone 5'4l. 1113_ <..j~1ol Over 1000 AmPsNolts S375.OO !l'-'f ,
. ~-I ENr_,f1t.t Only . $ 50,00 . Y ~
o loW rUI . regon I~ . . .
Notificati""ei4lt.wvJ~~~:E&ilE~~L~;;f,;;fX"'};~<:'''';';i;:!;TD';i',f'{:t;;,
~ CAR 9;;~;:;I'fllll~!o't'~:;~~rtJbtMfJ;:i;;;';';;';;;;"::""i ;.:';;<ti';;{)"."S:"';"i
090, YOU m~ns iR~lQhlftr13fJgROWcilrR~~~?1h
--aIling theiO!~hc~es OAR 952-01)' S 50.00
nUmber for 6P/ . sftd~fI9:tmW~ the rUles h)' S 69.00 '
. CenttiPts 1 (lo]~itly~~/ephon" . SIOO,OO
o~'~'J~?~~~~lts~~Tlt_~llove:. ". _'.,
D. f~1~~~:~~l~t~~\~~i1}1~~-~~1f~ffi~frr#~:~~~1~~f\f.~~:~:*1.~~~t~?J~~;~iq~p~~
s.
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Address
2.\'1 -^-'A.N
CIty A....~A.J-(
Supcrvi$or.license Number
12lJLE
Constr. Contr, Number
Jo<;<\\
'1-01
Expiration DOle
Signarure ofSupcrvil\iag Elcctrici811
~.~+-Jj--
- ( ...-'
Ownen;~,
Address 5: I? l.{ 2..
City '=S;?,::=-6\
I'fAM~ ~o.J
,/I114-llt( '>)'
New A1teratiou 0.- Extension Pe... rane.
One Circuit
Each Addiliolllll Circuit or with
Service or Feeder l'enni.
S 43.00
S 3,00
E. t~~~~~~@~;'~;r~~&~~K{~,t~{,~~~'ij~~~~dJ]I~~~~:,t~~~i~'~iif~1;
l'ump or irrigation S 50,00
NO T Si~n/Outline l..ighting $ 50.00 .
OWNER INSTALLATION THIS 'ftWiited EnergylResidenti.'II. $ 25.00
n,e instlllatlon IS being made on prop<:rty I own which AUTH Pfj).I";i.t,ep El1~~/Coml\\ercial I S 45 00 ~ ~~
. ded < I I C .OR/7r "'f-It1! I r,..
J!' not I11ten 101 sa~. ease or I en!. 01M.iJili;iumtEltctrk"Perm\f-1meecrinn Fee L~ $45.01) + SUI'Chnr~es
"'IV/t;^' . v1vl..'{;" "11 }'r- D
~ne'" Signature ANy 14Jrr~'$I0f/Ilijjlf;'1<f.Qr'14~W.f{[;1~f;Wtft;;;;~:E.'~",' .1 t-"
II u'/,*PfJffd,.,.,tj'l(f{DO//"t.v'!S' "'I6tt ,'" , ~ -
7% So"e Su,.i!ilaJ'se ED FOR l~__
10% Adminislr'tivc Fee ...j e
~
p)l(Ine
-yr
Inspection Request: 7Z6-3769
TOTAL
S-7.~
Sh:.uu.ll.'>li...c(T:)'Bwldin~ l~onn~/1::1Cl;tricul pcnnit Arrliclltinn l-t)3.dnc
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01287
ISSUED: 10/19/2004
APPLIED: 10/19/2004
EXPIRES: 04/19/2005
VALUE:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 3842 MAIN ST
ASSESSOR'S PARCEL NO.: 1702314200300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
PROJECT DESCRIPTION: Low voltage
Owner: JAMES DOBSON
Address: 3842 MAIN ST SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
law reo.tt.lfe:; v~t} ",',
Contractor TYP~TTE.fJolRi'liaot;9~nh\l the 6r~9( " ';' ." License
Electrical fol1owMAR\I1l~EgJJ!~t<;:, ",1M "j,_ "A' Ie .\1 40591
NotitiC~~~~_~~;':OO1 0 thrCluBUlLDING INFORMATION I
In QA btain caple:; VI ''', '
# of Units: 0090..VOU may ~ter. (Note: t\'># or'Storles:
Primary Occupancy <JFllli~9 the ~~e Oregon U\i!i\'~eightofStructure
Secondary OccupancJl~:for . 1.800-332.,,1)pe, of Heat:
Primary Construction Type Center 15 Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: Energy Path:
Sprinkled Building: nla
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Addition
Commercial
Expiration Date
09/28/2007
Phone
541-928-4544
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:
I PUBLIGm.PR()yI;;m;NlfSIIEXPIRE If' ~{\~v~O~
~'U'';''~O-R\ZEO UNDER 1t1I~i~i~lktl1iJW"':
" In R IS "'B"'NUUI~C 1
COMMENCED 0 0100 Downspoutsffirains:
",I'll' 180 OAl' PEn .
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project
Page 1 of2
Value
Date Calculated
.
. CITY VI' ~YKlNu1'lJ!,LD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2004-01287
ISSUED: 10/1912004
APPLIED: 10/1912004
EXPIRES: 04/19/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fp-p-s Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
Receipt Number
$4.50
$3.15
$45.00
10/19/04
10/19/04
10/19/04
2200400000000001312
2200400000000001312
2200400000000001312
Total Amount Paid
$52.65
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, Rp-ollirp-d Insnp-dinns I
Low Voltage: Prior to cover.
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 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 readahle 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
Page 2 of2
225 Fifth Street
SPri~gfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-01287
COM2004-01287
COM2004-0 1287
Payments:
Type of Payment
Check
10/1912004
.
RECEIPT #:
....~"~. '!"".~""'-''-' ....
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IJjJ,y of Springfield Official Receipt
Wvelopment Services Department
Public Works Department
2200400000000001312
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Paid By
MARTINVEST INC
Received By
djb
Page 1 of 1
Date: 10/19/2004
Item Total:
Check Number Authorization
Batch Number Number How Received
40910
In Person
Payment Total:
10:04:20AM
Amount Due
3.15
4.50
45.00
$52.65
Amonnt Paid
$52.65
$52.65