HomeMy WebLinkAboutPermit Electrical 2004-8-24
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2-25 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54.P~6-368~:{~
ELECTRICAL PERMIT APPLICATION . % ~, ~ <1o!g" ", ~" ",,:,
City Job Number r f"'IuVf 7 {')n 3 - C> //7 ~ Date 6/r'l 'Ii} V~, ~ '\ '. .
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1000 sq. ft. or less _ $IO~~
I ? r.1'7 /" . .l- Each additional 500 sq. ft.,or ,~ y (0 ~
'i2occ""V\csc..X- ..:> '-' 'L.L.J,^."S portion thereof '\ \$ . 9.0~ ,;,
Permits are non-transferable and expire if work is Each Manufact'd Home or
;, not started within 180 days of issuance or if work is Modular Dwelling SerVice or $50 00
Suspended for 180 days. Feeder .
2 l;'CQNjAACT7)R;rNstALiXtroN~~JiCe:R.MJT B1J Se[vi~es oYFeede~s'-:~Insialiatioi1, Alteruiions or Relocation:' "1
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Electrical Contractor (f:kY.....Akd1.. <C cm,~ZEO UNf3liRtIpljSr~MIT IS NOT $ 63.00
-~ ' . \ CEO OijdS~NOOllf&POR $ 75.00
Address f, 0 \ <<?'o)(. '2.<'0 4 ANY 180 DAY PE.ftIlIDnps to 600 Amps $125.00
, I . ,./ 601 Amps to 1000 Amps $163.00
City VJ\4-l-ktl.lI\ (~ Phone 71.{ L( -07 o~ Over 1000 AmpsIVolts $375.00
Reconnect Only $ 50.00
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LEGAL DESCRIPTION
17033. h4Z-
0-:'/00
Service Included
JOB DESCRIPTION
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Supervisor License Number 3<:0(; ~ - S
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Expiration Date
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Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Constr. Contr. Number
Expiration Date I 0/101 cJ U
Signature of Supervising Electrician
Over 600 Amps or 1000 Volts see,~:B:above.
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PO~ii~A $50.00
Sign/Outline Lighting ~ $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Comnierclalh , $ 45.00
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Owners Name AAilA,Cd [h,Q.l,j
Address z..z."\ 1M r4-r1l/ '> I
City c;.pF~) Phone
OWNER lNST ALLA TION
The installation is being made on property I own which
is not intended for sale. lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
. 4.!&~TQ.tAL(jFAIi?Vf' "" . .: j 57
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n.~~ '\S~ 10% Administrative Fee 5'70
Inspection Request: 726-376~ A~ \.~ TOTAL ' /-, /9.}..
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. CITY OF SrK11~hH~LJJ
Building/Combination Permit
PERMIT NO: COM2003-01178
ISSUED: 04/09/2004
APPLIED: 11125/2003
EXPIRES: 10/09/2004
VALUE: $ 45,500.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2251 MAIN ST
ASSESSOR'S PARCEL NO.: 1703364203100
Springfield TYPE OF WORK: Restaurant
TYPE OF USE: Remodel Commercial
PROJECT DESCRIPTION: Interior renovation & site work - for additional parking see permit# COM2003-01210.
Applicant is N & S Enterprises
-Added $20.00 credit to be applied to future fees, since applicant wrote check for
$20.00 over required amount. SWB
Owner: ASAYED YASER
Address: 12932 S W WINTERLAKE DR TIGARD OR 97223
Contractor Type
General
Engineer
I CONTRACTOR INFORMATION'
, Q,\\;;
Contractor ~ ,,\\\'t.\l'I: ~~nse
FRED GREENINGER t"'\l\~~~"'~\' \~~0284
ACCESS~E~~y;),..\._ '<"\'S \l ~.\~\l ~~.,
,,~~ \>~\\~~kBt:lkDiN6\}NFORMA TION,
'\"'~\\C1~\&...r ~ U~:! ~.
. ~\S 'fA~'f;,~C€ ~ ~tories:
,,();~ \~\) l;)~ Height of Structure
~ Type of Heat:
VN Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Expiration Date
12/20/2005
Phone
503-283-1914
485-3215
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Ocsupant Load:
nla
Street Improvements:
Storm Sewer Available:
Special Instruction:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Notes:
Pal!e 1 of 4
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Estimate
Estimate
Pavine:
Tvpe of Construction
Estimate
Estimate
Use Bid Amount
Fee Description
Plan Review CommlIndlPublic
Plan Review Fire & Life Safety
Deposit
Planning Final Ocey Inspection
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Return - Deposit
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Building Permit
Fixture
Inspections - Investig. Bldg
Inspections - Investig. Electr
Inspections - Investig. Plumb
MinlmumlAdjustment Mechanical
Paving
Penalty Fcc - BWOP Building
Plan Review CommlIndlPublic
Plan Review Fire & Life Safety
Storm Sewer - 1st 50 Feet
Vent Fan
Encroachment Permit
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Penalty Fcc - BWOP Electrical
Service Reconnect
Total Amount Paid
.
. Uly'OFSPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01178
ISSUED: 04/09/2004
APPLIED: 11125/2003
EXPIRES: 10/09/2004
VALUE: $ 45,500.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
$1.00
$1.00
Square Footage
or Bid Amount
3,000.00
27,000.00
15,500.00
Value
Date Calculated
$3,000.00
$27,000.00
$15,500.00
$45,500.00
03/29/2004
03/29/2004
12/2912003
Total Value of Project
Fpp<. PiIilLI
Amount Paid
$120.51
$74.16
$20.00
$118.00
$10.00
$976.27
$1,433.82
$571.57
$7,346.15
$1,665.23
$-20.00
$10.00
$87.75
$32.88
$253.65
$126.00
$45.00
$45.00
$45.00
$33.00
$154.20
$253.65
$44.36
$27.30
$45.00
$12.00
$120.00
$5.90
$4.\3
$9.00
$59.00
$50.00
$\3,778.53
Date Paid
Receipt Number
1200200000000002511
1200200000000002511
2200200000000001919
2200200000000001919
2200200000000001919
2200200000000001919
2200200000000001919
2200200000000001919
2200200000000001919
2200200000000001919
VOUCHER #71290
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000000346
2200400000000001051
2200400000000001084
2200400000000001084
2200400000000001084
2200400000000001084
2200400000000001084
11125/03
11/25/03
12/29/03
12/29/03
12129103
12/29/03
12/29/03
12/29/03
12129103
12/29/03
1/7/04
4/9104
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
4/9/04
8/16/04
8/23/04
8123/04
8123/04
8/23/04
8/23/04
Pal!e 2 of 4
. CITY OF ~rKll~ul'mLJJ'
Building/Combination Permit
PERMIT NO: COM2003-01178
ISSUED: 04/09/2004
APPLIED: 11/25/2003
EXPIRES: 10/09/2004
VALUE: $ 45,500.00
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fire Department Review
Initial Review
Planninl! Review
Public Works Review
Structural Review
I Plan Reviews I
12/24/2003 OK
1210512003 APP
12/12/2003 APP
12/19/2003 APP
1211112003 WE
GRG
LLH
EMM
SB
JMP
12/10/2003
12/05/2003
12/10/2003
12/10/2003
12/05/2003
Structural Review
03/29/2004
03/29/2004 WE
TCM
SUB Review
12/1012003
12/16/2003
APP JF
See attached document.
Kay Bork Planner DRC2003-00044
Received from Dave Puent on
12/1012003. 12/1112003 JMP called
Wade Holaday at Access
Engineering to ask for sheet C3,
correction in accessible parking
dimensioning, and contractor
Information. 12/1712003 JMP left
message for Michael Welshar at
Access Engineering noting
differences in Cl submitted with
final site plan set and the
requirement for a dimensioned
drawing of the Interior. 12123/2003
received a scaled Ooor plan.
12/29/2003 JMP left a message with
Loretta for Michael at Access asking
for the change of use/occupancy
report. .
Mechanical not provided. Revised
plans submitted.
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.
IRPn~
Final Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required Inspections have been requested and approved and the building is complete.
Rough Plumbing: Prior to cover and including required testing.
Sanitary Sewer Line: Prior to filling trench and Including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work Is complete.
Underslab Plumbing: Prior to filling the trench and including required testing.
Final Paving: After paving Is complete.
Storm Sewer Line: Prior to filling trench.
Final Building: After all Conditions have been completed as required on Development Agreement.
Pal!e 3 of 4
.
. CITY 01' ~rRINGFIELD .
Building/Combination Permit
PERMIT NO: COM2003-01178
ISSUED: 04/09/2004
APPLIED: 11125/2003
EXPIRES: 10/09/2004
VALUE: $ 45,500.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspectlon Line
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 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 4 of 4
225 Fifth Street
I Springfield, Oregon 97477
541-7.26-3759 Phone
.
~
Job/Journai Nomber
COM2003-0 1178
COM2003-0 1178
COM2003-0 1178
COM2003-0 1178
COM2003-01178
Payments:
Type of Paymeat
Check
8/23/2004
RECEIPT #:
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
2200400000000001084
3:07:22PM
Description
Penalty Fee - BWOP Electrical
Service Reconnect
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
GLEN CAMPBELL
Received By
djb
Page I of 1
Date: 08/23/2004
Item Totai:
Check Number Authorization
Batch Number Number How Received
Amount Due
59.00
50.00
9.00
4.13
5.90
$128.03
Amount Paid
3527
In Person
Payment Total:
$128.03
$128.03