HomeMy WebLinkAboutPermit Electrical 2005-9-27 (2)
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: ,(541)72~9~~~L.v-\ T '.: " , ''j.-}' :"~f::
ELECTRICAL PE~T AP~ICATIbN " Date; - (:':.. ',";'
City Job Number l'...'?). rJ \ -,~B ',', D:ii'eonzed Sign' .
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I.. U)CATION'OF INSTALLATjON~ 3. ':COMPLETE FEE SCHEDULE BELOW','); ,
'-Yoor'~n\'if\_"'" "...w .."". "".- "''','' ..,.,' ,..--......"...""...... ". ..-'.- ..",.'.. ,'..,'
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. I 'J J~ u UV Service Included
JOB DESCRIPTION
J.u~ @-A
Permits ~transfe;able and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1000 sq. ft, or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
(, """'-:7\ ","~""""""1"7".~' ~"'_".'l t\'"' ...~.'I>. ;t"'....., ""V'l'" . ,~.....~.,."':"..
,'CONTRAdoR iNSTALLATION ONLY;;
2. u:......~___:'~Ho'" ''^'.:...:!-~'s....:O;..._L..:..\'>>...;.p'l;-.~..:L. ~lkiU-.'I!ST.--d
'JY.~"':4.7'I:O;Y~~ "~.;;.~':""''''<:'~: l<<~r. ',0-:':;' r:-(,;,o:...:'lT':""T('f..'l,~':.-mr. :"...-~-;:~Z"'~~':>'q"J<:t -r.. ~'":'-':
B. :; Services:or Feeders':::: Installation; Alterations or Relocatio~:~;'::';
"'_"~_';;'~.=~,~.. ~~""-"';:-d'.:.:":..J~: '.:..;>'~ "f...~J:i:=... ...~.l;r.t:::,~~",,:,,~, .,...~" .,:-'".
Electrical Contractor "1'\oll ) uJz 'l fLR,(' !/U.V 200 Amps or less.
. /J '1 201 Amps \0 400 Amps
Address r () .f yhl~ r-:2I5'O~ 401 Amps to 600 Amps
I
j 601 Amps to 1000 Amps
City vi "'tOf JU ~ Phone Sl/ I {.J;1a -;;? 365 Over 1000 AmpsNolts
o Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Supervisor License Number ,,-:J2 J~~~:r.1IT SH~l{f~~~~f~~';"F~~~S~:m~~J~~Jlf~t~~;c~~;0
Expiration Date _/0-0/-0 ~THOR'ZED UND~f{'~~ibgl:!frtI/:J.i;.wQilKelocation
P~MENGED OR I~OQto-.iri.p.s oH~MIT IS NOT $ 50.00
Constr. Contr. Number ~ '5 /0 R~y 1 se DAY P 101%\l~DtG/lOdJNrhlR $ 69.00
ER/QO'\.Amps to 600 Amps $100.00
Expiration Date 010 - d 7 -() 7 0 600 A 1000 V I "B" b
ver mps or D ts see a Dve.
> 7J2G ~~~~~~i~::~~:"
,/ / Each Additional Circuit or with .J
(\, .t'l. Service or Feeder Permit ::#' $ 3.00
Owners Name ~l-)
Address jbD \ \J...rU.l\ ~
City Phone -:J1:1o t~ Pump or irrigation $ 50.00
ON:Oregon law requires you !\illn/Outline Lighting $ 50.00
OWNER INST 10 oj~~l!l6 adopted by the Oregon Utilj~Y':ted EriergylResidential $ 25.00
The ins\allatiorNb\'lfhllll~@lJplbperiyhl3~ (;4JRIf are set 10tlIlted Energy/Commercial or ~.OO
is not intendediYlrGA.'R1952~lJ'lUOO10 through OARIWfril;J;\\l;\ Electric Permit Inspection Fee i~Surcharges
0090 You may obtain,copies of the rule~ P"~""~.l ',-,.:...'~',..,'".,:;;'J"....,_".-S.,.;, --~,
Owners Signature: '111 the center, (Note: the telepl1qr@~T(~TAL.9f ~Q~;,~i::;,};ir..;;';:;ii,::::. 4-~CO
::m::i::'4~:~:;rifl"'I~,:,;~:";,:c_. .n,'. -.. 4~ :.~
\0 \() L:::::> 10% Administrative Fee
Inspection Request: 726-3769 TOTAL F3'L.(P
>'l;. .'^'\'{,'-'"....i:'T-,.;~!Y";'\"\.~..-;....~.,'r.v::r...~~~e:;.-.,..r.-A'l11~.. ..'...,.~..c~ ....'l,. 1:" ,"'~.
E. . 'I\1iscella~eous (Sen::ice/feeder-'notinchided) ":':'Ea'ch I~stallation '';
_'::"1:',"'Ar:.H..':,.._':::-,~'-;~;0,."":,, ,"'>':'..iI".."(,;;,o._'lj-;(,.,.",: ,''Jd''~,.'.~:' ",,,,,"".'\.."'-.;", .\.\:1,:"&' .,to,.>..... >..;.',
Shared Drive(T:)/Building FonnslElectrical Pennit Application I.03.doc
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01318
ISSUED: 09/27/2005
APPLIED: 09/27/2005
EXPIRES: 03/27/2006
VALUE:
.
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone'
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1001 MAIN ST
ASSESSOR'S PARCEL NO.: 1703354105300
Springfield TYPE OF
Electrical Work Only
PROJECT DESCRIPTION: Lights at Annex Building - One Circuit
TYPE OF USE: Addition
Commercial
Owner: SPRINGFIELD UTILITY BOARD
Address: 223 A ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
NEW WAY ELECTRIC INC
License
51088
I BUILDING INFORMATIONI
# of Uni1s: # of Stories:
Prima"Occupancy Group: Height of
Secondary Occupancy Type of Heat:
Primary CO,ffi(ruction Type Water Type:
Secondary CWltlil~n Range Type:
# of Bedroo~L~ PERMIT Energy Patb:
~.;,~ORIZf:f1 ~~~~LL EXPllJt; .;a; _ Sprinkled nla
ANy 1~tNCED OR IS ~ rHIS PFbbt.~iJ(!)~ENTINFORMATlON I
i 0 DAY PERIOD BANDONED FOv ,VUr "
Frontysrd Setback: . ROverlay Di~
Side 1 Setback: # Street Trees
Side 2 Setback: Paved Drive Rqd:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks:
f~;;; t:NTtON: Ore IPUBLIC IMPROVEMENTS'
. N '. W rUles ad gOn Ja'V
Street . olifJcation C OPted by th reqUires y
In 04R 9 enter r, e Ore Ou to
Storm Sewer Av,,--U,lIJ>be: 52'001'00' hose rUles 90n Utility
Special Instruction:, I" YOU may ob 1.0 thrOUgh 0 are Set fOrth
La ling th lam c' llR 95
, nu e cent oPJes of 2'001
Notes: mber for the oer (Note: the the rUles b -
C"nl~,. reQon II."" teleoh"". Y
'V l-dOO,~"t~1f;Z~~~~lJeSCriDtion I
Phone Number: 541-746-8451
Expiration Date
06/27/2007
Phone
541-686-2365
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
Description
$PerSqFt
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
1 of 2
Value
Date Calculated
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CITY OF SPRINGI<u.,LU
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01318
ISSUED: 09/27/2005
APPLIED: 09/27/2005
EXPIRES: 03/2712006
VALUE:
Total Value of Project
Fp.p.s Paid I
- Fee' Description
... + 100/0 Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
MinlmumlAdjnstment Electrical
Amount Paid
Date Paid
$4,50
$3.15
$43.00
$2.00
9/27/05
9/27/05
9/27/05
9/27/05
Receipt Number
1200500000000001403
1200500000000001403
1200500000000001403
1200500000000001403
Total Amount
$52.65
I Plan Reviews I
To Request an inspection caD the 24 hour recording at 726-3769. AIl inspection requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. wiD be made the following
work day.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
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 m accordance
with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaming to the work described herem,
and that NO OCCUPANCY wiD 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 reqnested 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 wID remain on the site
at all times during construction.
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
. .
" SpnngfieId, Oregon 97477
541-726-3759 Phone
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8f~,'~.!'I_q.F1...~.) .._____.,_.:,',
Wir- I
",~.'~ .
',~ J
_ity of Springfield Official Receipt
.eveIopment Services Department
Public Works Department
Job/Journal Number
COM2005-0l3l8
COM2005-0l3l8
COM2005-0 1318
COM2005-01318
Payments:
Type of Payment
CreditCard
;.
'c
'r
'i
9127/2005 '
RECEIPT #:
1200500000000001403
Date: 09/27/2005
Description
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
NEW WAY ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Ilh 027890 Phone
Payment Total:
I of I
11:12:35AM
Amount Due
43.00
2.00 '.
3.15
4.50.
$52.65
Amount Paid
$52.65
$52.65