HomeMy WebLinkAboutPermit Electrical 2003-11-7
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225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
COIM z.co3-c.\\ )2~ Date
City Job Number
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I. ,''LOCATION.OF:INSTALLA1'lON,.. ;"",,,,"'~
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JOB DESC!uPTION
tfaJlI.~~~./$MpA~ i1~k;.
PermitS are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
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Electrical Contractor VrOCfSS- dI,~
Address va. i:x-....L
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Phone 135'-76 d /
City
Supervisor License Number
l/'7.?/os
Expiration Date
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Constr. Contr, Number /~-I 7<'--0
Expiration Date q, (1. ,;J.oO~
Owners Name
Address 5 PI21 /lfG- I3l.1 [)
City -6A..6trifE('" Phone
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OWNER lNST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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3. ,;COMPEETE;FEE'SCHEDULE'BELOWi"'-':;'2-"~'"
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Service Included
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
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B. l~fiJs~~~~~~~e,f~~ffL~\~!~~~H~,Jl~I~~~!\!!-~.t:u~,~~.s_;gr~~~~B~~~~~;~
200 Amps or less 2' $ 63,00
201 Amps to 400 Amps I $ 75,00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps "a\) \0, $163.00
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Over 1000 AmpsNolts ~0o.\)' r:/' U . _<;\$375.00
Reconnect Only (\ \~'I'l Ol0g _ <;0'- ':0$ 50.00
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c.' :r.Binp'ora'.'~r.iilS.\lr. rv;c'es:orcl'.eeders' '~"N'~,"c'~",..,.:, ,', ;.~ ';',.c ~<"i
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\OIIInstallatlOn,.A1lera lIon 'or -RelocallOnO\'\'
~0\~\ff.~l?s-~~I~Sl'O~0a.:' '\~o\~;~,\\\'l ~"A'\. $ 50.00
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(\ '201 Ainp~ to.:WO)~p'S}~O " n.,~~.t.-u $ 69,00
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0'401 Ain-ps.... to.600~ps _~v $100.00
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Oyerj600 Amp) or 1000 Volts se<;.:'B" abov~: .
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7 s:;; CO
New Alteration or Extension Per Panel
One Circuit ;F- $ 43,00
Each Additional Circuit or with lAD 20 CO
Service or Feeder Pennit I'D $ 3,00 c....:>.
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Pump 'orJrrig~0'n~\ U~~t.\'I '\ 'l')(\~t.i j<t.\lo
SignlO~t1~\WlIlit1rliP 0\'1 \S (1..\)1'1 $ 50.00
Limited !E~ergy~~~tialc:\\\Q\). $ 25.00
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Limited Fneril~\tiercial $ 45.00
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Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
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:J 31. OD
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;)70.:;).,
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FonnsJElectrical Permit Application I-03.doc
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.
CITY OF ~rK11~ld<mL1J
Status
Issued
Building/Combination Permit
PERMIT NO: COM2003.01124
ISSUED: 11106/2003
APPLIED: 11106/2003
EXPIRES: 05/06/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1124 MAIN ST
ASSESSOR'S PARCEL NO.: 1703354104400
. Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
PROJECT DESCRIPTION: 400amp panel, 2- 200amp panels and 10 circuits
New
Commercial
Owner: PETER KRYL
Address: 3474 SPRING BLVD EUGENE OR 97405.
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor License Expiration Date
PROCESS AUTOMATION INC 151750 "n'V\~... 09/19/2004
BUILDING INFORMA TION>, ?'-"o~ 0~~,~(\,
\'3-~' O\'d~ \0" ~O
# of Stori~SjeQ,o~ 'Oi \.'(\0 ~\0S ~ ~ "!JS ~!ioi'Size:
Height;!!f.Stru\',ture S0 \ 1(\ 01'1 ~0 \~ :\9IFt 1st Floor:
~~ji'e00! ~ea~'\ ,"\'(\~'(\\o'V~ SO'" ~0~:~ai.!\f2nd Floor:
~'i'~~!!,r-'I;~p"e:,0 0\0" cO~\~~0\0 o\\"Sq FtBasement:
,0\\CR~'\.\l~;TYI!lS:"O :o\iv(\ 'l!AO\0' ,~\\i ~ b.b.'ISq Ft GaragelCarport
o'i.~!!liter~fPathJ~ 0 '!,.0\' \l 0(\0" ']:'l.'O Sq Ft Other:
~ o"'~" o~ \\\ cf~{' 0\0~ ,\\)''0'3 Impervious Surface Area:
('\ '" '\ 1c,,"{i!1 __I> 0.\.1
Phone
541-935-9321
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
SETBACKS
I DEVECO.BMEN:f'INEORMATlON ,
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
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I PUBLIC I~R<V-EMfl\'fS.t:-\\\\~ \'~~~\) t\)l'\
~~\~ 'il~~~~\) '0~\,-\~ \lSia~~alk Type:
\>.'0\~ ~t.~e,t.\) 'ilt.~\\J~ownspoutslDrains:
e,()W\ \ ?l~ \)\>."
\>.~"
(I.:v.'" \
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
REQUIRED PARKING
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descrintion I
Description
Type of Construction .
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pa~e I of 2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Perm ServlFdr 201 to 400 amps
Total Amount Paid
.
.
U 1 f OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01124
ISSUED: 11/06/2003
'APPLIED: 11/06/2003
EXPIRES: 05/06/2004
VALUE:
I Fees Paid J
Amount Paid
Date Paid
Receipt Number
$23,10
$16,17
$30,00
$126,00
$75.00
11/6/03
ll/6/03
ll/6/03
1116/03
ll/6/03
1200200000000002430
1200200000000002430
1200200000000002430
1200200000000002430
1200200000000002430
$270,27
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 Reouired I nsneetinns ,
I Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 Final Electric: When all electrical work is complete.
By signature, 1 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,
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
1 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
Page 2 of2
225 Fifth Street ,<'
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01124
COM2003-01124
COM2003-01124
COM2003-01124
COM2003-01124
Payments:
Type of Payment
Check
WI"'I~'~'~".~.~'? '~,., ',J
--~!
........, . ,e"'"f" ..,..'
Receipt #: 1200200000000002430
Description
Perm ServlFdr 200 amps or less
Perm ServlFdr 201 to 400 amps
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
PROCESS AUTOMATION
Received By
djb
L'heck Number
Batch Number Authorization Number
City of Springfield Official Receipt,.,
Development Services Department,
Public Works Department
.,
Date: 11/06/2003 9:32:34AM
Amount Paid
Item Total:
126,00
75,00
30,00
16.17
23.10
$270.27
How Received
In Person
Payment Total:
Amount Paid
$270,27
$270.27
.
.