HomeMy WebLinkAboutPermit Electrical 2004-11-8
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225 FIFTH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (5'tW~ ..-4b"":!l'-,'~!::""'"
ELECTRICAL PERMIT APPLICATION , zoning, and doleS ".~, """'l.
City Job Number Q:yvt'l..O bl{ - 013 gO Date I ( Q~7..2.. Lf
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LEGAL DESCRIPTION
1703363Z
JOB DESCRIPTION
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_ 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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Phone 7'd.Cf- fO?Y
t(70~ ~
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Expiration Date q - 7 - 0 CO
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City DA-lI~S ~Tk' Phone
Electrical Contractor
Address
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City
Supervisor License Number
Expiration Date
Constr, Contr, Number
3. I: C.Q-MfJEr:E'FEE:!;~!2!::0:- :~~(Q:W;~" ;
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A. f:,~~'-iY:R~id.;~!iai ~ID'~gleJ. r;M~i~~f?wJ~}~p'e~E~~~'lIi~g"-~uilit.: ' ..j
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Service included
1000 sq, It or less
Each additional 500 sq, ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
F ceder
$106,00
$ 19,00
$50,00
B. ~ :S~'~~Jm~;'t;~ ;F~ed~~s'!~:In~t~'II~ti'oittAit;:ati~'n, s'orRelo~~ti~n:~ :~'.1
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, .hIfENTION: Oregon law reqUlfes yOtfttJ
200 1C/l'i'o~ \lares adopted by thp. OreoOl$ '63~?Of.
201 tmtlti!fu~er. Those rules are$;'75,00"h
40 1 ~lfl ~tooRs001 0 throuQh OAR '$1,2'5;00 1-
6011G1lOO.0WlO~~tain copies of theS163:0b'y
Over 10ilQ.\l\nJp1hloIlt)nter. (Note: tne u~le$3'fs':Oo
Reco~br for the Oregon LHIIIlY "ulIS(SOIOo'1
Center is 1-800-JJ<:-<:"""),
C. 1~,.T~'i-ri'f;';6ra' ~-- 'S~rVi~~s':(jt:Feed~i-s;/;;
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Installation, Alteration or Relocation
, 200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50,00
$ 69,00
$100,00
Over 600 Amps or 1000 VollS see "B" above,
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43,00
$ 3.00
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E. Ll\fis:f~l!a!l~ui (S'~i:yi~e~fe~~e~ ri'.it, ;;'c{[d~d) ~E,3chln'St~U.ti~~J
Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50,00
OWNER INSTALLATION MOI\et', L~~ted Enxtu;W~'id'l'\q[IWOf\K $ 25,00
The installation is being made on y'oY-'~J I own W!'tiClill'tf\M\li..fJI~~~knfuq.oewtl'tqil\6 N01 $ 45,00
is not intended for sale, lease or rent. 1\1l1\-\O'Mi'JiR.Jm El1ostr-iSXI'.OOiJmriGdbn Fee ~Surcharges
COM\\~HlC~t--Q.\J~.l.;""w.-- .'-;::"-;--'C7'", -j " . '1 I I <C
Owners Signature: Ml'1 '\ B\HtL$,T~W;1f OF,4R?~:"'> ~; :"::'J '-f ~
7/5'
l{S-=>
5Z.~
7% State Surcharge '
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:" ,I:,~:' '"r:,.{ 'd~~"j...~l.f~t9:~q;P.t.?mini&trative~Fee
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<,~pr"'J~1. TOTAL'
Inspection Request: 726-3769
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Shared Drive(T:)/Building Forms/Electrical Permit Application 1-03.doc
.
. CITY U.l' ~YKlI'Ojt.-.l'1j<,LU '
Building/Combination Permit
PERMIT NO: COM2004-01380
ISSUED: 11/08/2004
APPLIED: 11/08/2004
EXPIRES: 05/08/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1396 MAIN ST
ASSESSOR'S PARCEL NO.: 1703363203501
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION: Add 1 circuit
Owner:
Address:
SEVEN ELEVEN #18092-2351
% SOUTHLAND CORP PO BOX 7\1 DALLAS TX 75221
. es'lOU to
1_." r~nu\r .
_ rT'1F-NT)ON: U"'\;~:: ", ''1e Oregon u''''''
, CONTKAC:TOR./!N~eRMA'fION-1 u\es are set \ortli
,- Cemel .r.__ r ^R952-001-
Notification . .<r'l. .hrOUgh 0" . . _, '
Contractor , OAR 952-001-(J)jc~n~~ ies ~l'wratJon Date
JEM ELECTRIC INC I~ ~" Vnll maV ot6t12'!j,S~?_, .ho \809/0712006
BUlLD1rb-INroRMAiib~, '''n- 'Utility NQtilic<J""'''
I I I " go 2344)
llUmoe. 'v' '''-, 1_800-332- '
# of Stories: Center.S Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
Phone
541-729-1074
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secoodary Construction Type:
# of Bedrooms:
I DEVELOPM..". mrORMATION I
Frontyard Setback:
Side 1 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:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
"f\",!~~lr.m OR IS ABANDONED FOR
ANY 180 DAY PCln,;:;;:;, I
Valuation Descriotion '
Sidewalk Type:
Downspoutsffirains:
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pa~e 1 on
.
. CITY 01< ~rK11~ut<1J!,LU
Building/Combination Permit
PERMIT NO: COM2004-01380
ISSUED: 11/08/2004
APPLIED: 11/08/2004
EXPIRES: 05/0812005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Ff'f'S P~id I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
$4.50
$3.15
$43.00
$2.00
11/8/04
11/8/04
11/8/04
11/8/04
Receipt Number
1200400000000001584
1200400000000001584
1200400000000001584
1200400000000001584
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 Reouirf'd Uf'ctinns ,
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 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 ofany 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
Paee 2 of2
225 Fifth Street
Sp!:iilgfield, Oregon 97477
541-726-3759 Phone
.
8iiifi
Wit.
~ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001584
Date: 11/0812004
11:58:21AM
Job/Journal Number
COM2004-0l380
COM2004-0l380
COM2004-0l380
COM2004-0l380
Descrlptlou
+ 7% State Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
Payments:
Type of Paymeut Paid By
Item Total:
Check Number Authorization
~eceived By Batch Number Number How Received
Amount Due
3,15
4.50
43,00
2,00
$52.65
Amount Paid
Check
JOE MEYERS
djb
3936
In Person
Payment Total:
$52,65
$52.65
11/8/2004
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