HomeMy WebLinkAboutPermit Electrical 1998-12-24
225 FIFTH STREET
SPRINGFIELD, OREGON
OFFICE:
ELECTRICAL PERMIT APPLICATION
City Job Number ~\~~~.
3. COMPLETE FEE SCHEDULE BELOY
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
JOB DESCRIPTION. 1000 sq.ft. or less
8']ci\\,",,;'^":\P~ \,,y...\\ ':::::)\c.f\::'::. Each additional 500
-..) sq. ft or portion
Permits are non-transferablel and expire thereof
if work is not started withiJCl89,qays Each Manuf'd Home. or
of issuance or if work is ~\lffp'<~~de'd' for Modu~ar 'Dwelling
180 days. AU 0Pf.09",._,. SerVIce or Feeder
INn!:.>. ' Sly;!,
2. CONTRACTOR INSTALLATIOll ONLY:"'I,' ((~;"IRservices'or Feeders
. '. -.','OCR" q,ifs;tallation, Alterations
Elec trical Con trac tor'E<:...~f\<:"~J'3.filAnyr.S ,,,filS Pt?;lf ~'i~t~t ion:
-, ". "~lID 't!1lr IS I(
Address '~'l\ C\w<~c'h ~,..,,.,rl '. O"'2..9P,<:;amS~');or less $ 50.00
.) ; 201 G.iiips to 400 amps $ 60.00
City F, ,('~..._ Phone'1x':;-S34l0 401 amps to 600 amps $100.00
~ 601 amps to 1000 amps $130.00
Supervisor License Number 4~ Over 1000 amps/volts $300.00
~"""r Reconnect Only $ 40.00
Expiration Date \ 0 - \ - '1 q ! fOlln, <::1v7"l8
. 'Ot/t,. " rUle ~'or.emporary Services or Feeders
Constr Contr. Number rl.()-:4;:;~LI~'.:'~tiOI)~"O'o~It;'1~lation, Alteration or Relocation
-VB~<? el)t eO' 6 II< re
Expiration Date \0- \ -o,Cj CfJ/;,'yOU;,OOT'O~r.2~'!a~9If{re!~ss $ 40.00
. "UI7'z6' 'll the "Y06t ~<2~ tlliil}~rFtJOIt ~ttmPs $ 55.00
Signature of Supervising Electric1mrfort cel)te "'IfJIf&'f:lltftfJ. 05'\141& O~/~ps $ 80.00
d7/ , Ce 'heO r.(Jq;;~.ii9 ~t%1000 volts see "B" above'
f/;( ...IA ri-. ~/V I)terio5' /:gol) 1e:' the t the rlJl. '"OOT.'Ii
- V-. D.Oo..Y~{{fiy~~U~It!iy .'
Owners Name. \A '!::A.V<" f"Y"C.v" ~ ,T..r '<'<3dOtifica ol)e
New,A~.ter~'~on or Extension Per Panel
Address~'>'">:'\ n Nt:. ,",:;).')Y st.. ~1'7
Items
Ci ty I.....t<!.o..., Clk Phone
O\INER INSTALLATION
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
. Sign/Ou tline Ligh t ing--.i2.....
Limited Energy/Res
Limited Energy/Comm
Owners Signature:
DATE~-~-------------~~~~-~--
RECElPT II: J J f)t'I~,
RECEIVED BY: t:?)/n1 ./..Jv .
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
Cost
Sum
$ 85.00
$ 15.00
.$ 40.00
$ 35.00
$
2.00
not included)
$ 40.00
$ 40.00 ~
$ 20.00
$ 36.00
8D . GO
'f.00
IhR~
SIGN 'PERMIT APPLlCA TIONe
SPRINGFIELD
JOB r4t3ER
Q,~\~rv
225 Fifth St'~et
Springfield. OR 97477
SITE ADDRESS: Jz.c bt'fN Ply $r
ASSESSORS MAP: 1'1 n ''>~I
OWNER: IJJA~I1~{l/(, /tJt"
ADDRESS: ~ j\Je ~tJt- >f' . >v r (b:
1UIhA
.. ti;i
.. .7\ ..'-'rr\MO ~
. ..,__-_ TAX LOT: -'Xl' I!) iJ -\,'::..1\ .
, PHONE: ~8.. 3f)'. f/6z() !.Itz.4/1 OMIJIC-
I
Inspec,ion Line: 726.3769
Office: 726.3759
CITY:
U1
Ole-
ZIP: '1f/.I:5S
STATE:
BUSINESS NAME, FIRM EOC.: f)J/rJ('.i) fbat>b
, "ll1-_
'.- 11t.':"1O "Vl"t,
DESCRIPTION OF PROPOSED SIGNIS): (please cheCk and comp.llitWal\:l'tP-I.Q1)r9t\'<!5'formationl
Q O"l,lj> "liOI) ~ /1r:J. ~19.90
Freestanding _ proie~f1till y, BS<-o~I9f1.,::/F(~ 61} //1~,.. _ Marquee
C/1/;,' 0" ','" ~ 'Y III 199iJ.'
Bil(il~18:.9 111:/1;' "f~~8" _,,19 O,.-::~/'198_'~
"'0 Cel} t/1il} "0iJ. ~198 YOI} U. 11 10
(C{}}F~~r.~fl{fJS;l/Jff:l. /1/'e % ti/i~.
Ie. "19.9 0/19: I^~ 01 ~;;:'~~~,I fo;U; I &;11
a ~0)h!tf0v&~':.""W,,:O(l.J
'a.1 ~ I1t. &.oll 686"
: ..L Ye ~1?&'!<IOliltyJ$Je 'Y saGO ('0
trical per t is re~~i~edl ~. oF'S'~: , I . --
~ vJU~U) II
./
Wall
Single Face
Square Footage: *
Double Face
\~loa
Vertical Dimension of sign or enclosure:
~rc,' 10"
Material Sign is constructed of:
I~\
~\"U\-1
Electrical Instal a,i
(If yes additiona'l ele
U:--WtJ, (
Dimension trom Grade
to bottom of Sign Enclosure:
CITY: .616P.AA.lt
CONSTRUCTION CONTRACTORS REGISTRATION NUMBER:
CITY BUSINESS LICENSE NUMBER: ~~/'1 t,..
"0'
Y.' ';,,~
(bl TY'~~.'-~.o.' ','
,:. J ....11)'
r '~/> (fl..
(dl Type _,"f'^ .,,"',.
'/L ".; T <I". .~~ h
T .. ., 'V!}... <S~'^'
_';) -~Ij' . i,y,
~ ".' 'If!,Q., ~.o,. ~/,c-"I PHONE:
. 'Ii;, . '~1. '-('; 'l::'
O~ /t100A.0>1/&1',. ~O.-9...
.STATE: &tt. '''O,c-O;4'OZl~: t1I....,f/6~
(1f1/t~... EXPIRES: '?J~ c;
EXPIRES: ~(pt ~
OFFICE USE ,', ')
Land Use: .~ '3lJ:r.J <fad ~ea: /) ~1VtL/
Code SectiO~\ . ~ . fl4 R l I ,,'-
Approved By: Um. J.)\~ oJL)
Sq. Ftg.
List ALL existing signage and attach a photograph of each sign:
lal Type
Sq. Ftg.
Icl Type
Sq. Ftg.
Sq. Ftg.
,'.
CDNTRACTOR/lNSTALLER: ~ k A
ADDRESo: fz.IO t>>-ltAln;.H' ~
Sign DiS'rict:~ rt'lll Q
Zoning: 0 t /
\\f) ';D
Sign Permit Fee:
DATE:
1J..I138'
REQUIRED INSPECTIONS:
Site
to be madp. prior
to Sign placement
Footing
prior to placement
of concrete
v" Attachment /EleClriCal ~inal.
after fasteners are prior to energizing completion of sign
instaIlJd/P"O~O G~J::;sttaAQIHl; ;rft~' .Jiua(
'. l I
~ional C
. By signature. I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereir
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 0
Springfield, and the Laws of the State of Oregon pertaining to the work described herein. I further certify that only contraCtors an
employees who are in compliance with ORS 701.055 will be used on this project.
I further ~gree to ensure that all required inspections are requested at the proper time, that project address,is readable from the street. thi
the permit card is \0 ated at the front of the property, and the approved set of plans will remain on the site at all times during the installatio
of the signlsl.
Signature
Date
It .11 '~f>
Validation:
I
Amount Received: {(){X.U
Receipt Number: ~\ ~
./
nfiL
Received By:
Date Paid:
SIGN 'PERMIT APPLICATION.
JOB.ER (~~ \5Q,,~
Inspection Line: 726.3769
Office: 726.3759
.f~ ~ 'D
to
~~ C~1l1L-
225 Fifth Street _
Springfield. OR 97477 ....... ~
SITE ADDRESS: \"\10 Ot,,'fKPt~ 6~
ASSESSORS MAP: ~lJl')ll c:.,~\
WH.tIJI4: INv
ADDRESS: ~~(, Nti ~~. $r . 'bIJ,T& Z'1
CITY: 1~th>A STATE: O~
BUSINESS NAME, FIRM EOC.: /JJ luto lOot/f;.'
..\,r"!
TAX LOT: \ Yl!/f/-/
. PHONE: ~, ;l\-~. '-1010
I
ZIP:....,L/ f'3S
OWNER:
DESCRIPTION OF PROPOSED SIGNIS):
./ Wall
Iplease check and complete all appropriate informationl
Freestanding
_ Projecting
Roof
_ Marquee
Single Face Double Face
Square Footage: ."'1 ~ 1\
Billboard Other
Total Height above Grade:
Ma,erial Sign is constructed of:
\q;~
\ ~ \ Electrical Installation: Yes No VALUE);,;-:: rn-';'
(If yes additional electrical permi, is requiredl OF SIGN: ~ ?/vW .
AUI'1 . t-l~. tfIIJt&r \i {f5oif/ _
Vertical Dimension of sign or enclosure:
~
Horizontal Width of sign or enclosure:
Dimension from Grade
to bottom of Sign Enclosure:
List ALL existing signage and attach a photograph of aach sign: "/0-,
IA. 10lt ~A'
.'Vo/til.OI1-,,'IiJtO
lal Type Sq. Ftg. Ibl Type Sq. Ftg, ~ 1('- (II. ~.-
~1. OOB. ~.</-9 ~"Ol}''''qo: "'1'&
Icl Type Sq. Ftg. 'Oh,ldl Type Sq. F\\l. ~ L.o:19S..:>,_C'&", O.o/~;gOl}i
lliJ.co . .,,~. I}/.t <1%, v/.t In vU,. ''''~ -;'0'6" '111-"
J -'I(;rlt, . ~lTl/1lr "IU&?''l& r;:~~' .O~" ~ ~:~VI;'&.s..
CONTRACT:JR/lNST ALLER: es A r'\_ 0". .co, . ;:;[/QNE. ~ ~~ '0
,-,.,;& ~t!{, .,<f:t"-'I{, .ti1~ '1)& >: 1:0. ~ .,.</. ~I} ~
ADDRESS: , Z,(O Of"ll'r"r~ru-I ."'..... \$'i<~...D (;/111'>_ (, ~..r,O,_ ~&I'I." ?1'&,,!""Olb:O/&.s _ O,,/,()I'& .s",~~~
t "" ,.u a "I)' 1; "'l::';,IO..,A "~A1' II} "'~ "',s:' '0
CITY: &I(p~ .~~, L'. 'IT IS A .,Sfu:E:.. .V"~ ~ ZIP: -1 ~~ 1&lfO,c& 1'q1;'00,.
CONSTRUCTION CONTRACTORS REGISTRATION NUMBER: "71lt~alv~~l/1lrIS ~~irI{XPIRES: !;{Ift~ '.<'a.;;;'i~;;'~I}& "'6;-
L:l, "/<l!2.. _ .~ Fa 'vT .. fA 01}
CITY BUSINeSS LICENSE NUMBER: ,...., '"1 -- 'IT EXPIRES: vr7~
OFFICE USE
Quad Area: cV (IJ\) (J
6(1) u
t1) DATE:~ . ~.q){'
Zoning:
. Code Sectio~:
tJvtly)
A.
Sign DiS\ricJ\H\U'{\Q.f~...fa (\
(\{\ )
'0 CX)
o .
Land Use:
Sign Permit Fee:
Approved By:
REQUIRED INSPECTIONS:
Site Footing ~tlaChment L-Electrical L..----'Final
to be made prior prior to placement after fasteners are prior to energizing completion of sign .
to sign placement of concrete ~ i:1~~I~d/Pnor t~ c.over elecv.cal installation .. I _ ~n~.t~II~tl l\. n I ~/
t~' ~oI;ili{j"'o[g~ltfh.~ I MfJ~ f fLWr
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereil
is true and correct, and 1 further certify that any and all work performed shall be done in accordance with the Ordinances of the City 0
Springfield, and ,he Laws ot the State of Oregon pertaining to the work described herein. I further certify that only contractors an
employee~ who are in compliance with ORS 701.055 will be used on this projec,.
1 further agree to ensure that all reQuired inspections are requested at the proper time, that project address. is readable from the street, th;
the permit card is I cated at the front of the property, and the approved set of plans will remain on the site at all times during the installatio
of the signlsl. If~
Signatu J' { - ~ Date 11-, fI~&
Date Paid: ,~~ . \ b !.{ K
. . I
Received Byd~
Validation:
Amount Received:
f) ()W
~~3\',
Receipt Number:
'.