HomeMy WebLinkAboutPermit Electrical 2003-11-7
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.2251'lnnSTREET 0 SPRINGFlELD,OR97477 0 PH:(541)726-3753 o FAX: (54l)726-3689 ~ 1 .3
ELECTRlCALPERMITAPPLICATION ,/.J (\ 1 0
City Job Number COwflcD3-0 I JI <7 Date (I/O S"lo3 . ~ -
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tEGAL DESCRIPTiON
/7023000 01 CJ Z 7
JOB DESCRIPTION
1I0/e&~A CAf:>UNG'.
Permits are non-trQilsferable and e:<pire if work is
not started within 180 days of is.<uanee or if work is
Suspended for 180 days. .
2. lJSq~~iq~~~r~cgil~RR~f~;1
Electrical Contractor .:5"rZlt.JElE'':::; -...., '" 'c
Address J <t04- ~ e:x..J,.oc..c
City fVt . I.. W1fut<. I!'
Phone S'D'3-4t.Z~l)
Supervisor License Number 349(..s
Expiration Dale
/oh/o4-
Conso'. ConO'. Number. 44-82.3-
E,pil'lltion Date 3/2.D/o/r
SignatuIe of Supervising Electrician
-
M. ~
, L ,_
--
Owne",Name Ctt(Z..\.~ ,/Z.L.<.1> Ty
Address /17 A- HIIAlANALIAA {tvI!'
City ~",ol,^l,^ HZ Phi:lne
I
OWNER lNS'fALLA TlON
The installation is being m3de all. property I own whkh
is nol mtended for sale, lease or rent
Ownt:t'S SignsOJre:
Inspection Request: 726-3769'
A. ;fN~f.~:;:(i~~ittI;E~jllil~~;~;q~~~;~~:~DIY.;~~F~fiir;;i~;:~~i(.::::..;
Service Included
1000 sq. ft. or less
Each addition.1 500 sq. ft. or
portion mereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B. ~:~~"~f~'2l;r.~~1~~E~~ff[~~::f'@~f,~;~~~:~~t~I~,f;i~~~:/
200 Amps or less $ 63.00
201 Amps lo 400 Amps $ 75.00
401 Amps [0 600 Amps $125.00
601 Amps to 1000 Amps .~ $163.00
au .-
Over 1000 Amps/Volts eC. 'oj .,'.\-.1 $375.00
. Reconnect Only leo,\l\l ,.." V''';':'($ 50.00
..__'_ \a:\l'I O(e~ ",e"-
C. ~::W~~W&~Fr~t~~~~J~m~~t,J.~~'R~~;:~'lYt~Wf;:;';X{,~;z;
-<'I'~~ .,,-;, '0.00 ~( i"O 'ou~" ~l \"e ( ~e
i>-' InstaUation,.A'iteiatitiil'or Reloe.tjon~""O ,', o^ .
'~o,. . u~. u''-'' "'- \~,uY. ",\ ,.
\0' 200'xa(\ -le'O . (\ co,. . \"e ~\\\C'" $ 50 00 .
."'u- ps,\!!" 5S ':0\'3-\ ~'o\e. . ...10 .
. O'20!;-A'fu'Vs to.~d.OOA~ftS~~ ^' \~I\\\~_':'o\o.). $ 69.00
(lr\ \.),' ~ o',v
, 40h~s '" 6oo'3J\l!lps3g ",'!-o?.e-- $100.00
vO'!J . ",,,g ,,'- , ,,,e" . 9-0""
Over)600 Amps orJooO Volt< see "B" above.
D. ~f~tr~~~~1Es~1~~~~~>.Iii;{iI~;ij~t~f~~~E~~f~1~:~~!~0?~~!~:t~j:"l~G:~~~~~~\~:Y!i~:~!:~~<.l~
New AJteration or Extensiun Per Panel
One Circuit $ 43.00
Each Additional Circuit or with ,.,L
Service or Fecdc-r Pcnnit ,\ \'t. \f\lO\l\.S 3.00
1>~~~JjIa~~~'f.:~~~~~~t\~*1t+~~~h;ji#~Y~:;~~;;'
~\J i' ?tt'\!'ii.\"i:l'~\)t.?;~:~,\"\\~ti6~t\}X"N.....,.... -,..",..' . ,. ... .' ..' '..".
\I'~, 'olJJfiIl ~ ,,,- fI.~fI.~ $ 50.00
,,\tR),~ .~~'" .
r>Si~oatllil..~~ . v,O'0. $ 50.00
r NIl"'" \' ~
1Ji1);\~~g;.p~ rR...idential $ 25.00
L~;ted Energy/Coll\mercial I $ 45.00 !tS.~ 0
Minimum Ele~trie Permit Inspection Fee is $45.00 + Sureh.rges
4. ~~!wlt9.fi;~Ji~9fJt~~2~?;J~FI1~;j:4:;'~;~~j;
~oO
3 .j '!'
4-.~O
62..(.,~
7% Stale Surcharge
10% Administr.ltive Fee
TOTAL
Shared Drivc(T:)lBuildin~ fonnslElcctrical permit Appli4i3tion 1-03.doc,
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-01119
ISSUED: I I106/2003
APPLIED: 1l/05/2003
EXPIRES: 05106/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa,
541-726-3769 Inspection Line
SITE ADDRESS: 3520 Olympic St
ASSESSOR'S PARCEL NO.: 1702300001927
Springfield TYPE OF WORK: Electrical Work Only
'TYPE OF USE:
New
Commcrcial
PROJECT DESCRIPTION: Low voltage
Owner: CHRIS TRUSTY
Address: 117AMAUNALUAAVE HONOLULU HI 96821
I CONTRACTOR INFORMATION I
Contractor Type
Elcctrical
Contractor License Expiration Date
STONER ELECTRIC 1NC 44823 _..Q312012004
BUILDING INFORMATION lao.\}\la~ ~ \)\i~I\'l
1'0'" OTagO a\ \of\
,,0(\ '(\a la S ^(1
# ofStories:.,.Qla", -' 'O'l ~ . "as ~ Lot~Size:
-' C\\"'. ~e\) (v r"I....~ -..... .. \
',W~..'iof.S~r.~E.tJlre i'(\osa '(\ Or ~I\&m~ Floor:
~1);f,~ofI.Hea~; a(\\aT. 0 \'(\TO\}~ s 0\ \~~'!i!l1)2nd Floor:
\Wa!er T.yp'e:J ,,< .00'\ .... co"\l\a ....a \as!!. \F.t~ast'ment:
.,.,..a>. OV' 'a.'I' a' ". ~\ I,'V
.~ngQ;?;l!e:' ~ o'ti' ,~O~' .,i\':I ,-Sq:Ft Garage/Carport
~.ner'gy ~~~:rI'a. ca(\\al. 0(\ \)\\ :t~Sq'Ft Other:
0090. '(\g \'(\a ",a Olag 00,33'2. Impervious Surface Aren:
_nlli ,^,\I. <,fI
Phone
503-462-6500
# of Buildings:
Primary Occupancy Group:
Secondnry Occupancy Group:
Primnry Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
SETBACKS
I DEVELOPMENTlNF0RMATlON I
REQUIRED PARKING
Frontynrd Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
~lnT'r.F' _,.^,n\, Ie TI4F WORK
I PUBLIC 1MPROY~'I1St ::i~~~P.1H\S 'Pr.RM\1 IS NU \
/l.U \ Hun'L.'- UO\~i~j~;i1JlJt9PI),~t.D fOR
COMMr.NCEO
/l.NY 180 O/l.Y PlDlI~~poutslDrains:
Total:
Handicapped:
Compnct:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Vnlue
Date Cnlculnted
Total Value of Project
Paee 1 of2
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-01119
ISSUED: 11/06/2003
APPLIED: 11105/2003
EXPIRES: 05/06/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa,
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
$4.50
$3.15
$45.00
1116/03
1116/03
1116103
Receipt Number
2200200000000001726
2200200000000001726
2200200000000001726
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 Reouired Tnsnection'iJ
1 Low Voltage: Prior to cover.
By signature, I state and agree, that I have carefuny e,amined the completed application and do hereby ccrtify that all
information hereon is true and correct, and 1 further certify that any and all work performed shan 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 witbout permission of the Community Services Division, Building Safcty.
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 an required inspections are requested at the proper time, that each address is readable from thc
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the sitc at an
times during construction.
Owner or Contractors Signature
Date
Paee 2 of2
225 Fifth'Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-0 1119
COM2003-0 1119
COM2003-01119
Payments:
Type of Payment
Check
.<
........~. .o~'!',!>... .:.
w.:. .
. :...,
. ,", '-r~
Receipt #: 2200200000000001726
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Paid By
STONER ELECTRIC
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt
Development Services Departmlont
Public Works Department
Date: 11/06/2003 8:24:49AM
Amount Paid
Item Total:
3.15
4.50
45.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65
.
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