HomeMy WebLinkAboutPermit Electrical 2010-3-5
225 Fifth Street+Springficld, OR 97477+PH(541)726~J75J+ FAX(541)726~J689
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,,' DERARTMENTUSE ONLY'
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Date:
This permit is issued uuder OAR 91"8-309-0000. Permits are uontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
1"\'::"" , '''110CALi'G0VERNMENT';Ii.~f!ROVAIf;B.;,<;t'!i;i'':~':; %:'?~<"~:~'*~:,~1,)i~,i~;sil?r;tti!f",{tl;_~'~S<PRt:;p.llfmEf;:J:l~1;(~~1{gtl[~;~~JJ~# .
Zoning approval verified? 0 Yes ONo ;'i:~ ~ ~i~i,?Ji,i~~p~~~'~e~~ ,g$~~;~ii.~;:-~';)~~r:\:" '9!r" .:~;:,~~~~:_: i, Total
t:;;:~.!; 1'\{:""\\cMEGOR~(rbF~cbNSJ:ROCTION['{'" ;;;/ ',' ;;~ "-'cos! t,,_
Residential, per unit, service incl~ded:
D Residential I D Government D Commercial 1.000 sq, ft, or less (4) $
~:tir~i~f~.(OEliSIJ:EjjINF,ORMAJ:IONliANt:)1\L()C'A;r,lbNi,;~1i;~';;!'! $134.00
Each additional 500 sq. ft. or pOr1.ion
Job site address: t:-/S'!'- 'II, ...r -I..... i<tfJ thereof $ 25.00 $
City: S p,;-'" ....{.,..t./ tI lState: n (Z. TZIP: t:;'7 l.iJ B Limited energy (2) $ 32.00 $
Reference: \'101. n. A,/J \ I Taxlot.:DO'O\ \ Each manufactured home or modular $ 63.00 $
".",>. . ,c::"OESCRII'TION: OF~.wb.R.(;::rf~;;t;:.;. :"~tj;!1~~.;;::,\'e" ". dwelling service or feeder (2)
7...( -k. /1 cr'J L SI.JK Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
:F'ROP.ERTY, OWNER..' " -. 201 to 400 amps (2) $ 95.00 $
'. .. .
\' , E'(.;'\\(X\ \T1T\Ir VY\ \:X\VYI . , )l01 to 600 amps (2) $158.00 $
Name: N A
~O tx1x \"2- 601 to 1,000 amps (2) , $205.00 $
Address:
City: \nUl::') .U\ .., Statef')/L. 1 ZIPq1~ - . Over 1,000 amps or volts (2) $469.00 $
1
Phone: ' I Fax: - - Reconnect only (2) - I $ 63.00 $lv0
- -
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(I). 401 to 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
:C.ONTRACTOR .. INSTALlATION , Branch circuits: new, alteration, extension per panel
..
Business name: /!Jul- I":/",;.-(,,;z.. 'J:V' c.... a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 1'77- !J 2 p,7h .r-/- Each branch circuit $ 6.00 $
City: 5tJr,I,,'/''6-/./ I State: DI'L 1 ZIP: ('7t!,?h b. Fee for branch circuits without purchase of a service or feeder fee:
.' ' I Fax: JYI - '12'_ 02--2-7 First branch circuit (2) $ 55.00 $
Phone:S'II-1jiJ- 2- 2.11
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: ILt7 z.. . I BCD iicense no.: 20-5'5 c-- Miscellaneous fees: service or feeder ':lot included
Signing supervisor's license no.: ("On-~ Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: ,lr; ,r """" J-k-r/~~"'..-a, Each sign or outline lighting (2) $ 63.00 $
I/' V"//', ~4'^' -7--' -"- -Signal circuit or a limited-energy panel,
Signature of signing supervisor: alteration, or extension (2) $ 63.00 $
(sdJ / V 1/7 /
"- Each additional inspection: (1) $58.00 $
~1ij~tH~;~~~1t~~~~11i1AR'Fii2iGgf;j_ft~~U$"~1~1(~~~~~~~~:{~~~i/;{tii~~;>~-'~
\$- (A) Enter subtotal of above fees \.9~.a )
~~ CA,'\ \ (Minimum Permit Fee $58.00) $
~
tQ' ~.0'\O (B) Enter 12% surcharge (.12 x [AJ) $ "1 .51..,
~~~ (C) Technology Fee (5% o[[AJ) $ 9l.\ C:,
TOTAL fees and surcharges (A through C): $\ 'b:- \
~
440.2584.) (9/08/COM)
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00285
ISSUED: 03/05/2010
APPLIED: 03/05/2010
EXPIRES: 09/05/2010
VALUE:
, ~t_
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SITE ADDRESS: 6155 THURSTON RD
ASSESSOR'S PARCEL NO.: 1702342100511
_ _~__.Springfield. TYPE OF WORK: Commercial Miscellaneous
Commercial
TYPE OF USE:
PROJECT DESCRIPTION: Reconnect Effl1l'tCE: E IF THE WORK
Hila pi=J:lMIT SHA.LL EXPIR 1\1 \R" IS ttQT
Owner: RESERRECTlON LUTHE~"OR~BO UND,ESRATBHAI~;~N~D FOR
Address: PO BOX 12 COMMENCED OR ..
THURSTON OR 97482 ANY 180 DAY PERIOD.
I CONTRACTOR INFORMA T10N I
Contractor Type
Contractor
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type.
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
,.,t <
".
License
BlJILDING INFORMATION ~
# of Stories:
A3 Height of Structure
Type of Heat:
Water Type:
Range Type:
ATTE~~tath: I.., uIroo
~1
~i;
0090. You may obtBln copies 01 tho ruI8lllllf
CBIllng tM~~s{Note: the telephono
iIUIIIber ~IMAr_1ty Not~
Cp~li 19,.1 . -2344)-
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Expiration Date Phone
Lot Size:
Sq Ftlst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
"'.
Sidewalk Type:
DownspoutsIDrains:
/r', ~,
I Valuation Description ~
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Page I 01'2
Value
Date Calculated
Sta tus
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Service Reconnect
Total Amount Paid
i.(..':,,,.
I'"
Total Value of Project
Fees Paid I
Amount Paid
$7.56
$3.15
$63.00
$73.71
I Plan Review~
, .~.;."
Date Paid
3/5/10
3/5/10
3/5/1 0
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00285
ISSUED: 03/05/2010
APPLIED: 03/0512010
EXPIRES: 09/05/2010
VALUE:
Receipt Number
2201000000000000205
2201000000000000205
2201000000000000205
To Request an inspection call the 24 hourrecording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, in~pections requested after 7:00 a.m. will be made the following
work day.
I Reouired InsDections .
Electric Service: Approval required prior to utility company energizing service.
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 tbe work described herein, and
that NO OCCUPANCY will 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 requested at the proper time, that each address is readable from the
street, thaythe permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times dU,.i"} con t'i1tction. _
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Date
225 Fifth Street
Springfield, Oregon 97477
541-726.<3759 Phone
J~~~;ttJj
WiL-
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000205
2:51 :25PM
Date: 03/05/2010
Job/Journal Number
COM20 I 0-00285
COM20 1 0-00285
COM20 I 0-00285
Payments:
Type of Payment
CreditCard
cReceintl
Description
Service Reconnect
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
ALERT ELECTRIC INC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
63.00
7.56
3.15
$73.71
Amount Paid
KLK
KLK
005764 In Person
Payment Total:
$73.71
$73.71
P~~e I pf 1
3/5/20 I 0