HomeMy WebLinkAboutPermit Electrical 2010-3-24
225 Fifth Street. Springfield, OR 9747HPH(541)726-375HFAX(541)726-3689
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Zoning approval verified? 0 Yes 0 No
:;t~A,.\,'i;\(C)l.TEGORYJ:Of'.::CONSTRl!JCTI()N:l;,j.. '\10;' '....
o Residential I 0 Government I if Commercial
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Referenc\: 1"1 TJ...-r)~ Taxlot{ 7'" J.)
,.~j .:~ ,... ESCRIRTIOiol OF'WOR.
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, -PR'O!\I;RTYQWNER"-" . .
Name: ~.m f'\.,;n J,\i)C\ lI'II\n,1\ A\
Address:jlJ 'X...... \;-l(~.. _\ l~,.l~ ~ /
City:"l \.---\1 ~ 0 --4IV\I Stat{( .j,ZIP:n-t::7.1')
Phone: - - I Fax: - - .
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E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
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440-2584-J (9/08/COM)
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. DEPARTMENT USE ONLY .
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Residential, per unit, service included: -...
1,000 sq. ft. or less (4)
Each additional 500 sq, ft, or portion
thereof
$134,00
Limited energy (2)
Each manufactured home or modular
dwellin"g service or feeder (2)
r\r- I r ~ rvices or feeders: installation, alteration, relocation
-; 0 amps or less (2) $ 81,00
$ 25.00
$ 32.00
$ 63,00
201 to 400 amps (2)
40] to 600 amps (2) .
60 I to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
$ 95.00
$158,00
$205,00
$469,00
$ 63,00
$
$
$
$
$
$
$
$
$
$
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
201 t0400 amps (2)
40 I to 600 amps (2)
$ 63,00 $
$ 87,00 $
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
Fee for branch circuits whh purchase of a service or feeder fee:
Each branch circuit
$ 6,00
b. Fee for branch circuits without purchase of a service or feeder fee:
$
First branch circuit (2)
\
\
$ 55.00
$ 6,00
Signature:
',CONTRACtOR INSTAllATION
Business name:CD"'O}~ih: (I ec:..Tri C'q) "J::r')$T<::,.)'- ~
Address 330Z4 CaY"'loZ ~......o'" (<,J
City:~(~!. '" t. \ \ State: 0 R ZIP: 91lJz 0
Phon64)-!z..t;;, ?1iz.71 Fax-5:.41- ~ -~qe.~
E-mail:
CCB license no.:t'SlIZ74 I BCD license no,: c.~"7I/f..
Signing supervisor's license no.: ~ z.~ ----=lc:::.
Print name of signing supervisor: V'\~\"'r- (..Q-re.c
Signature of signing supervisor- '" ~/_
rftz ' 17~F...
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/, COl/1114. O~/?E{) SIf, ) Enter subtotal of above fees
^Wy 1,%;,C," %:" :'i5;"
'4y p. '1/" 'U'l:fr rge' (, 12 x [A])
. 't~/O ( ]) . ...
TOTAL '. I"ges (A through C):
Each additional branch circuit
Miscellaneous fees: service or feeder not included _
Each pump or irrigation circle (2) $ 63.00
Each sign or outline lighting (2) $ 63,00
Signal circuit or a limited.energy panel,
alteration, or extension (2)
Each additional inspection: (l)
$ 63,00
$5~1C:'1
$ [allY
$
$
$
$58,00 $
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$ \4:.~
$ 'W1\U
$l ~'l.. f\
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00355
ISSUED: 03/24/2010
APPLIED: 03/24/2010
EXPIRES: 09/24/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 770 HARLOW RD APT 114 '
ASSESSOR'S PARCEL NO.: 1703223402800
':,Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Remndel- Add/AlterlExtend 2 electrical circuits
Commercial
Owner: SUN RETIREMENT CORPORATION
Address: 200 HAWTHORNE AVE SE A-140
SALEM OR 97301
I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor License
COMPLETE ELECTRICAL INSTALLATION 184274
BUILDING INFORMATION I
Expiration Date
10/14/2010
Phone
541-225-7827
# of Units:
Primary Occupaucy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy, Path:.
i'~',' " ,,....,
Sprinkled'Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION ~
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Iustruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
Description
Tvpe of Construction
I Valuation Description ~
$ Per Sq'ft .:' c' Square Footage
or multiplier'." ,. or Bid Amount
Value
Date Calculated.
Paee I of2
,.
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00355
ISSUED: 03/24/2010
APPLIED: 03/24/2010
EXPIRES: 09/24/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726.3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid.
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Penalty Fee - BWOP Electrical
Amount Paid
$14.64.;,~~; .
$6.10 .
$55.00.
$6.00
$61.00
Date Paid
Receipt Number
-.:.
3/24/10
3/24/10
3/24/10
3/24/10
3/24/1 0
2201000000000000274
2201000000000000274
2201000000000000274
2201000000000000274
2201000000000000274
Total Amount Paid
$142.74
Plan Reviews ~
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Reauired Insuections ~
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete. .
, .~ -\ -..' .. "
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By signature, I state and agree, that 1 have carefullyexamiued the completed application and do hereby certify that all
information hereou is true and correct, and I further certify that any and all work performed shall be done iu 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 withont permission of the Commnnity Services Division, Building Safety.
I fnrther certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I fnrther agree to ensure that all reqnired 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
.i'
Pa2e 2 of 2
,'. i~.
City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Str.ect
SpringiiCId, Oregon 97477
541-726-3759 Phone
RECEIPT #:
2201000000000000274
Date: 03/24/2010
12:38:22PM
Job/Journal Number
COM2010-00355
COM2010-00355
COM20 1 0-00355
COM20 1 0-00355
COM20 I 0-00355
Payments:
Type of Payment
Check
cReccintl
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Penalty Fee - swap Electrical
+ 12% State Surcharge
+ 5% Technology Fee
Amount Due
55.00
6.00
61.00
14.64
6.10
$142.74
Paid By
RICHARD OLSON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
1043
In Person
Payment Total;
$142.74
$142.74
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