HomeMy WebLinkAboutPermit Electrical 2010-3-24
225 Fifth Street. Springfield, OR 9747HPH(541)726-375HFAX(541)726-3689
...DEP~RTMENT USE ONLY
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Date:
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
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Name: S\.lt'\
Address: '2,ClC>
City:Sc:. Q..~
Phone:
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).
zIP:Cl1 "30
Signature:
Business name: Go f"'\
E-mail:
CCB license no.) 2 '727
Signing supervisor's license no,;
Print name of signing supervisor: V"l~
Signature of signing supervisor: ~
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440-2584-J (9/08lCOM)
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Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 amps (2)
601 to 1,000 amps (2)
Over \,000 amps or volts (2)
Reconnect only (2)
$ 81.00 $
$ 95.00 $
$158.00 $
$205.00 $
$469.00 $
$ 63.00 $
Temporary services or feeders:. installation. alteration, relocation
200 amps or less (2) $ 63.00 $
201 to.400 amps (2) $ 87.00 $
40 \ to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
Fee ~or 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)
Each additional branch circuit
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$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder ~ot included
Each pump or irrigation circle (2)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00356
ISSUED: 03/24/2010
APPLIED: 03/24/2010
EXPIRES: 09/24/2010
VALUE:
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 770 HARLOW RD APT 204
ASSESSOR'S PARCEL NO.: 1703223402800
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Remodel- AddlAlterlExtend 2 electrical Circnits
Commercial
Owner:
Address:
SUN RETIREMENT CORPORATION
200 HAWTHORNE AVE SE A-140
SALEM OR 97301
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I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor License
COMPLETE ELECTRICAL INSTALLATION 184274
BUILDING INFORMATION ~
Expiration Date
1011412010
Phone
541-225-7827
# of Units:
Primary Occupancy 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:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION ~
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
, % of Loi ~overage:
, . "'~~ ..l ,:"
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I ~ aluation Description ~
Description
Type of Construction
$ Per Sq Ft
or multiplier
, Square Footage
or Bid Amount
Value
Date Calculated
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Page I of 2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00356
ISSUED: - 03/24/2010
APPLIED: 03/24/2010
EXPIRES: 09/24/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Total Valne of Project
I Fees Paid ~
...
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend C;rc Ea Add
Penalty Fee - BWOP Electrical
Amount Paid Date Paid Receipt Nnmber
$14.64 3/24/10 2201000000000000275
, $6.10 3/24/l 0 2201000000000000275
$55.00 3/24/10 2201000000000000275
$6.00 3/24/10 2201000000000000275
$61.00 3/24/10 2201000000000000275
Total Amount Paid
$142.74
I 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.
ReQuired Insoections ~
Rough Electric: Prior to Cover
Final Electric: When all electrical work is 'co'mplete.
By signature, I state and agree, that 1 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 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 furtber agree to ensure that all required inspections ~re req~ested at tbe proper time, that each address is readable from the
street, that the permit card is located at the front Of the propehy, and the approved set of plans will remain on the site at all
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Imes urlng cons ructlOn. , "..,;.
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Owner or Contractors Signature
Date
Page 2 of 2
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City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street
Springfield. Oregon 97477
541-726-3759 Phone
RECEIPT #:
12:41:4IPM
2201000000000000275
Date: 03/24/2010
Job/Journal Number
COM20 I 0-00356
COM20 I 0-00356
COM20 I 0-00356
COM20 1 0-00356
COM20 1 0-00356
Payments:
Type of Payment
Check
cReceintl
Description
Add, Alter, Extend Circ
Add, Aller, Extend Circ Ea Add.
Penalty Fee - BWOP Electrical.
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+ 12% State Surcharge
+ 5% Technology Fee
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Amount Due
55.00
6.00
61.00
14.64
6.10
$142.74
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Paid By
RICHARD OLSON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
IIh 1043 In Person
Payment Total:
$142.74
$]42.74
Amount Paid
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