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HomeMy WebLinkAboutPermit Electrical 2010-4-14 . . . DEPARTMENT USE ONL. Y CooM 'ZO I 0 - CO 3. Pennit no.: Electrical Permit Application 225 Fifth SITeet< Springfield, OR 97477 < PH(541)726-3753< FAX(541)726-3689 Dale: L( -II.{ -I U 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. .' 'LOCAL><;;OVERNMENTAPPRO\lA.LJ:' ""i Zoning approval verified? DYes D No ,'" .....CATEGQRy:(jFCQNSTRUCIION}..'., 11'- I 'k, . Residential, per unit, service included: o Residential I D!J Government ~Commercial ~.!'P~4f~~;~,OB\;;$@EiINFQRI\IIMloNt'ANDn[i(j~cAtION;;;'0:~\\)'i.;: 1,000 sq. ft. or less (4) ~ _ _ \' \' r.J II \. I I .i-f-\. Each additionalSOO sq. ft. or portion Job site address: j }t', l-rn r I ~ . \ ~ \A n ,-r -;. J thereof City:S m; {k C,\ fMl I State:f') (/ I ZIP: Limited energy (2) Reference: 1"7'63. Z 7.. ~ l.f Taxlot.: DUDe. Each manufactured home or modular 'DESCRIPTION. OF WORK"';.';''': . .:" dwelling service or feeder (2) f'^ - ) :'oJ~ (, ~x- ~ V \) Services or feeders: instal/ation, alteration, relocation UI ,.0/ ~ r /~,-<"'1 , , ~ I L-t'. 200 amps or less (2) $ 81.00 $ PROPERTY QWNER 201 to 400 amps (2) $ 95.00 $ Name: 5:004.""- ?J r.r__+- Coro::1 401 to 600 amps (2) $158.00 $ Address:2c>= H"w~~€ -iVf- S_E- [,:' ~Ires you to $205.00 $ City: 51ke~ I State:o!L I ZIP: Ie ~ (~~~~!.. $469.00 $ Phone: _ _ I Fax: _ _ In OAR lJ~QIl0th~h OAR 952-001- $ 53.00 $ E-mail: .............~g;;.&lll.Al~McfW41liJ1!lzllallOn. alteration, relocatIOn . 'iD This installation is being made on residential or fann propmlmber fa r .. $ 63.00 $ owned b~ me o~ a member of my immediate family. This C e lBCIIiSo~a~)2344). '$ 87.00 $ property IS not mtended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $ :" "'I.';:.::\~iI"!;';;'i{'i: FEE\SCHEDUL:E'. . _' '-. ..,.". : '; ",r ,Num~er ofi~spections ,Wite']' ()'. .... Qty. Cost ea."' :;'~j;::;~i(r7:i{~i?;;'0;?.'~~~~2~{~~:~ Total cost. $134.00 $ 25.00 $ 32.00 $ 53.00 $ $ $ $ Over 600 amps or 1 ,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a Fee for branch circuits with purchase of a service or feeder fee: Signature: CONTRACTOR INSTALLATION Business name: Co"'" 1)),,1--1' ij ""* -1-. A-_ Address: ?,'2/'z.. L; U La J"V\q <' .5,,--= z.;, '0 City: I' re.<"'-""6\ \ I StateO-(<( I ZIP:'i't:;7r...... PhonR;tJ2.Z~-79?/ I Fax: - - 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 $ 55.00 $ 6.00 E-mail: CCB license no.: 1~/2'. '/4 I BCD license no.:CL;q 1: 5~/~ ') 5 ttY)c:iTr CD\~ V'.o r Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) Each sigo or outline lighting (2) $ 63.00 $ 63.00 Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: Signal circuit or a limited-energy panel, altera.tion, I?r extension (2) ~ ./ L:_ Eacha_~,d,iNRR~H~.spection: (I) NOTICE: III'" :emCANTi~'i.JsE\fi': THIS PERMIT SHAlt 'IS~fve fees . AUTHORIZED UNDER . Fee$58.00) . COMMENCED OR IS 0 ".-;' O AV PERIO" ) Enter 12Yo surcharge (:12 x [A]) ANY 180 '" . ."., (C) Technology Fee (5% of[A]) TOTAL rees and surcharges (A thrnugh C): $ 53.00 $58.00 ':;':?"i!~.::"t:;':.,' ~~~~~ ~ \Y \.\)'~ ~ ~.~ b<' R<t' ~t:1 ~ 440-2584-J (9/08/COM) $5::',0"- $G ,so $ $ $ $ $ t;f $ 73Z $ ::sc.r $ . 1{"J I ':0 'I" CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00463 ISSUED: 04/14/2010 APPLIED: 04/]4/20]0 EXPIRES: ]0/]4/2010 VALUE: ~.,' , Status Issued : ! 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541- 726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 770 HARLOW RD APT 107 ASSESSOR'S PARCEL NO.: 1703223402800 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Add/alter 2 circnits Owner: SUN RETIREMENT CORPORATION Address: 200 HAWTHORNE AVE SE A-140 SALEM OR 97301 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor ~"'" 0,- License COMPLETE ELECTRICA~lNSTALLA TION 184274 I BuiiillNG INFORMATION I Expiration Date 10/1412010 Phone 541-225-7827 # of Units: Primary Occnpancy Gronp: Secondary Occnpancy Gronp: Primary Constrnction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structnre 'res yOU to _.....nil law requI , . A'TTENiIi~~~,:.. by the Oregon Utility follow r~'8oIJl.!I/:rhOse rules are set lolt" Noti1icat.!~..:~!r;b through OAR 9521-~0~y. In OAR _".".,,1<IM . ies ollhe ru e 0090.. 'fSuJ1ll&'J ~~: the tel~~l'IO~e Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occnpant Load: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: 0/0 of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS. Street Improvements: Storm Sewer Available: Special Instrnction: ;....;.-;: "~ '~ Sidewalk Type: .~-\ , " Valuation DownspontslDraIns: , " '.'~c ;;,o'-;.~i,;o<:t.;~' ". , \CE' -";f~HEWOR\( , ~~~ PERMIT SH~\.\. EX~~~~RMIT \5 NOi,:; UOlilE OR IS ABA NY 18 PERIOD. A Square Footage or'Bid Amonnt .. " ~ Notes: Description Type of Con'struction $ Per Sq Ft or mnltiplier Value Date Calculated ",. Paee I of2 ""., CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM201O-00463 ISSUED: 04/14/2010 APPLIED: 04/14/2010 EXPIRES: 10/14/2010 VALUE: Sta tus Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . '.' .. ~ .., ;'. Total'V~lne of Project , , LFees Paid I Fee Description + 12% State Snrcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amonnt Paid Date Paid Receipt Nnmber $7,32 4/14/10 1201000000000000342 $3,05 4/14/10 1201000000000000342 $55,00 4/14/10 1201000000000000342 $6,00 4/14/10 1201000000000000342 Total Amount Paid $71.37 ' 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, insp~c~ions requested after 7:00 a.m. will be made the following workday."'"''''',''''' Retluired IhsDections ~ Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, 1 state and agree, that 1 have carefnlly 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 he 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, 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 ;J ;,.,,,.,..,. '- " Paee 2 of 2 225 Fifth Street Springfie16t, Oregon 97477 541~726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 1201000000000000342 Date: 04/14/2010 11:44:14AM Job/Journal Number COM20 10-00463 COM20 I 0-00463 COM20 I 0-00463 COM20 I 0-00463 Payments: Type of Payment CreditCard cReceiotl Description Add, Alter, Extend Clrc Add, Alter, Extend Clrc Ea Add + 12% State Surcharge + 5% Technology Fee Paid By COMPLETE ELECTRICAL Check Number Received By' Batch 'Number djb ';1 f" ;.>> ',,'.' Page I of I Item Total: Authorization Number How Received Amount Due 55.00 6.00 732 3.05 $71.37 Amount Paid 430380 In Person Payment Total: $71.37 $71.37 411412010