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