HomeMy WebLinkAboutPermit Electrical 2010-5-10
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Electrical Permit Application
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225 Fifth Streett Springfield, OR 97477tPH(541)726-3753+ FAX(541)726-3689
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, DEPARTMENT USE ONLY
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Permit no.:
'{r S- 6A
Date: 5: (d /P
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] 80 days.
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 Na
CATEGORY OF CONSTRUCTION
D Residential D Gavernment S Cammercial
,.JOB SITEJNFORMATION, AND lOCATION,
City:
Reference:
ZIP: 9?Lf? 7
Taxla\.:
DESCRIPTION OF WORK
PROPERTY OWNER
Name: C MIN F - t:
Address: /460 (,
City::5' _ F. /'
Phane:5Jf -726- If So
E-mail:
This installation is being made on residential or farm property
owned by me or a member afmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTAllATION
Business name: .-LN [i.
Address:
Phone:
E-mail:
CCB license na.:'1 '1&>03
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
440.2584.) (9/08/COM)
, , FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, senrice included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary sen'ices or feeders: instal/aNon, alteration, relocation
200 amps or Jess (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 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
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
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, I $ 63.00 $ & ~;,e
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $.~
(Minimum Permit Fee $58.00) IV
(B) Enter 12% surcharge (.12 x [AD $ ;4IIf~
(C) Technology Fee (5% of (A]) $ 1/J.'17
TOTAL fees and surcharges (A through C): $~
'109
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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: COM201O-00582
ISSUED: 05/10/2010
APPLIED: 05/10/2010
EXPIRES: 11/10/2010
VALUE:
SITE ADDRESS: 1460 G ST
ASSESSOR'S PARCEL NO.: 1703362204601
"::'" .:: ,Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Commercial
PROJECT DESCRIPTION: Low voltage
Owner:
Address:
Contractor Type
Electrical
MCKENZIE WILLAMETTE REGIONAL MEDICA
PO BOX 190700
SAN FRANCISCO CA 94119
'"'1" Io::IW reQUires yuu. ~.""
ATlrE'(1J~'FRAifn~:R IJ:'/liQ.RW.~Ir<<)~~;~h
tollow r ~~ ~- -, Those rules ii'" -' 1
Contractor Notitication_g~~:~~10 through ~ aij~~Obj:xpiration Date
MOLLENHOURiIS!?i'>1f 52 btain cople5ljl~ e 08/31/2010
itication
Phone
503-473-2721
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
~~T lNFORMA T1QN_I: 1\\f. WOR\<.
\1 SH/l.LL tN ...- RM\1 \5 N01
1'6\i'JJtR~M ~ UNDER 1~~~rici\'4f.O fOR
NiJSt'i'~ ~l{}IiJ~S t>.:u...
Q1a~~lt\ IH1\!~~R\OO.
AW1{filil~e'dVerage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm SewerAvailable:
Special Instruction:
, .t"
. ; l ~ :'! .
>. I I
Sidewalk Type:
Downspouts/Drains:
Notes:
Description
Type of Construction
I Valuation Description ~
$ Per sit Ft Square Footage
or muhip'f.ierl,;:.'f[. I~', or' Bid Amount
Value
Date Calculated
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Low Voltage - Commercial Indus
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Amount Paidj..f
$7.56j;)
$3.15"" .
$63.00
Total Amount Paid
$73.71
Total Value of Project
Fees Paid _
; ,
.~, :1' ;.'
, , Date Paid
Plan Reviews ~
5/10/10
5/10/10
5/10/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00582
ISSUED: 05/10/2010
APPLIED: 05/10/2010
EXPIRES: 11110/2010
VALUE:
Receipt Number
2201000000000000477
2201000000000000477
2201000000000000477
To Request an inspection call the 24 hour rec,ording at. 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, :hispections requested after 7:00 a.m. will be made the following
work day.
I Reouired Insoections I
Low Voltage: Prior to cover.
Final Electric: When all electrical work is complete.
, -
"i{1'VJ"' i i
By signature, I state and agree, that I have carefully examiiied"the completed application and do hereby certify that all
information hereon is true and correct, and I furthelf~c'ertify i~at 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 Oregoll 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 further agree to ensure that all required illspections are reqllested 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 durillr;JilJ ~1kJ 1fV'v
, . ,
Owner or Contractors Signatllre
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Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000477
Date: 05/10/2010
12:06: 18PM
Job/Journal Number
COM2010-00582
COM20 J 0-00582
COM20 I 0-00582
Payments:
Type of Payment
CreditCard
cReceintl
Item Total:
." -, " Check Number Authorization
Received By Batch Number Number How Received
cjc 026983 In Person
Payment Total:
Amount Due
63.00
7.56
3.15
$73.71
Description
Low Voltage - Commercial Indus
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
SCOTT MOLLENHOUR
Amount Paid
$73.71
$73.71
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5/10/2010