HomeMy WebLinkAboutPermit Electrical 2010-5-17
Eiectrical Permit Application
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225 Fifth Street+Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
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" DEP~RTMENt USE ONLY,
cO:"" Z.O/O .00 brf.{
Penmt no.:
Date: 5-(7-/0
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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PERTY . OWNER
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Address: z'o C!:> fl.A~7t+uvL"..~
City: ~ '+U-z--.-.- ZIP: f7.10 I
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Name:
,S".....-
Signature:
Business name: Low,
Address: '::'3'02.4
City' L (e./" ,-eo\
Phone:q/J. 2:2.1:; <)~
E-mail:
CCB license no.:\ t;Slt,' BCD license no.c..44
Signing supervisor's license no.: S- .) 0? ...s
Print name of signing supervisor: fr)<::itj G ('eJ ('
Signature of signing supervisor:
440-2584-J (9/08/COM)
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Residential, per unit, service included:
Total
cpst
$134,00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
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)
Services or feeders: instaltation, 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 ~
: installption, alteration, relocation
$ 63.00_
$ 87.00
alteration, extension per panel
a, Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
\
\
$ 55.00 $ 5<;'.p
$ 6.00 $ {",6>
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited~energy panel,
alteration, Or extension (2) . ...."'._~.. \l'~i:'(~-.'?'
$ 63.00 $
$ 63.00 $
$ 63.00 $
$
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$ 7;Jl..
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$7 :17
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00614
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11117/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54]-726-3676 Fax
54]-726-3769 Inspection Line
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":,Springfield TYPE OF WORK: Electrical Work Only
SITE ADDRESS: 770 HARLOW RD APT 4]L.,/"
ASSESSOR'S PARCEL NO,: 1703223402800
PROJECT DESCRIPTION: New light, change ont devices
TYPE OF USE: Repair
Residential
Owner: SUN RETIREMENT CORPORATION
Address: 200 HAWTHORNE AVE SE A-]40
SALEM OR 9730]
I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor License
COMPLETE ELECTRICAL INSTALLATION 184274
BUILDING INFORMATION I
# of Units:
Primary Occnpancy Gronp:
Secondary Occnpancy Gronp:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structnre
Type of Heat:
VB W.ater Type: ,
ATTENTION: OWgCti!f~eq'uires you to
foHow rules adtlilii;<81l!:OY,1fu Oregon Utility
~otlflCatlOn CelJt\!t.il'i1i~~I!UIbiN8 set forth n/a
In()AR~~
OO;~iin~ " e e ep one .
number for the oreaOn~jility Notification
Center i~lll!lll\r. :[-23441,
# Street rees Rqif:
Paved Drive'Rqd:
% of Lot Coverage:
, ,
Frontyard Sethack:
Side] Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLlCIMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Speciallnstrnction:
Notes:
NOTICE:
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Description
IF THE WORK
ERMIT IS NOT
~~~.M~~O(jRIS~DMrwl'l~~FOR . , "
olrJJm;JllsY,PERIOlX Bid Amonnt '
Tvpe of Constrnction
Paee I of 2
Expiration Date
10/14/20 I 0
Phone
541-225-7827
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq.Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
Valne
Date Calcnlated
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
"'
PERMIT NO: COM2010-00614
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Total Valne of Project
!':tFees;paidj: "
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Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Pai"d"
Date Paid
Receipt Number
$7.32
$3.05
$55.00
$6.00
5/17/10
5/17/10
5/17/10
5/17/10
1201000000000000465
1201000000000000465
1201000000000000465
1201000000000000465
Total Amount Paid
$71.37
Plan Reviews I.
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.
Rougb Electric: Prior to Cover
Reouired Insnections .
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Final Electric: When all electrical work is c"omplete. .'
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B"y signature, I state and agree, tbat I bave carefully examined the completed application and do bereby 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 Springtield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any strnctnre withont permission of the Commnnity Services Division, Bnilding Safety.
I fnrther certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensnre that all reqnircd 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.
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Owner or Contractors Signatnre
Date
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, Paee 2 of 2
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department.
RECEIPT #:
1201000000000000465
Date: 05/17/2010
8:52:18AM
Paid By
CMPL TE ELCTRCL INSTL TNS
Item Total:
Check Number Authorization
Received By Batch Number Number Ilow Received
Amount Due
55.00
6.00
7.32
3.05
$71.37
Job/Journal Number
COM2010-00614
COM2010-00614
COM20 1 0-00614
COM20 1 0-00614
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add.
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Amount' Paid
djb
004973 In Person
Payment Total:
$71.3 7
$71.37
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5117/2010