HomeMy WebLinkAboutPermit Electrical 2010-5-17
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00612
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: ll/17/2010
VALUE:
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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 101
ASSESSOR'S PARCEL NO.: 1703223402800
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Demo can light, ch'''nge out devices
Owner: SUN RETIREMENT CORPORATION
Address: 200 HAWTHORNE AVE SE A-140
SALEM OR 97301
I CONTRACTOR INFORMATION .
Contractor Type
Electrical
r;
License
Expiration Date
10/1412010
Phone
541-225-7827
# 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:
nla
I DEVELOPMENT INFORMATION ~
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
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NOTle . .':~;'_~ .! ~UBLJClMPROVEMENTS~
Street Improvements: THIS p E. . ...." "':;,';,'.'ji#'i1\"""'"
Storm Sewer Available-AUTHo~~Mrr SHAll EXpi~: . "'HI"'OI','<,
Special Instrnction: COMMENCZEO UNDER THIS l IF THE WORK
ANy ED OR IS A ERMIT IS NOT
NOles:' 180 DAY PERIOD BANDONED FOR .
Sidewalk Type:
Downspouts/Drains:
I Valuation Description ~
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
,. o'r Bid Amount
Value
Date Calculated
I: ~,
Pa2e I of2
SQ:lJlNqFlllcLQ~-
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Status
Issued
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-006I2
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
541-726-3769 Inspection Line
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Total Value of Project
Fees Paid ~
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Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
, Date Paid
Receipt Number
$7~32, .
$3:05 -
$55.00
$6.00
5/17/10
5/17/10
5/17/10
5/17/10
1201000000000000463
1201000000000000463
1201000000000000463
1201000000000000463
Total Amount Paid
$71.37
Plan Reviews I
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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, ins'pections requested after 7:00 a.m. will be made the following
work day.
Reouired Insoections ~
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I 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 strnctnre without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliauce with ORS 701.005 will be 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.
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Owner or Contractors Signature
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Date
'Page 2 of 2
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Electrical Permit Application
-
225 Fifth Street. Springfield, OR 97477 tPH(541)726-375H FAX(54t)726-3689
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~}\' DEPARTMENT USE ON.l Y
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Co~ ZO(O- 60 bl z:
Permit no.:
Date: ') ~'7 - /0
This permit is issued uuder 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.
200 amps or less (2) $ $
This installation is being made on residential or farm property 63.00
owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, orrent. OARATTH T4(L1"'- ""^ ----- '" $126.00 $
479.540(1) and 479.560(1). folio I\V IIl'mIll'llT '61..
Signature: NOlifi a: ~~~~ Inyl i<Ifl!J OJl&~~el?c;'6:\~s or feeders section above
',CONTRACTOR'INSTAllATION In A 9 I!reD~~ .' i ?~'N:tH/Mrlill~etlr6j{f('perpanel
\' Yc UallRilYWbla!llc(JcfiJ"iiIW}.~) 1>1 a service or feeder fee:
: ~nc~tthe te'eD':;~~:.. ur $ 6.00 $
( e1ntllR<jj>r,b _ ~ \\ItHi1icilllloJjase of a service or feeder fee:
First branch circuit (2) ." I $ 55.00 $.{;<:
Each additional branch circuit I $ 6.00 $ C:,
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
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NOTICE: (A)'Enie.subfot~J'.of.'al;io~~:fee~j.,.
r~~H~~~l ~UN~~~~ ~~
COMMENO&fMR:~S:>AMNOONEr1fM . ....
ANY 180 D and surcharges (A through C):
" Y;EOCAl:.GOVERNMENT:A~PROVAG?",<:it,,,,"7;;;",
Zoning approval verified? 0 Yes 0 No
I;;: ":f! i,'C;,(CATE GORY1i'OF ;'CONSTRUCTIONT!,\}-"',~! "
D Residential D Government m Commercial
~!~g1JOB}{SIJ:E';INF,ORMA,.fON,;AN[j~ )OC-A'l'ION~l<"W~~n
Job site address: . ! ;-t
City. 10',,, 'e. State: Cl
0.3 Z. 2-'3 tf Taxlo!.: OZCO
:.. :DESCRIPTION, 'OF<.wORK!,~y!:",(,:"";,!iY';:::f'};
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PROPERTY.OWNER
Name: __ I"e---e..... f
Address: ZOo c.::. 1f;f/,,-l"rff<Nll'f~
City: 5Alc"lvt State: CJtC.. 730 (
Phone: Fax:
E-mail:
E-mail:
CCB license no.: ~
Signing supervisor's license no,:
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-J (9!08/COM)
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, '. ,..., . . ," .. Cost 'Total
.N~~~~er ?fl~spectI~~ ~~r ~tt~ ()I:J',u qty. j -ea: 1~:"',cosL :'"
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) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
40 I 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 services or feeders: installation, alteration, relocation
Miscellaneous fees: service or feeder ~ot included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
$
$
$ 63.00
$ 63.00
$ 63.00
$
$ b (
$ 732
$ '3 <>5
$ 7(3
City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth. Street
Springfield, Oregon 97477
541-726-3759 Phone
RECEIPT #:
1201000000000000463
8:50:54AM
Date: 05/17/2010
Job/Journal Number
COM20 1 0-00612
COM20 1 0-00612
COM2010-00612
COM20 10-00612
Payments:
Type of Payment
CreditCard
cReceintl
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ. Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Amount Due
55.00
6.00
7.32
3.05
$71.37
Item Total:
Check Number Authorization
Paid By Received By Batch Number Number How Received
CMPL TE ELCTRCL INSTL TNS djb 004973 In Person
Payment Total:
Amount Paid
$71.37
$71.37
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