HomeMy WebLinkAboutPermit Electrical 2010-5-17
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00613
ISSUED: 05/1712010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
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 301
ASSESSOR'S PARCEL NO.: 1703223402800
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Demo can light, change out devices
Owner:
Address:
SUN RETIREMENT CORPORATION "
200 HAWTHORNE AVE SE A-140
SALEM OR 97301 !. . !
Contractor Type
Electrical
I CONTRACTOR INFORMATION .
Contractor License
COMPLETE ELECTRICAL INSTALLATION 184274
BUILDING INFORMATION.
# of Units: # of Stories:
Primary Occupancy Group: Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VB Water Type:
Secondary Construction Type: Range Type:
...""-~to
# of Bedrooms: ...... ..,-r'ON' Oregon law<mergy.....d .~.~
If_.. ." d b lSnMIllIlIi''B ,II . /
. :lo'J! wles adopte ~... Y... e se 0 Ii' n a
I<Qiiilcatl~n '-'~I"o"'oE.\1EW MATI ON
in OAR 902-001-0
0090. You may ob al ote' tM telephone
Front yard Setback: calling the center. (N gtll\t+a~Iti1IMation
Side I Setback: number for the. Or1e8gg~;S3l1aat\t)-.ees Rqd:
Center IS .. .
Side 2 Setback: ~aved Dnve Rqd:
Rearyard Setback: Yo of Lot Coverage:
Solar Setbacks:
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
~ ~_ :,,:",~.~~~~~fi~~P.4t:W},}'~_.i'
O"f,ct~ " ~~..- . ';,;~ If 11-\E 'NO?>~
'THIS '--Toe" fOR :c....
f:>,Ul ilIUm' e '. "
. COMM!ti!~IilER\OO. SqU;r~;~~t~ge
Type of ConstructlOnANY It' I' B'd A
r mu Ip ler l?r I mount
Description
Pa2e I of 2
.i
.\1. S 'L,.',l rn.,': (' "
Residential
Expiration Date
10/14/2010
Phone
541-225-7827
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDrains:
Value
Date Calculated
',1-: \i \'..:t fr
,',
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
", Total Value of Project
Fees Paid ~
Fee Descriptiou
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$7.32
$3.05
$55.00."",:
$6.00~~.:'.. ",:':!.
Total Amount Paid
$71.37"
I Plan Reviews ~
5/17/10
5/17/10
5/17/10
5/17/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00613
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
VALUE:
Receipt Number
1201000000000000464
1201000000000000464
1201000000000000464
1201000000000000464
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.
Reouired Insoections ~
Rough Electric: Prior to Cover .
Final Electric: When all electrical work is complete.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 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 th~ State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any strnciure;withoui'permission of the Community Services Division, Building Safety.
I further certify that only contractors and employe.~~ Who are)n compliance 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.
Owner or Contractors Signature
"'-~ .;.,
Page 2 of2
Date
Electrical Permit Application
. .
225 Fif.h S.ree'.Springfield, OR 97477+ PH(541}726-J75J HAX(541)726-3689
.' tiE-P~RTMENTUS'EONl y.
.....:.,. , .
D..v1 ZOI<:) .006(]
Permit no.:
Date: S - ( 7 ~ ( 0
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started. within 180
days of issuance or if work is suspended for 180 days.
!' ('" , i~'1S0C~l::GOVERNMENT'Ap,F'ROVAb;>i\';!{:'<<;V':1;'.:
Zoning approval verified? 0 Yes 0 No
S.,:!.!ic.:f"N:;-!CATEGORY,:;(jf,.;:CbNSTRUc:J'ION'~0i;'o '.";,,,.' '. .,\
o Residential I 0 Government +8 Commercial
~~'Ii:'~0~tO:l3iSIr:Ei;INFQRIVIMIQN~:a:NI551IfO:C'A'l110N;tIi~;;f:\;;~
Job site address: ")? 0 ~ 'q<; 0.".. a. I tA \' '\'j'::bJ
City: 4.Q"',~.s:' <?)~ State: eN" I ZIP:
Reference: 170':> Zz. 3L( I Taxlot.DZ&,0 c>
,..'.. . , '.' -'DESCRIPTION:OF .ll\!ORK::;!.;..\::..,....'.'i::';.'.,.
.Del"'.f) I ",,-J(, L-T' -:r. ,..,0-,.,\\ ~.q,Y'---
L\--' , <:.,\..o1'\6..Q. 't:v:\' Dev:c:B<.
PROpERTY OWNER
>1.\....-... -;2L-h,er-.......~-F C~
Address: 2L:> c::> t!A-l.rtrf-.r<ttJr=
>~""/.V'-. I State:uL. T ZIP: '17 SO t
- - I Fax: - -
Name:
City:
Phone:
E-mail:
'~.;fN);!:,,\~~~k;:~tYS~Wt't~~~'t'} FEE:r:SCH EDU'111E6';iJ:i~\~j;~'''Jt:~)~~'ii:Pi:,,~~1:~:i4
',. .,' . '\'.\'i,yt~~'f,',:d'",,_,'!:'-:,.:~; I ".. .. 'j" " ._' ~ '. L.: ...7< ".lil~"'iVf,:f,"':1ip~"-~;l;:-!" ;~,~i"i,-,
. ..... ..,..... ...,.,....,..-". .
:N~niber ofjnspectii:;ns'p_er,ite-in'-c)\,~:', Q'ty.
,. :,.. ~"~",,..,;.--,- .-: . "':_~,,,_:','F;' .;n~;'i "-";i.""",',\;";;,~" '... :"
Residential, per unit, service included:
. CDs!; Tot31
,i. tea,:; : ,. cost. i.
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 $
40] to 600 amps (2) $158.00 $
60 I 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
This lOstallatlOn is be 109 made on residential or~~ erty 200 amps or less (2) $ 63.00 $
owned by me or a member of my immedIate flDmii:~t'itffONU 20 I to 400 amps (2) $ 87 00 $
property is not lOtended for sale, exchange, INo;j,P! If!fb,j)' r~. 0, _. .
479540(1) and 479 560(1). InQA';,lltion C OPtEd .."'" tllaIJll.amps (2) $126.00 $
&,;_"" 95" enter. 'T~rn,.~. .
Signature' -vtI(J. ";::"''..()()'-''': . v :r (<P:~,"O volts, see services or feeders sectlOn above
CONTRACmR "STAL~""~ ~ ~",~'"" """..'",..~""
Business name: (.0 v-I'IR) et -e i)-:~IrW, JJ~B't'JfIi ~ts with purchase ofa service or feeder fee
Address,;OZ.4 -/,- - ,L.. s~~1t@t. '{~ $ 6.00 $
City: C (' e...S ,......e,\ \ I State: 0 ~ -, ZIP:41t13;:: ~ltS without purchase of a service or feeder fee.
Phone!:)4/ Us _ ?g2.,1 I Fax: - -- First branch circuit (2) \ $ 55.00 $5S~
E-mail: Each additional branch circuit \ $ 6.00 $ 6~'
CCB license no.: 942."J LI \ BCD license not:-----z.j41J Miscellaneous fees: service or feeder not included'
Signing supervisor's license no.: !:::~) 5 Each-pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: ""'-Gl1)- (Jr.-ave(' Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor' ~~ ~ ~ Signal circuit or a limited-energy panel, $ 63.00 $
~-,-~~ ~ /' alteration, or extension (2) ,
../ Each additional inspection: (1) $58.00 $
;:~~;i{g:&(~t~11~~f.~!~~~R~i2TcANt1~:US'E~)~~~~ij,~~~i?f;t~~~<',~q~i?~{:.:':~~~
NO'lIct: nSll~ '~Ri~~::,
1\-115 PE~~EO UNOE ~(lil'\l~~r e (Ii x [AD
AU~~ENCEO ORI~ ~ ogy Fee. (6% of [AD
~~'{ 180 DA.Y PERI )\lOT AL fees and surcharges (A through C):
440-2584-J (9/08/COM)
(,(
$ 7 7Z-
$ '50
$ 7('1
$
225 Fifth Street
Spri~gfield; Oregon 97477
541-726-3759 Phone
aJ~Q~~D.~....~.......
Wit ..
" .: .
..._0_....,.....:_._' h" o. ...
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
,j
1201000000000000464
Date: 05/17/2010
8:S1:37AM
Job/Journal Number
COM20 I 0-00613
COM20 I 0.00613
COM20 I 0.00613
COM2010.00613
Payments:
Type of Payment
CreditCard
cReceintl
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
.'
Received By
Check Number
Batch Number
CMPL TE ELCTRCL INSTL TNS 'djb
." " ~
.~_ - ~~. 0".. ..
,
.1'':'__,-
4:<.:':'!~
..-.'
,"'1,.
,
; ~~,:!: ,\
Page I of I
Item Total:
Authorization
Number How Received
Amount Due
55,00
6,00
7,32
3,05
$71.37
Amount Paid
004973 In Person
Payment Total:
$71.3 7
$71.37
5/17/2010