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Home My WebLink AboutPermit Electrical 2007-7-2 1:'4 ", I', . ~ ZON ~.> INITIALS t\J fV' DATE ,-OJ..-vI SOURCE j '(\..-(1...:.... 1 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COM L..o C 7- 00 9 15.3 1. LOCA.TION OF INSTALLATION: L.\bll LMA\\A 5J.. SO.l'-l"'-b ~~t"\..-n LEGAL DESCRIPTION:. J70l'Ylf(f 0 froe OA~A~ ~t"'1--M JOB DESCRIPTION: l v.-'S:~.4\..L :\...l\.~,^.oOrtp lul/\.\. ~(b~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor --. \-- ~'^ <:.:S-o;; ~-t;.'M~c.. Address ::sc::>?-o s. \ \. ..y '3'-\ ,/ City ~ \..~A-'-V l Phone j \..1\' ~-US- Sgs g-- Supervisor License Number 51. .s..\.l.::::. Expiration Date ,') - 08 Constr. Contr. Number ll..~l..l ~&-b Expiration Date L..l- C> & Sign;)'~OfSUP~ ~~ v Owners Name ~A-(' A)S -Vl J.-:l.A L I-.C- Address "2 1. D"=:. ~d.L A- \ L(b.... ~t -( D....o 7/zA7 / I COll.fPLETE FEE SCHEDULE BELOl1l Date 3. A. New Residential- Single or JVlulti-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or $50.00 Feeder I,""~ nrAl'Iml~r uk" you to B. SU\li6Nbr-tfee~~d.~r:'1 . l:Sf\r., or Relocation: follow rules adoptsTh se Nlea are set forth ifi ti ~~enter 0 2~9tm~t)t _ 01_0010throu~952~eo 2o'r~p~u aY'I()b\ain copies of the ~1@G7~0 40Yltm~n~\~e\mpar. (Note: the~upn~~".oo ""........... t hlhenO,tegon utnny nU ~ 601 ~~ Q\')w1i{1-800-332 ~--M)_ $16".00 Over 1000 A~WofI;; $375.00 Reconnect Only $ 50.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Over 600~rnref.~00 Volts see "B" above. WE WO"~ D. Branc . fSuf$!RM\T SHAll EXT'''~E \1= M\T \5 NO" . I nmER>TH\~ PER New AlterAU!tiOORiZiQsMtpll',S A~t'mONEO FOR One CircutOMMENCED OR \5 $ 43.00 Each Additm. ~81FDA\'~iR\Ou. Service or teeder Permit $ 3.00 E. Miscellaneous (Service/feeder not included) -Each Installation City \:."-2c.:.e.I.J-.~ Phone ~<..(\, ~~~ 27_,j Pump or irrigation $ 50.00 Sign/Outline Lighting l $ 50.00 5'0 OWNER INSTALLATION . Limited Energy/Residential $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: Inspection Request: 726-3769 4. Sl.TBTOTAL OF ABOVE SO 8% State Surcharge f./ 10% Administrative Fee ~ 5% Technology Fee j 2fo TOTAL 6! f!!- Shared Drive(T: )/Building FonTIs/Electrical Permit Application 8-06.doc Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2007-00983 ISSUED: 07/02/2007 APPLIED: 07/02/2007 EXPIRES: 01/02/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4011 MAIN ST ASSESSOR'S PARCEL NO.: 1702314105500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Commercial PROJECT DESCRIPTION: Sign electrical for Papas Pizza Owner: PAPA'S PIZZA-SPRINGFIELD Address: 2706 WILLAKENZIE RD EUGENE OR 97401 Contractor Type Electrical I CONTRACTOR INFORMATION I Contractor License{e~U~~\\~WI Date Phone FORESS SIGN & MANUFACTURING ~v.C0{el:,4:lrn~np. o{ego~~~~OO8 541-928-5858 I BUlLDI~,GI iNF.O~~If~~~se t~~~~R 9S2-00~~ 'iO\\~~' :\.\On e \''''O~o\ntOU~ o\U\etu\es e # o~ ~\it~~ 952-00~ -~'ota\n CO\>~~~e ~~~n Helgbl ~~~~ ~et. t~o': \\'<<'1 ~~Floor: Type al'!~ng tne ce~ Otegon ~ Il..~)ct 2nd Floor: Water 1Y~t'H'oet \ot \n \S \-800$ Sq Ft Basement: Range ~~e: cen\et Sq Ft Garage/Carport Energy Path: Sq Ft Other:' Sprinkled Building: n/a Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMATION I REQUIRED PARKING Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: -t!::tCC:. -- 'f 'Tue wORl< I PUBLIC IMPROVE~W~M\l S,",,,tt ~~~PERM\l \5 NOT AUiHOR\IE~%'~i{~Jl.<<DOMEO fOR COMMENC Qo.wmUfi~/Drains: ANY 180 DAV r~mv Total: Handicapped: Compact: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2:e 1 of 2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00983 ISSUED: 07/02/2007 APPLIED: 07/02/2007 EXPIRES: 01102/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project .1 Fees Paid' Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Sign - Outline Lighting Each Amount Paid Date Paid Receipt Number $5.00 7/2/07 1200700000000000857 $2.50 7/2/07 1200700000000000857 $4.00 7/2/07 1200700000000000857 $50.00 7/2/07 1200700000000000857 Total Amount Paid $61.50 I 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. I Reouired Insoections I Sign Electrical: After connection is made but prior to energizing 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 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 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 Pa2e 2 of 2 225 F~ftb Str.eet Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00983 COM2007-00983 COM2007-00983 COM2007-00983 Payments: Type of Payment Check cReceintl RECEIPT #: Description + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Sign - Outline Lighting Each Paid By FORESS SIGN AND MFG City of Springfield Official Receipt Development Services Department Public Works Department 1200700000000000857 Date: 07/02/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 7300 In Person Payment Total: Page 1 of 1 2:01 :46PM Amount Due 2.50 4.00 5.00 50.00 $61.50 Amount Paid $61.50 $61.50 7/2/2007