HomeMy WebLinkAboutPermit Electrical 2010-6-10
225 Fifth Street. Springfield, OR 97477.PH(541)726.3753.FAX(S41)726-3689
DEP.ARTMENTUSE ONLY
CoW\"ZOtO-OO 750
Pemit no.:
Date: /;'-(0 -/0
Electrical Permit Application
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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 wurk is suspended for 180 days.
. ".LOCAL'GOVERNMENT APPROVAL'.;'; , <",." .< :'~" :,''''i''i~_,~;!(r;~0:n~;FV;r3\;Wt;:;:?~~E~'1.~S~R EJ>.Q IjEfWqf:.)tt?;~1~V?~~fi~~~\~Wt~,~):
Zoning approval verified? DYes DNa . - - , Cost Total'
Number' of.in~peciio'ns p~r,i_tein'(,) Qty.
,c',> :.','CATEGORY00FCbNSTRUCTION\,," .' . :. ,:;" .",-' ,..' ", ,.,.,", ,'"':,.-"!.' e#i'-" . cost.
i_,., Residential, per unit, service included:
D Residential I D Government T o Commercial
1,000 sq. ft. or less (4)
f;\!i~1!:l7i:UOB)tSITE;INFORMATIONMN[jr;,IJ:OC:AtION~)~\:!tn $134.00 $
Job site address: k/l I. A.Jr :# /Ill Each additional 500 sq. ft or portion $ 25.00 $
thereof
City: ,-.,0. CN~/ I Stateo1. I ZIP:9)jr/ 7 Limited energy (2) $ 32.00 $ (2,<'>
Reference: tI) 70 '3 ~ s'{ 2- I Taxlot.: o2boo Each manufactured home or modular $ 63.00 $
, , '. .. . .{..:".~,' dwelling service or feeder (2)
DESCRIPTION OF WORK',.,.;:',' ,
.1)0/..<1..... A-/'" t-~ Services or feeders: installation, alteration, relocation
./ - 200 amps or less (2) $ 81.00 $
PROPERTY OWNER 20 I to 400 amps (2) $ 95.00 $
Name: -;r;! .-r (t.' #kcC-. - 7::' -r- 401 to 600 amps (2) $158.00 $
Address:jJ(ICHT!t7- nru1 IZt:, i .:rSl.AN~ c./tZ .- 601 to 1,000 amps (2) $205.00 $
City: Sf>F'!:. I State: 0L T ZIPS 71.(77 Over 1,000 amps oAJ;;f6.itiT'ON: Ore on r ~~r, slilou tn
Phone~f1If u.f",s-;:.G6'/1' I Fax: Reconnect only ( " f ~""l aao~1f~~ 0 lj1 %:Qtijl op Utility
- -
E-mail: Temporary servtlldi),A;Rl{jIlltf~G1"ll~tiPlt1fif ;';;i;::'. 9R~~'r
This installation is being made on residential or fal1D property 200 amps or lessI(W~:. Yo~ may obt inc Piihe$UfeSb
owned by me or a member of my immediate family. This 201 to 400 amps <i'U.tmb:r ~.., ,..""',, I'~c ~i" e e ~W1one
property is not intended for sale, exchange, lease, or rent. OAR 401 to 600 amps (2) Center is 1 ioo W2j)lj4 . $
479540(1) and 479.560(1).
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits: new, alteration, extension per panel
Business name: I? 1/17'/ ~f;;'", rtcC/h~ .-C./AJ a. Fee for branch circuits with purchase of a service or feeder fee:
Address: J077 CA./ //0 ? Each branch circuit $ 6.00 $
City: JZV"",N<-- I State 0"1.. 1 ZIP:'?7'i-'OZ b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: (~_d-~hrq'l.tJL I Fax:s<,.;I ,(.-Y-l~7rJ/ First branch circuit (2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: /~ '- "07 I BCD license no.: '?rVo,",C/L Miscellaneous fees: service or feeder ~ot included
Signing supervisor's license no.: '( q 7"7 .L;f' A E.ach pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: /;'::./.:7 ;2. C//'i.... Each sign or outline lighting (2) $ 63.00 $
I.::
Signacure of signing superviso"<' >-- ?~ Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
c:::-- --- Each additional inspection: (1) $58.00 $
~~~ W
\o\~.\'Q ':~t:~!~9*1t]$~~t~it[iit~){;:~tA~'~:LjCA~Tt~V'S.E1~;';it~ti;:,::;/.;tf~;'i;,;:;l!;;~t~::~{;;h:~': ,t
V--~'i{/ (A) Enter subtotal of above fees $ 5B
NOTICE: e; ,"".J (Minimum Permit Fee@j:bO)
THIS PERMIT SHALL EXPIRE IF THE WORK ~ (B) Enter 12% surcharge (.12 x [A]) $ b?b
AUTHORIZED UNDER THIS PERMIT IS NOT (C) Technology Fee (5% of [A]) $ z: 1Q
COMMENCED DR IS ABANDONED FOR TOTAL fees and surcharges (A through C): $b78fc
ANY 180 DAY PERIOD.
440-2584-1 (9108/COM)
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00750
ISSUED: 06/10/2010
APPLIED: 06/10/2010
EXPIRES: 12/10/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54] -726-3676 Fax
54]-726-3769 Inspection Line
SITE ADDRESS: 806 A ST B
ASSESSOR'S PARCEL NO.: 1703354202600
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Burglar alarm
Owner: FITCH MICHAEL J
Address: 1269 ISLAND CRT
SPRINGFIELD OR 97477
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I CONTRACTOR INFORMATION I
Contractor Type . Contractor License
Low Voltage Electrical RUIZS CUSTOM SECURITY SYSTEMS INC ]08202
BUILDING ]NFORMA TION ~
Expiration Date
08/25/20] I
Phone
54]-687,9202
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
.Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
J.,OPMENT INFORMATION
I r8> €:-
~0~0<a~':~r8>~~'_D,,' 't.
~" v ~v_Qo. ,_ lYY,o,.ay .,.s. .
..q> -1$-0 ~0 O'r' -1$-0 ",~ljilheeHrees Rqd:
~~'l:>'Q"'~0;:,if ""~ 0~ ~'(faved [jrive Rqd:
O.../lJ ~/lJA..'<I:-~O it0.~oI;:~:'-~ of Lot Coverage:
~. bO to..~ & A0~"'!fi'" .
o '6 l': " ~ "" V', .
if ~f6 CJ-,,>'" if>~. ~ PUBLIC IMPROVEMENTS
t.' ~..-"-o~w>- ~ ~O.../lJ
Street Improve~~~~4';:,,~ ,.t}-I$-0.. '"
"Ii! ~"c.'r' ~O ~ ~ ~
Storm Sewer A vallli~....~. ,,-~t:b ~..'o ftJ~
Special Instruction: Vj 0'" ~ #/lJ CJ
~o<$
REQUIRED PARKING
Frontyard Setback:
Side] Setback:
Side 2 Setback:
Rearyard Setback:
SoJar Setbacks:
Total:
Handicapped:
Compact:
.-t.!"....
Tvpe of Construction
~'
~\j<(!.~"
Sidewalk Type: '\~~ ,<:;, ~\j
" ~ ~~ ~
Downspouts/Drain~~<i:. ~~:~ ~(S .
. ~\,<;}~<:;,~ ~~<i:.~,.:
. <:;,~~ ~~..:"\ '!t-~<:;)I"
~\~'fr;. ~~ ~~<:;) fo ~~
, ~ ".
I ~ \~\ ,,-\j<(!. R,<i:.\:) ~'Y",<(!.
Valu~'tion Des~ription I 'r-'0'\"~S~ \:)~
~~ 'O~
Square FootageCl ~o.I, \ V I
or Bid Amount ~ a ue
"
Notes:
.J,....
Description
$ Per Sq Ft
Or multiplier
Date Calculated
}b'-?i ..r~.;\ ''''1''
Paee] of2
If-'Sd i'4""~ l~'
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'Jr,'
....~.~; 1 \ 1,
It:-., ,( j,
..j....
J -" "',
""e
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Une
'.' Total Val~e of Project
I Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Low Voltage - Commercial Indus
Amount Paid
$6.96
$2.90
$58.00
'liA"
$67.86';'>
"Lt '~,," .'
"-..' ,
, '
Total Amount Paid
'l'j.
I Plan Reviews ~
Date Paid
6/10/10
6/10/10
6/10/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00750
ISSUED: 06/10/2010
APPLIED: 06/10/2010
EXPIRES: 12/10/2010
VALUE:
Receipt Number
2201000000000000679
2201000000000000679
2201000000000000679
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.
Reauired Insnections I
"
Low Voltage: Prior to cover.
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 r 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.
1 further certify that only contractors and employees.!y,ho.~re i,n5ompliilnce with ORS 701.005 will be used on this project.
I fnrther agree to ensure that all required inspectio'ris'are'req't'ested at the' proper time, that each address is readable from the
street, that the permit card is located at the front o.t,ii:~ prop~rty, and the approved set of plans will remain on the site at all
times during construction. "1~-'-.:" ,.,. ""
Owner or Contractors Signature
, .
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.'
Pa2e 2 01'2
Date
225 Fifth Street
Springfield, 'Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000679
Date: 06/10/2010
2:18:30PM
Job/Journal Number
COM20 I 0-00750
COM20 I 0-00750
COM20 I 0-00750
Payments:
Type of Payment
CreditCard
cReceiotl
Description
Low Voltage - Commercial Indus
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
TED RUIZ
Amount Due
58.00
6.96
2.90
$67.86
,.
lIem Total:
Check Number Authorization
Received By Batch Number Number How Received
DJB 006334 In Person
Payment Total:
Amount Paid
$67.86
$67.86
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