The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2010-7-8 Ele~trical Permit Application ,CiTY OF SPRINGFJELD,' ()REc;ON. ,. 225 Fifth Street. Springfield, OR 97477+PH(S4I)726-3753+FAX(541)726-3689 DEPARTMENT USE ONLY CO....-l ZO(O -00 -,01 Pennit no.: Date: 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. 'LbCAV GOVERIIIMENT AP,PROV AL';c.,,~ Zoning approval verified? 0 Yes 0 No " ", ,.';:CATEGOR.Y>bFCbNSTRUCTION';' '0 Residential 0 Government 0 Commercial ~fff;.fjOB};.$ITE'INFOR.NiMIOlilr~Njjf:UOC'Af:jON:i~?i~~fr Job site address: 'I c; g It R.L.O tJ lLc.( City:. S-=f>l~ State:d'( ZIP: 97'(77 Reference: 1703 220-0 Taxlot.:OZ~Oo DESCR.IPTION; OF WORK .i..;. ;,.~: ",;.' L~41( lv't+sl..t-o'\... Pfl e-'l. Cl rUA ~ 'PROPERTY OWNER Name: ~ 14""1.1"- ?/t..fJ/~^-77~S. Ll. L Address: 3 zi. '7 ( ~\C HAL"t. L.I Y City: l:=-u..v-e-N~- State: oR ZIP: 77C(o~ Phone: E-mail: This installation is being made on residential or fann property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR N 479.540(1) and 479.560(1). T Signature: A C Business name: A City: Phone: E'mail: ~ Signing supervisor's license n Print name of signing supervis : Signature of signing supervisor: ,~~ ~/tj ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010through OAR 952-001- 0090. You may obtain copies of the rules by calling the center, (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). ...~, Q ~.I\.'\ ~.~~~ ~.$- 440-2584-J (9/08/COM) :{'1';!.';~1:,f,:r:?{i;~r+~~~~~~~.FEE~SC HED..UtEr;j}iY~rIf~1;?h]'t%~q~~1~~~ " ". '."'.".' .... Cost ..Total Numb.er ofiitspectio~s p~r ,it~~ ()i Qty. ea:, 'I' cost. Residential, per unit, service included: 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 manufacture,d 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 I 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: instal/ation, alteration. relocation 200 amps or less (2) $ 63.00 $ ~<,o,I,,9-400 amps (2) , .", .::.", ".-;'r:"> $ 87.00 $ '.'A ~II !:VDID!: 1 26.00 $ I ~1.DhP; lrP.ll? :'~rrl ,'ll'fRMiFfslS- N@Trs section above (1Itl...~r~~J eroieR'~S M9ANOO<<&li>,p~~r panel r I\~. neJ<!!J)iN.rjilH!I{ll~ with purchase of . a service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) I $ 55.00 $ 5S' Each additional branch circuit I $ 6.00 $ ~ Miscellaneous fees: service or feeder ~ot included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ ,i{fy,S~~~:}~~l~2J~18;~~AR~,(jcANt:~:USEr)~;).;;~C?:t7i:"::,:IF:~~X(';;::;}~'~,';' (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ bf (B) Enter 12% surcharge (.12 x [A]) $ 7'11- (C) Technology Fee (5% of [A]) $ ;Jo.f" TOTAL fees and surcharges (A through C): $ 71'S; Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00907 ISSUED: 07/08/2010 APPLIED: 07/08/2010 EXPIRES: 01/08/2011 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 498 Harlow Rd ASSESSOR'S PARCEL NO.: 1703220002800 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Commercial PROJECT DESCRIPTION: Add 2 circuits - suite 5'" ,', Owner: SKYHA WK PROPERTIES LLC Address: 32671 SKYHA WK WAY EUGENE OR 97405 j. ,L ;~~ I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor JB ELECTRIC -License 104929 BUILDING INFORMATION ~ Expiration Date 03/14/2012 Phone 541-687-5770 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: NOTICE' Sq Ft Basemen,!,:,.;/,.:.(;;,;,},<._:... Range Type: '. ,S.q Ft Gar"$!/Ca!J.l~rt Energy Path: THIS PERMIT StStf-t.t~lI;;l: 1Ft HE WORK " Sprinkled Building: AUTHOIn~:OED UN06IG!iddI9J?ldlMIT IS NOT ~), C2~.~~.~:::rJ8eB SA IS ABAfJ8S1JeB rSR;:,;' I DEVELOPMENT INFORM~fIiIlj)ii'i1IJAY PERIOD." ,_ .\" REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: RearyardSetback: Solar Setbacks: Overlay'Dist: #Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Sidewalk Type: Downspouts/Drains: Storm Sewer Available:. law requires >you to . Special InstructiWENTlON. ~re?~ by the Oregon Utility " o follow rules a op e les are set forth Notes: Notification Center. ThhOSe rUh OAR 952-001- , . In OAR 952-001-0010t roug h"1 by , , les oft e ru es calilng the center. (Note: . 'f' ' number for the Oregon ur ity 8lWill'iiltlOOescri Canter is 1-800-33 - . . $ Per Sq Ft Type of Construction It' I' or mu Ip Ief , " Description Square Footage or Bid Amount Value Date Calculated . -../ Paee I of 2 U',r{,', .':';n~. ::';c: ._ ..~~~~x'.! " Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00907 ISSUED: 07/08/2010 APPLIED: 07/08/2010 EXPIRES: 01/08/2011 VALUE: 225 Fifth Street, Springfield. OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line h 'Total Value of Project Fees Paid ~ Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number Total Amount Paid $7.32,., ,( $3.05 ,,~1,~1"'. $55,00,,,,, , $6,09<;:. $71.37 '""i"..' ~:',.. ::.., 7/8/10 7/8/10 7/8/10 7/8/10 2201000000000000807 2201000000000000807 2201000000000000807 2201000000000000807 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. ..." ... ,. " LReouired InsDec~ Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, tbat I have carefully.examiiled.tbe completed application' and do hereby certify that all information hereon is true and correct, and I furth~rcertify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the ~a,~s"of the,.St~te of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any struct(.r.e 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. 1 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 .' . .: ~\ ' Page 2 of2 225 Fifth Str:eet Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #; 2201000000000000807 Date: 07108/2010 9:45:39AM Job/Journal Number COM20 I 0-00907 COM2010-00907 COM20 10-00907 COM20 I 0-00907 Des~ription Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Fee 'I., Item Total: Amount Due 55.00 6.00 7.32 3.05 $71.37 Payments: Type of Payment CreditCard Paid By JB ELECTRIC Check Number Authorization Received By Batch Number Number How Received djb 023854 [n Person Payment Total: Amount Paid $71.3 7 $71.37 .< .t' ',Y. cRcceintl Page] of I 7/8/20 J 0