HomeMy WebLinkAboutPermit Electrical 2010-8-5
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~rical Permit kpplication
5P3- 51t>9- l/F!
225 Firth Slreel+Springfield, OR 97477. PII(S41)726-3753+ FAX(541)726-J689
DEPARTMENT USE ONLY
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Permit no.:
Date:
f.;.>.o
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Penn its" expire if work is Dot started within 180
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government ommercial
JOB SITE INFORMATION AND LOCA liON
lob site address: 5103 I1IItJ 51
City: .5f'~//l/4 j,'t-l. t> State: 1HZ ZIP: 9;1'(7 f
Reference: 170 z.. 3.'3 C{ Taxlot.031.{ ao
DESCRIPTION OF WORK
f'tfR/llJE Iff,/} t!<WT,t.t)'- el'llJce-
ADT JOB :283-oS/(P:;J-'T'
PROPERTY OWNER
S &" Al~
C:S S
State: C
Fax:
Name:
Address:
'SS-ClI
Signature:
CONTRACTOR INST ALLA TION ,
Business name:
ADT Security
Address:
2815 SW 153rd Dr
City':
Beaverton
Phone: 503 - 469 -7 206
E-mail:
spate@adt.com'
CCB license no_: 59944
D license no.: 26 - 2 0 9 C L E
Signing supervisor's license no.: 389 LEA
Print name of signing supervisor:
Signature of signing supervisor:
NOi\ct:
1\1\S PER
p..\.l1\10RI2
COMMEN
p..N\' i SO
440-2584-J (9I08/COM)
Residential, per unit, service includ~d:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limitcd.cnergy (2)
Each manufactured home or mOdular
dwelling service or feeder (2)
Services or feeder.!: installation, alteration, relocation
Total
cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Number of ins pecti ODS per item ()
200 amps or less (2)
$ 81.00
$ 95.00
$158.00
$205.00
Phone:
E-mail:
This installation is being made on residential or fann property
owned by me or a member of my immediate family. This Jt=NT 0
property is not intended for sale, exchange, lease, or rent. fJ/'i.FC u e
479.540(1) and 479.560(1). 10\loW r.
Notilicatl n
. 92,
Y u
callin t\1 ~I
nu d nHJI'aiIl a- $
ZIP: 97 006 b. Fee for branch circuits without purchase of a service or feeder fee:
20 I to 400 amps (2)
401 to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
$469.00
$ 63.00
$
$
$
$
$
$
$ 63.00
Temporary services or feeders: installation, alteration, relocation
$ 87.00
$126.00
_ First brancncircuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel, /
alteration, or extension (2)
Each additional inspection: (I)
~Pf>L1CANT USE
OR"
1
$ 63.00 $
$ 63.00 $
$ 63.00 $
$58.00 $
$
$
$
"
$ 63.00
$ 7.56
$ 3.15
$ 73.71
-.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-01064
ISSUED: 08/0512010
APPLIED: 08/0512010
EXPIRES: 02/0512011
VALUE:
0=1 }~'.l \
SITE ADDRESS: 5703 MAIN ST
ASSESSOR'S PARCEL NO.: 1702334103400
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Upgrade controls
TYPE OF USE: New
Commercial
Owner: MCKENZIE CROSSING PARTNERSHIP LTD
Address: 2811 EST STE B
EUREKA CA 95501
Contractor Type
Low Voltage Electrical
I CONTRACTOR INFORMATION ~
Contractor License
ADT SECURITY SERVICES INC 59944
BUILDING INFORMATION ~ .
'#.~f St~~iJ1'~' . ,
Height of Strncture
Type of Heat:
Water Type:
Range Type:
Energy Path:
. S '1olSp~inkled Building:
\\{e \ rMI..'l
a: -. -...." .
. \'I' Olegol' '0'1 \ne "DJ;:YEOOP.NIENT INFORMATION'
P;\\~~:\~S ~d~~;~~nose ~~~ Of>-\'. \J~:I~S '0'1
Frontyard SettlJ\~ca\\Ol' eel' _OO~o \nlO leS 01 \n~epy,erllly Dist:u, " ,
S~de I Setbac~o\\I~ 952-00~ o'o\all' C~~e" \ne \6 o\<<(Stree'i'~rees Rqd:
S.de 2 SetbackiSl 0 0 '{ou \(\a'll'\el. ,,,, \)\\1\\'1'" tiPaved Dnve Rqd:
Rearyard Setb~ ailil'g \ne ~~e Oleg~~.332.'2.34 to of Lot Coverage:
Solar Setbacks: C \(\'oeIIOI \el is ~.Il '
l'U .el'
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
.\.-,,,_:,::,:-:
SidewalkType:"" ~'f-
",' '. Downsp~~~~~~O\ .
,,',' ' ' O\~t. \ .~,~ \':>
.="" .,''^' """ul,', ". " \. 'tf\ 't.?-\"\\ ~ ,'. '.
,,"'. "." n1'\Ct. rl S"",\'; ~y..\S? ~\X.\) to,.,
,,01 . '''',.). \ c~\1'i\' ~t.?- \ '!i\\)O\~ ".,
B'il .. ""i~\S?'- 'C.\l U~ S r>-'Pf:' ....;.
V I 't' D t'~""t~ ,,' ot.~\Cl
a ua IOn e "m In", r ,
1'~ 'v
Square Footage
or Bid Amount
n/a
I PUBLIC IMPROVEMENTS.
$ Per Sq Ft
?r multiplier
Paee I of 2
;'
'. J ,. .'... ~ ! (. .
Expiration Date
05/07/20 II
Phone
541-736-4973
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:
Value
Date Calculated
~'
~..~.
, "
~ ,. .'
CITY OF SPRlNGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-OI064
ISSUED: 08/05/2010
APPLIED: 08/05/2010
EXPIRES: 02/05/2011
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
"JI''''_. '_\;.' '~,:;.,..,
:, ~ .'. .
)':;~f
\ :'( :'j; t, ~
~
Total Value of Project
Fees Paid i
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Traffic Signal - Panel
Amount Paid
Date Paid
Receipt Number
$7.56
$3.15
$63.00
8/5/10
8/5/10
8/5/10
1201000000000000880
1201000000000000880
1201000000000000880
Total Amount Paid
. ~-\". .
$73.71' '
Plan Reviews ~
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. ,_~:_ '
'f!; "
L-Reouired Insoections ~
Low V ollage: Prior to cover.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
informatiou 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 permissi~n of the Community Services Division, Building Safety.
. I further certify that only contractors and employees who are in compH;,"ce with ORS 701.005 will be used on this project.
I further agree to ensure that all required insp~~t,~n,s,are reques\ed at the proper time, that each address is readable from the
street, that the permit card is located at the fronf Of the property, and the approved set of plans will remain on the site at all
times during construction. ""
Owner or Contractors Signature
Date
~ Spt.' 1..\-t; 1-':,"1',1 : ;', ! .
....)
. }!.. .' ~
'ri',"
Page 2 01'2
225 Fifth Street
, .'
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Departm'ent
Public Works Department
RECEIPT #:
1201000000000000880
Date: 08/05/2010
2:49:23PM
Job/Journal Number
COM2010-01064
COM2010-01064
COM2010-01064
Payments:
Type of Payment
Check
cReccintl
Description
Traffic Signal - Panel
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
ADT
Item Total:
Check Number Authorization
. -~,~~eiyed By Batch Number Number How Received
Amount Due
63.00
7.56
3,15
$73.71
Amount Paid
djb
3279293
In Person
Payment Total:
$73.71
$73.71
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