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Home My WebLink AboutPermit Electrical 2004-4-1 }jJ E,f" If:> . ~~fVE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAX: (541)726-368 A.PR 012003 ~n ELECTRICAL PERMIT APPLICATION CHE~!jjj/j City Job Number C.Ow\'Z..oo~ - 00.351 Date 3 - ~1-Z.s)04 'RY CITY ELEe 1. S 11;) ~ 1) 'a ; j 3. ff)i~)Jf.q;~Wl$1iijjlrJf."lf!Ba~ " -' LEGALDESCRlPTION ~ t.\/LI~ ~~0'~i1il~~~~~ 170 7. 3341.f 0 I bO I ~1\P-1V Service Included ' r ne fOllOWing I ' JOB DESCRIPTION zoning e d pro ect ss sUbm/lle!:IWJls~>>: ft or less --\-, S apprOv~1 n does no! require s~a~_OOO sq. ft or T\\\\",;\---.,.\)"", ~<v;,--I..-~, /111 I1rtion!l!ef!Jt - ,...~ VV' Plo Permits are non-transferable andQatp. . work is not started within 180 days of issl<\im'Ntgr if wor IS Suspended for 180 days. Od Signature Sl06.00 S 19,00 , Home or Dwelling Service or S50.00 eder 2 li(;f1tf~&E@i?.f.1iYsi'jd.jfr.,;~t.f@Nl(j}_. B..li!:S~~F:~ci~~~~lff~~' . c;. ,-".~ __J_ ...,... "'1. i UiII I",., r,. ..Ii ~..., ,;;a:::~'t.t..IuI.,;;..~' ~ ' ....... ..flT.;1, :Z:l/rIm!I ...iV-;-;-;"iiiiiIII Electrical Contractor C. L- ~ ('f' ~C;\~ t:. I (>c,;t fi <. 200 Amps or less \, $ 63,00 <; 3~ \ -\.. \J 201 Amps to 400 Amps $ 75,00 Address \5<1& ~C"d . \r-Q.el' S(_ 401 Amps to 600 Amps $125.00 \ I 6.0 I Amps to 1000 Amps $163,00 CityS., ~.,.. 9'73:J(Phone~S<)3Y3"1~-76<J~ Over 1000 AmpsNolts $375,00 Reconnect Only $ 50,00 Supervisor License Number \3t5~-S E~piration Date \.0 - \ - c.. '0 rJ' 4 Installation^f~Wration or Relocation ' ") 'GOI'cl3c12blJ'~~I~ , $ 50.00 Constr, Contr, Number ~ \ 66 IJ uJ~'V '3\ \:l\2li\3~I\\ ,t R/Amps $ 69.00 1 ;:) q} ;:>~;..C\?N '3\\.\1. 'cl3GNfOOA1\. 01 tn'Ps $100.00 Expiration Date - '-- --1;...\,.l.eN\Wd3d d'o/311"u.c \I 3 ~ooo V I "B" b J'" 1.:11 :ll:l' ^ vr\jV<!t,..~ 015 see a ove. SigJ1ature of Supervising Electrici~\:lOM 3\-1 D. r..lJlcli~lm:ui ~_~\J~~ ", ~'e'i"1-t. ~/. .;r. I~jl" '" '.....,;.. r~,,; ,~....:t,'~~~~_""~'" or ,,'l>t'-$U;, .i:;i"'W",,, ..:.;:...._.,....~,... Address OwnersNameGo.,J J.:rL&O 62"2-/5. '~+\.. '.-/ /' 10 S ? Go Phone New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with ,~ Service or Feeder Permit U $ 43.00 $.3.00 ~,~ '~~" ~tfMifuJt." p ~~t~~.~~ no 'Si~u~t' "h~~~~1ill~~J rJatec y 'e ,t r n II Y I';:~I"~ r .,.~III .;0;. II.:'" ,I lfer1r"uinPDG~gatiallre set forti $ 50.00 In OAR 952-001-00S~~llGlihEib!i52-00' $ 50.00 'OWNER INSTALLATION 0090. You may obtBiifu&afE~gyhtQ\rdl':lrlllAlll $ 25.00 : The installation is being made on prop;rry I o~IIDilgJhe cent€J!:~~~Wgy~b.~ $ 45.00 , , number lor thA Orellon Utlht}(.Notlflcatlon - . IS not mtended for sale, lease or rent. _ _' !\fi111qJ,\W,~~",ct')i~:MllY.t Inspection Fee is$45.00 + Surcharges , ~_ ''''''''''O'''''''J!llilI__''''",,''I'''- ,- '1(0'" Owners Signature: 4. . ""l!Ii~!Mi)~@./jfllJJjl!J. _ ;.-- ..-.."J!i.....:.....Nlw.II,'!.~iil~~I. ,,' 6~q fZ'" ~ <G-fz.~ M-.. '14 City 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:YBuilding Fonns/Elecmcal Pennit Application 1-03.doc Building/Combination Permit PERMIT NO: COM2004-00351 ISSUED: 03/31/2004 APPLIED: 03/31/2004 EXPIRES: 09/30/2004 VALUE: . '" Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . CITY V1< I)rKlj~lJ1<l~LD SITE ADDRESS: 5702 Daisy St ASSESSOR'S PARCEL NO.: 1702334401601 Springfield TYPE OF WORK: Electrical Work Only REQUIRED PARKING Total: 0 HlIfdlS.~ed: ,,\),~{>cOnlpli~'i: ....\ ~eV\ ,,0"- :1.\01' \~'ll O~9" e S0 ,,0' 0'(1 \~9 ~~ Sz...v ~\"O~e16 6 '0'1 ~\)\es I'~ 9 ~eS \ A('\'" ,...\0 _",e ~o _I\) _ I PUBLIC IMPROV1iilVl~1:~'I'S a.~~0~' ~~\~~Ol>~s 0' ~~\e9~O~~~0{\ . \0\\0" \,0'(1 G r.SiaOO ~liPr9.,?9 ~'. \~0 ~O'i.'\'C ~o'i."'C~ 9SZ.!V ,,'-I b~""';. ~~\.\'i.,~,\':l f1,AA"\. Ol""'O\) ~DO~J,Ispout.IDhm~.'l- ,'(I "\ X\0 (jV O~"'il~l':.~.'- 0090 ~\~,'(IQ, '\O~ \~e" ,r ~ .9' C :\)e~ "..~ '(I\)~ r' TYPE OF USE: PROJECT DESCRIPTION: Illumination service Owner: GOOD NEIGHBOR CARE-SPFLD LLC Address: 622 S 57TH PL SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor MORROW MEADOWS CORP License 91668 BUILDING INFORMATION I SETBACKS # of Stories: Height of Structure Type of Heat: Water Type~ Range Tyq~:. En:lSlJY'lPMhfJ'J ... ~ ~~'t''' \-C0" ,,\').0 ^",'j ,,(\~ 'l \ \. .... ,,- .),...... "\ I ,...... \ ....,. :t I ~E~E9~ME~J:']NfORMATION I ~'O' ~\.l'- S ~" ,-~J' ~~ \-'0 ~y: , ~~r::s S\~:\ .-o,(jverlay Dist: 'O\J~ \J ~'O~\'O"fj:' # Street Trees Rqd: S\ ~ \- ~ Paved Drive Rqd: \.~~\J~ ~~ % of Lot Coverage: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I I I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Pal!e 1 of2 New Commercial Expiration Date 07/20/2005 Phone 503-399-7609 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Impervious Surface Area: Value Date Calculated '?~. . . CITY OF ~rKll'lu1<l1!,LD Building/Combination Permit PERMIT NO: COM2004-00351 ISSUED: 03/31/2004 APPLIED: 03/31/2004 EXPIRES: 09/30/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I Fl'l's tiWiLI Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Perm ServIFdr 200 amps or less Amount Paid Date Paid Receipt Numher " \" $7.20 $5.04 $9.00 $63.00 3/31/04 3/31/04 3/31/04 3/31/04 2200400000000000303 2200400000000000303 2200400000000000303 2200400000000000303 Total Amount Paid $84.24 I Plan Reviews , To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 ~:in~1"I'f1 Tn~?I'r.tions I 1 Rough Electric: Prior to Cover 2 Electric Service: Approval required prior to utility company energizing service. 3 Final Electric: When all electrical work is complete. "'. By signature, 1 state and agree, that I 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 the State of Oregon pertaining to the work descrihed 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 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 ~:' Pal!e 2 00 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00353 COM2004-00353 COM2004-00353 COM2004-0035I COM2004-0035I COM2004-0035I COM2004-0035I COM2004-00352 COM2004-00352 COM2004-00352 COM2004-00352 COM2004-00353 Payments: Type of Payment Check Change Job/Journal Number COM2004-00353 COM2004-00353 COM2004-00353 COM2004-00351 COM2004-00351 COM2004-0035I COM2004-0035I COM2004-00352 COM2004-00352 COM2004-00352 COM2004-00352 COM2004-00353 Payments: Type of Payment Check Change -~'r:. "-~"'=.-'ii'.""..' .' ~ ..... 1 ""-Ii" , ", , 1 , ' ",.,"" .'~" ,',. ~ .'; '.' Receipt #: 2200400000000000303 Description Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Temp Power 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Paid By MORROW MEADOWS MORROW MEADOWS Received By djb djb Description Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Temp Power 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Perm Serv/Fdr 200 amps or less Paid By MORROW MEADOWS MORROW MEADOWS Received By djb djb Check Number Batch Number Authorization Number 17618 Check Number Batch Number Authorization Number 17618 City' of Springfield Official Receipt Development Services Department Public Works Department" Date: 03/3112004 1l:17:S4AM Amount Paid o Item Total: 3.00 4.62 6.60 63.00 9.00 5.04 7.20 50.00 3.00 3.71 5.30 63.00 $223.47 . How Received In Person In Person Payment Total: Amount Paid $224.80 ($1.33) $223.47 Amount Paid 3.00 4.62 6.60 63.00 9.00 5.04 7.20 50.00 3.00 3.71 5.30 63.00 $223.47 . Item Total: How Received Amount Paid $224.80 ($1.33) $223.47 In Person In Person Payment Total: 'I