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Home My WebLink AboutMiscellaneous PLANNER 8/11/2010 (3) ~" i , " " \ , . - . The IoJlowlng pro/act as IlUbmllt z<:'nrIlQ. and d066 not . .. .I~ ed has thofoNowfne apPI:JvaJ. r&q""tf SPeclfiC'end use . ~~~}~~~~i1Go~Ui91~~7qr~ INSPECTION REQUESf!'lh'7~91ure. n M OFl'ICE: 726-3759 E~crRICAL PERliIT U~LICiT~ ~7 Cl ty Job Number I. 0 ,B. S'rvi~es ~~~eeders Instal.~Dl]k Alterations Electricd ContractorSecureCom,!nc ~{.\~~~\S~~ Address 1126 Gateway Loop, SUIte 122, ~ \.~i-~~Jl~~s .<n?J.ess _ , ollli\~ . ~ o:.",~\l ,\NPl jl,~ ';;'0 400 amps _ Cl ty Sprlngfreld Phone'",,", ~9;!t~\. ~Q~~ 4~Qallip's to 600 amps _ ..I.l,\'?,~ ll.~QJ ~~~Ol amps to 1000 amps Supervisor License Number 791l'J(~()~\ tdO~~ .Q~er 1000 amps/volts == l>-\l ""~v ,,"~.o'Reconnec t Only _ ~~\. c{ ~v . eP ,\'QI)e~ C. Temporary Ser"'ices or Feeders ~~~ Installation, Alteration or Relo~ation 200.alllps'c'or-less, '--- - '540.00-. 201 ~ps to 400 amps - S 55.00 Over 401 to 600 amps -. S 80.00 Over 600 amps or 1000"""VOI[s see "B" aOci'Ve 3. COMPLETE FEE SCHEDULE BELOIl \ ~~';2..C(A~~N,.2!r!:!!.s;IAJoM.T-tOll, ".Ie.. ~_~~~~~ LAJl-~~ ,A. Nev Residential-Single or Hulti-Family per dvelling unit. 1ftf:)~~~No4oo() Service Included: Items ~~~~~BJ~~I1fNC~\(I~T(\'\JATIa1~~~ =~df~io~~l-~;~~ . - \/D sq. ft or portion . V Permits are non-transferable and expire . thereof _ if york is not started \lithin 180 days Each Hanuf'd Home. or of issuance or if \lork is suspended for Kodular'P\lelling 180 days. Service or Feeder 2. CONTRACTOR INSTALLATION ONLY Expiration Date 10/01/99 Constr Contr. NUPlber3.353CLE , ExpiratiOI1 Pace IO/OJ!28, Signature of Supervising Elecrrician ~~ ~--"'"~ Ovners Name~E:Ed; ~"'la,,lxj..\I'& Addressl.\O<bD (~~Il1.LCU,)S. Ci t~I(\(::7f=- \SLOhone Branch Circuits Cast Sum 5 85.00 . ....---~ $ 15.00 $ 40.00 S 50.00 5 60.00 5100.00 $130.00 5300.00 S &0.00 Nev, AltQration or Extension Per Panel 5 35.00 One Circuit Each Additional Circuit or \lith Servi~e or Feeder Permit OYNER INSTALLATION The Installation Is being made on property I o\ln \lhich is not intended for sale, lease or rent. E. His~ellaneou$' (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting----- Limited Energy/Res ----- 'Limited Energy/Comm \ Ovners Signature: ~;;::~-~~f 5. . SUBTOTAL OF A110VE' 5% State Surcharge 3% Administrative Fee TOTAL Date Received: Planner: SH 5 2.. 00 not included) 5 40.00 $ 40.00 5 20.00 5 36.00 ~rD 1.~D 1.0"& ~~, g,'lS, co-II'IO ) ), e. C:'.. e . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT' VALIDATION I. Applicant to furnish A. Job Address ,. Legal Description I.. e;amPle- Tax Lot 100, Lane County Map Reference 10343 2. ~;(amPlr Lot.I. Block 3. 2nd Addition to pnng ieldEstates C. Name, -etc. of owner and construction lender D. Energy Sources 1. examp;e- heat/electrical cell inajor forced alr QilS E. 2. examp e-waterheate, electncal/or solar . . Square footage or valuation, etc. . I. example-~sq.foothouse,500sq.foot9arage 2. e~amPle- if new project, check new - if addition, ceckadd, etc. F. Building permit infonnation: I. example - construct single family house with an attached garage 2. example - remodel existing garage into family ropm 3. examp e - convert single family residence into restaurant (change of use) G. Value of wor~ as defined in Section 303 (a) of the Structural SpedaTty Code H. DESIGN TEAr,1 AND CONTRACTORS To avoid design or construction delays, Building Division Staff must b-e able to contact appropriate .persons regarding design information or job site corrections,etc; II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the appl icant need fi 11 ~in only the No. Boxes adjacent' to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules. are available at the Building Oivision 1. To conserve space' on the permit form the schedules have been abbreviated 2. .If the item(s) to be installed are not covered on the abbreviated schedules you should consult. the full schedules. C. BUILDING DIVISION STAFF WILL FIll OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractoris.notauthoriled to sign the electrical label. - Ill. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet ollly. Where possible, Building Division Staff will prepare a type written copy alld return it to t'he applicant at the time the actual permit is issued for his signature. IV. Fees and Charges Phil check fees are due and payable at the time of the app J i ca t i on, and no plans ~Ii 11 be processed un t i 1 these fees are paid. All other fees and charges are dlJe and payable when the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permi"t appl ;cant exempt from' registration with the Bui1der's Board because: .. . Additional Project Information: . PLANS REVIEWED BY: . name signature date ~ I -.. ...... I ~ "0 !eJ: Ow C/) o a>L.: !".r<l> c _@; C; i..;: ~~ r~ "J.,.. ), .. . ., The following project as submitted hos the followi zoning, and does not require specIfic land UE:0 approval. Zoning l /}'I1C 225 FIFTH STREET '~ ~ SPRINGFIELD. OREGON 97~f7 -I L INSPECTION REQtIEST: 7Z~.7;~i~~ Signature OFFICE: 726-3759 . OVNER INSTALLATION The installation i~ being made on property I ovn vhich is not intended for sale, lease or rent. Ovners 'Signature: DATE: RECEIPT lUlCEIVED B City Job Number 01. COHPLETE FEE SCHEDULE BELOIl 1. LOCATION OF INST,u,V,TIOtl '--~ 4otO l..ctYYv-vlA~~. ~Oi3l~IONO+()cO JOB DESCRIPTION ' SJ.:.C6TxlS~~-\f\~~' ~ Permits are non-transferable and expire if york is not started vithin 180 days ~ of issuance or if york is suspended for 180 days. A. 'YO)} 2. CONTRACTOR INSTALLATION ONL~ ~~ ~4<B. Services or Peeders .!..\ '(//.: ,()~ ..... Installation, Alterations ';::) Electrical ContractorSecureComq!>p. ~t( ;s:'4.," or Relocation: ~ 'VA_ ~_ ~ ,7;- ddress 1126GatewayLoop,Sultel'22;Yy ''?'<'1- ~ ~-S! 200 amps or less _ $ 50.00 -., .~ t<:; G-~ "7'~il amps to 400 amps _ $ 60.00 ~r)\ CHY Springfield Phone988-35 ~ <?q V<<;: 1 amps to 600 amps _ $100.00 v () ,() 9/.1~)} amps to 1000 amps_ $130.00 , Supervisor License Number 794JLE (C'-9t! 1S'-1<9. 'S'~ve~<<1000 amps/volts _ $300.00 . V "7'~ l!.~n~t Only _ $ 40.00 _ ~ Expiration Date 10101/99 . eo '~~ ~'" C. ~~~~~~rvices or Feeders ~ Constr Contr. Number3'353CLE I~q~ i(lif; Alteration 0" Relocation , ~ ~ ~ Expiration Date 10101197 200 amps"or less $ 40.00 , 201 amps to 400 amps ----- $ 55.00 ~SIgnature of Su~~~~i_s~n~ ~lectrician___ g~:~_:g~ _~~p:o~:~g~o vons ~e:~:'~? above ,_ ~""':?--- ~--~ Ovners NameP--t-:t:() S ~ Uc l + 1~~\~& Branch Circui ts Address" ObOCD(Y\{'('f.~\D..L ST Nev, Alteration or Extension Per Panel Or'"". Q One Circui t $ 35.00 CitY~rrL- Phone Each 'Additional Circuit or vith Service or Feeder Permit , A. Nev Residential~Single or Hulti-Family per dvelling unit. Service Included: Hiscellaneou$ (Service/feeaer not included) -Each installation Pump or irrigation Sign/Outline Lighting----- Limited Energy/Res ----- Limited Energy/Comm ::r:: ov,OO m~- Items 1000 sQ.ft. or less Eaeh--a-ddfticmal;- 500 SQ. ft or portion thereof Each Hanuf'd Home,or Hodular'Dvelling Service or Feeder E. 5. r- SUBTOTAL OF ABOVE ,5X-$tate -Surcharge-- 3X Administrative Fee TOTAL Date Received: Planner: SH Cost Sum S 85.00 ~-- $ 15.00 $ 40.00 , , $ 2.00 S 40.00 $ 40.00 $ 20.00 $ 36.00 ~cO ~. \I -I D