HomeMy WebLinkAboutPermit Electrical 2006-7-6
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ('{)'{Jf ?JYJ;:'JX) R-;
1. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION l -1 '):::. '"7- ,_
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JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2.
CONTRACTOR INSTALLATION ONLY
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Electrical Contractor,>"t r~,,((i~M{ A.,.L'(r_,-"-'.j)
Address -) i '') ), ! ; (
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City ~ c () Phone 'j/; ,) I 5 ) ~ (I
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Supervisor License Number >hj5':5
Expiration Date //, I / ;;' (
Constr. Contr. Number _,);J) /~
Expiration Date / /;; ( /(, /i/
Signature of Supervising Electrician
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Owners Name:"", JI/lh.r ,_i r c,. ,J ,i y If: "L ;1/
Address ~/, ('-(
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OVVNERINSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Date
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3. COJl.1PLETE FEE SCHEDULE BELOHT
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INITIALS I\J)I'\/\
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A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B. Services or Feeders - Installation, Alterations or Relocation:
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only :~
C. Temporary ServicesorFeeders.>' ,\
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 63.00
$ 75.00
$125.00
$163,00
$375.00
$ 50.00
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$ 50.00
$ 69,00
$100.00
$ 43.00
$ 3.00
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25,00
/ $ 45.00
4. SUBTOTAL OF ABOVE
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
8% State Surcharge
10% Administrative Fee
TOTAL
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Shared Drive(T:)/Building Fonns/Elt:ctrical Pennit Application] -06,doc
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00833
ISSUED: 07/06/2006
APPLIED: 07/06/2006
EXPIRES: 01106/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1600 H St
ASSESSOR'S PARCEL NO.: 1703362105700
Springfield TYPE OF WORK: Office
TYPE OF USE: Alteration
Commercial
PROJECT DESCRIPTION: Install burgleI' alarm.
Owner:
Address:
WILLAMETTE COMMUNITY HEALTH SOLUTIO
2650 SUZANNE WAY STE 200 .
EUGENE OR 97408
Contractor Type
Electrical
, I CONTRACTOR INFORMA nON,
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Contractor ' ~(.. \ , \~~
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L M COMMUNICA TIONS"INQ\ . \ ,\\
License
152276
Expiration Date
07/22/2008
Phone
541-543-3560
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. .-:::\.... I BUILDlNG~INFORMA nON I
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# of Units: ...
Primary Occupancy Group:, ,'-' ~. '
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Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
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# of Stories: Lot Size:
"
---Height of Structur.~" Sq Ft 1st Floor:
Type of Heat: ~ ,\0, Sq Ft 2nd Floor:
Water Type: ~ ,\0 ')':...~\'''-.'\. .M Ft Basement:
.~'?; \ ~~~
Range Type: .e,c~"\. ,,0'0 .,-,.,0, \-'.,Q"Ft Garage/Carport
Energy Path: ",~ \ . ,~". ,', ~ 7 '~q J+:t Other:
'\(' ' (' , . J / -, j,\
Sprinkled ~u.i!f;.n~.:~, ','\:: ,,.:. ?(a',~. v,O~~upant Load:
I DEVELOPMENT' INFORMA BON ,. . '",o\.:J '?' ~~'Q.,:.)\\
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Overlay Dist: '. . ,j:J"
# Street Trees Rqd:
Paved Drive ~qd:, ": ,:'\Y~
% of Lot Coverage: .
REQUIRED PARKING
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Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e I of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00833
ISSUED: 07/06/2006
APPLIED: 07/06/2006
EXPIRES: 01106/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 80;', State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
Receipt Number
$4.50
$3.60
$45.00
7/6/06
7/6/06
7/6/06
2200600000000000927
2200600000000000927
2200600000000000927
Total Amount Paid
$53.10
I Plan Reviews I
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.
Reouired Insoections .
Low Voltage: Prior to cover.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information 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 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.
I 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.
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Owner or Contractors Signature
Date
Pa2e 2 of2
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
0"" of Springfield Official Receipt
1 Jopment Services Department
Public Works Department
RECEIPT #:
2200600000000000927
Date: 07/06/2006
10:18:46AM
Job/Journal Number
COM2006-00833
COM2006-00833
COM2006-00833
Description
Low Voltage - Commercial Indus
+ 8% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment
Cred itCard
Paid By
DON MILES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
45.00
3.60
.4,50
$53.10
Amount Paid
Jmp
045109 In Person
Payment Total:
$53.10
$53.10
c Reccio! I
Page I of I
7/6/2006