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Home My WebLink AboutPermit Electrical 2004-6-22 '[)/)rO' Ob6J 1eCI 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (~~n726-'lh89 S /JOI q"Ssvb f?:I <t)1) . 6J ~' ELECTRICAL PERMIT APPLICATION "ivII} ~I}{) 9vire :Iet/I)q '"\ b' (01't~ /? '.Dec' S II) City Job NumberCOtM ZOO l{ - () 07 L{ ,.J Date r- Z Z .-u \. et/ S,' L(! 7fic I. e lo//, . , " tsJl}Qlvre Cl/Jt/ vs~*i/J{) 3. "C01\1PLE1')1 FEE SCHEDlJLE JOB DESCRIPTION 1000 sq. ft. or less .,('.. j ...1\ . , I . ....L- Each additional 500 sq. ft. or IYA.LA. ~V~--.J portion thereof \,\t. \NQ~~ Permits are non-transferable and expire if_,yPRctttt. i~~~2t~~~&\O~ not started within 180 days of issuance or i~~i~t\\W\\\ S\'\ ~~~U:~to0fd~ or $50 00 Suspended for 180 days. ,\,\\S \\\lcO \.\ ~~f\~OO~ . 'C'.: ".-.. ,- . ',-- A~l~?: t.O 0\\ \S . 2. cqNJ;~,9rOR ~NSTALLATIOf'T ~~\~~~f\;'lt.~\)ces or Feeders - Installation, Alterations or Relocation: Electrical Contractor Bl )\'ldf'{S f7e~~, t InC 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 Amps/Volts $375.00 Reconnect Only $ 50.00 200 Amps or less $ 50.00 201 Amps to 400 Amps 1e\U~ M)$ 69.00 401 Amps to 600 ~\. ~ ." lC"\-le~~$IOO.OO .--"-,('~..."tt~;,~_e~ M\\\v- Over 6od.~\~~v~~. J&i.ve6Ot' D. u~"~r~t:a\O~) ~\G.O"~ e 'd'<lO \l\ N~~~~~~~~::~\te~~\\1t.)\}\\: ~ &.J / ~ ---- c6&~~~~'dO ~~1 ~so~1. '1~~9d~) ~N'oO 43 .00 Bf&.OA~~181'BlIS@\tc:<<\.~~_ ....\A\~~ ( i 1\' Il" IAAn4H-;;- r~._ . Hi I ~ rJJJ S~~~r ~a~@e~~t.e\uo6el0 .,~ $ 3.00 ,1,00 Owners Name \!VI lUY~ LVYYlmlU1L, VI -r tyU...fYl f..'\'\'\"\ 91\(\'091 Address l ~ \-\ 0iY -e..eJ- E. . ]\>liS\\JU~~;ou~ (Service/feeder not included)-Each Installation' C;ty ~v i j1M Phon' 3 'L14 - ~5;)S " OWNER INST ALLA nON 1. LOCA1I0N OFINSTALLA110N \~() ~ s-tYee;t-' LEGAL DESCRIPTION i7033bZ ( o ~7()O Address IQS Macl,SQr\ City ~L'5ene 4~S-CA~~ Phone Supervisor License Number 3J.q 0 .- S Expiration Date 10" 1- 04 Constr. Contr. Number 4- 'dq L:J The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 tW~ \~~. A. New J{csidcntial- Single or Multi-Family pcr dw'ng UI it. Service Included $106.00 $ 19.00 "!-> . '. . .j.' . ,. '; C. Temporary,Services or F.eeders .~ .l';" ,.~~ " '. ;......"'0.' Installation, Alteration or Relocation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL. OF ABOVE 41,tlJ '3.lf3 4,~O 67.33 7% State Surcharge 10% Administrative Fee TOTAL Shared Dlive(T:)/Building Fonns/Electrical PCl1nit Application I-03.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00743 ISSUED: 06/22/2004 APPLIED: 06/22/2004 EXPIRES: 12/22/2004 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: Electrical Work Only TYPE OF USE: Addition Commercial PROJECT DESCRIPTION: Add 3 circuits " ~ Owner: MCKENZIE WILLAMETTE HOSPITAL' Address: 1460 G ST SPRINGFIELD OR 97477 . .,.....~ '\" Contractor Type Electrical I CONTRACTOR INFORMATION I ^ . ~~Jalua-.l "(vvBZ-ZBB-009 \.. iQ~J~qUJnu Contractor '0 AWlrfUcettMe a\.\l E rnfi1tfdg~ Date Phone BUILDERS ELECTRIC INCUO\l'e~~~,~ RI;l':a!~~ "Ja\ua~_~; r\^~7W~7 541-485-0922 I BUlLDl~~~JtSFffJNf6~~~~O:Z96 \:I'VO U\ . o-~96 \i'V04ullw'''\.\1 "Ja\ua~ UO\\9o\l\\ON # Of~~S al9 sa\nJ asO do '9 s~Wl~~ Hei tfR16\Y.!V al\l Aq pal p" ~~~Ioor: Type 0 ~=SaJ\nbal M9\ U069.10 "N~q Ft 2nd Floor: WaterOfype: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: - 1u~ 'NOR\<. t401\~~p.lA\i ~\~~1!Ir\fis1~ ~~\-\OR\lEO l\ OR \S ~B~NOONEO Ut\ COWiWiEN~~ PE\\\OO. ft..N'l ,BO Sidewalk Type: Downspouts/Drains: Street Improvements: . Storm Sewer Available:' Special Instruction: Notes: I Valuation DescriPtion' Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee 1 of 2 I Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00743 ISSUED: 06/22/2004 APPLIED: 06/22/2004 EXPIRES: 12/22/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax · 541-726-3769 Inspection Line L Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $4.90 $3.43 $43.00 $6.00 . 6/22/04 6/22/04 6/22/04 6/22/04 Receipt Number 2200400000000000832 2200400000000000832 2200400000000000832 2200400000000000832 Total Amount Paid $57.33 I Plan Reviews I :.;. To Request an inspection call the 24 hour recording at 726-3769. Allinspection 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 Reouired Insnections I Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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, a.nd 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. ' Owner or Contractors Signature Date Pal!:e.2 of 2 225 Fifth Street Springfield, Oregon 97477 541"'726-3759 Phone Job/Journal Number COM2004-00743 COM2004-00743 COM2004-00743 COM2004-00743. Payments: Type of Payment CreditCard it. !i n 6/22/2004 RECEIPT #: Description. Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By BUILDERS ELECTRIC r:ty of Springfield Official Receipt ielopment Services Department Public Works Department 2200400000000000832 Date: 06/22/2004 3:30:44PM . Item Total: ' Check Number Authorization Received By . Batch Number Number How Received Amount Due 43.00 6.00 3.43 4.90 $57.33 Amount Paid djb 000417 097848 In Person Payment Total: $57.33 $57.33 Page 1 of 1