HomeMy WebLinkAboutPermit Electrical 2007-3-29 (2)
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; INITIALS N}-r--
, ~ DATE '5-2C, -01
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225 FIFTH STREET. SPRINGFIELD. OR 97477 . PH:(541)726-3753 . FAX: (541)726,3689
ELECTRICAL lffiRMIT APPliCATION 3 ):;)<1/6r
City Job Number C 1/ ()(JLJ5)( Date
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I. : LOCATION OF INSTALLATION:" fe' , 3.COMPLErE FEESCHEDULE BELOW-. . ,;: :.' "-:
'.. '-_d,,~,---~,,-'~c-"":"Rc''-'-'cc.. L,.~...." __,c.~,.,-~._~.. _c.c.;..~.c.-_,
LEG~~E~~T~~ ~ ffi (J . . =# 7 A. r'1'I~;~'k~~~~iJi~i'2.'si~~e~~~'~I~lii':ji;rrtiy-~~;.'.d~tii;;;Dnit..
_..............._ _.- ........-__ _~..,.- _ _ .. .::14 '">_...... .......,.. ~j _'~~~ _ _' ,
\""'10z'IS4m;: "310"0 Service Included
JOB DESCRIPTION: 1000 sq, ft. or less $106.00
O. . () '^ Each additional 500 sq. ft. or
t-e.o~ 't'CYits TO ~()()...b-Q portion thereof $ 19.00
Signature of Supervising Electrician
~~DU
J. _ TEIl&lAldaatdnaEeiMJit &J(iJiIilE I~ I HI: WURK
c. 5 r ^~M'Vjceror-lieedenRcnniITHIS PEnl"T In ,,$,-3.00
Owners Name J.g G ,02 Ii~ t uS2. OL.,UL "UHivn,Cl:u ,mt:h::n. 01,;", 'v ,11),
Address 'bSO tl. S/l20rJ(,-- (f:rb . fOWfJ;,tlM~rJP{1~~~/?l1~~~fnifdU~e;;);E~Th'ii~f~;laii;~~~
- ArtY1'80'i}AV"'PEji{HJD'-'~- ~-._--~ ,--,<.,-~..._~-
Ci~ 1 Os.. Phone. Pump or irrigation . $ 50.00
~ Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited EnergylResidential $ 25.00
The installation is being made on property I own which Limited Energy/Commercial $ 45.00
is not intended for sale. lease or rent. . Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. psU;jrOTALOfABqVE:i;~~-;B."~7>:').;.~~~'~~:-:~'~' 00
Owners Signature: .. L.,-," 'eo.. .~"._"."---'~.. .....__....~.._ So-
8% State Surcharge 0). . 50
10% Administrative Fee -4 . s ~.
5% Technology Fee ~ - 00
t1 u J - SO
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
~::.- roo', .....~.'r,~-..;,:.. :.-"". ,,"\ -;or;;- :-,,--~, -'":- ..-- -,r::---..-
. CONTRAcrOR'lNSiAtutrON. ONLY ~
2. t. '-"'.~. ,~.._ ;~A'."':"- . -"::..~l:;;~.\~,.. .::.,.:ir:'>'-f;.:~~;-).;.:.:.c.'Z.':'::"l
Electrical Contractor rfl y cJectl",d 1'\ JU I !'--'C.
Address '3 (1."3 I b f..l\ ev (~
. City ~ Phone 7ri."I-11/Si(
Supervisor License Number :~ 1I Cf '3 5
Expiration Date ! C9 II / D7
Constr. Contr. Number .1;' 7,,,\{) b
Expiration Date 11 } 1~) 07
Inspection Request: 726-3769
~\
Each Manufact'd Home or.
Modular Dwelling Service or
Feeder
$50,00
....-,--,,~. :,' .-- .~ 7""," -._,.~~.-:.., .... ': ....."-.~.~.. ....--.. ,,-.~, .....
B. :Se;~i~e~or.Feed~;s::' install~don,Aiterations or.Rel~cation:"
Ll:.....:J.\.;;;i.;} :-4..:..:..~-:--";;": ;,.~~,_~:.r~:.~UJ.;.d":";"'::';",.,.;.~';;,..;. -. ~.-::.:.~~.,....':.~"" -' .-' ,,::....~
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
Over1J()00,:.\mpsNolts . ;. . ~ - _' $375.00
Rej:9iinectt<DDly3 &Uop,e:rby ,r~ 'I e>l:,VP$ 50.00 ~-=; b .
)l.olili.caji9!' centG.r. Tho~e fU'ti::> cue s~' '~'_ .
r.c ,,"'.__'" ~-;;,,^,,,,,,,,...7UI'i'",<I""I1"'''Aft~2:;;{)''' '.ce..'
C. ",T~mporar.y_Ser.vJces or~Feeilers1 ~ I.: . ," :,;".',;
. Oci9(CYo~-ma\lijbI8ih"'c-opie-s-dftnertrtes' _Co .',
. , _.._... "',1 ,t~..+h.:.\ te'npllone
InstaJ~~9,!! A1ter>ll1on:or Relocal1'!n- " ''"': ',. .
. .~ 0 . ~r IJl,III'/ -''''If..,,,I'\1:
200"Arilp's'oftess ,,,('l d<,(ib, .' .' ':' $'50:00
201 Amps to<4(j()1Am;'~ : .;- ,-,',-" <.,. -" $ 69.00
40 I Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "BOO above,
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D. " !l~~~5~ C:i~~~!!.ti'~~.," _ ~:~:;~~:-.~_~ _'
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New Alteration or Extension Per Panel
t~9JKt~it
$ 43,00
TOTAL
Shared Drive(T:)/Building Fonns/Electrical Permit Application S.o6.doc
225 Fift!! Street
Svringfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-00458
COM2007-00458
COM2007-00458
COM2007-00458
Payments:
Type of Payment
CreditCard
~ \;'Receiot I
RECEIPT #:
. ~:;~
Wit.
Description
Service Reconnect
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
EDWARD M GUIDRY
Caof Springfield Official Receipt
_Iopment Services Department
Public Works Department
2200700000000000424
Date: 03/29/2007
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 01725 In Person
Payment Total:
Page I of I
1l:51:56AM
Amount Due
50,00
2.50
4.00
5.00
$61.50
Amount Paid
$61.50
$61.50
3/29/2007
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00458
ISSUED: 03/29/2007
APPLIED: 03/29/2007
EXPIRES: 09/29/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3530 GAME FARM RD SPACE 7 Springfield
ASSESSOR'S PARCEL NO.: 1703154003100
TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: reconnect
Owner:
Address:
SGB SPRINGFIELD, LLC
15500 STRONG ROAD
SPRINGFIELD OR
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
MY ELECTRICIAN INC
License
87506
Expiration Date
11120/2007
Phone
541-729-1454
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
Height of Structure: Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
WaterType:~TTEI\III',JI,.J'''lJv" "Sii Ffil.'striJent:
Range Typt>':JIIOW I'UIE::S aJopteJ bYsq'Fi Gfra~ftcarport
Energy Pat.h"tification Center. ThO::s1{iit'(jth"'e'r;' S~i , J'
Sprinkledi~u.!!~!!,gll52-001-Dla1 0 thrOc~"'p~t,i3o'il&~-n(
I, L_!_ ___:............$ ...!,.;,.. r,d~c:' .
... .~.. ....,.. ...., .~.............. - -.-
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INEORMA:r'(ONnl~r. (l'lott:: the ~<')'''pl'')ne
1urnb-arior:hc OWi:Jn Utili"! :RJj:QU-'-'~EDPARKING
. ,.,",- r.'7l'l ')'.....1'\
Overlay Dist: Cemer 'f ,.,'1.,.. ~ ., ,; "Total: .
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage:
Notes:
I PUBLIC IMPRO.\fEMENTS I
THIS PERMIT SHAL~i<t'i-'YII\lf[f~P~:HE wor\{
AUTHORIZED UNDE1>.o"lri~iiqu!~W.t~i...t NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Street Improvements:
Storm Sewer Available:
Special Instruction:
I Valuavion DescriDtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Sq uare Footage
or Bid Amount
Value
Date Calculated
Paee I of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00458
ISSUED: 03/29/2007
APPLIED: 03129/2007
EXPIRES: 09/29/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fl'l's P'lid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Service Reconnect
Amount Paid
Date Paid
$5.00
$2.50
$4.00
$50.00
3/29/07
3/29/07
3/29/07
3/29/07
Receipt Number
2200700000000000424
2200700000000000424
2200700000000000424
2200700000000000424
Total Amount Paid
$61.50
I Plan Reviews I
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.
I Rl'olJirl'd 1"~\l'i~rion~J
Electric Service: Approval required prior to utility company energizing service.
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.
Owner or Contractors Signature
Date
Paee 2 of 2
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