HomeMy WebLinkAboutPermit Electrical 2005-7-5
225 FIFTH STREET- SPRINGFfELD, OR 97477 It PH:(541)726-3753
ELECTRICAL PERMIT APPLICATION
City Job Number C-D..... -z.OO r- - t>c>8S0
1.
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LEGAL DESCRIPTION J 70 33'00
Jns-~ \O-t-; Dr. or ('1, ~~
JOB DESCRIPTION n-e.....:::. S:. t<-
SY1~S
C>0300
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Low 'io/~e
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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.
Electrical Contractor Se.)e..c.:...-\y-C{\ , \ YI c_
Addressl--:.r .I.t:::::.. ~\ I ~- '" \? () ~\
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I-~'
City Yrw:~\cv(\cl
Phone c::.3)'~.(,,?q_q~ .
Supervlsor'License Number
q 1;..4 LG~i\
Expiration Date
It> h i ~c:..
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Constr. Contr. Number
by:t-\ \
Expiration Date
:1) \I,-;~ ;)Jllc I Dg
Signature of Supervising E]ectrician
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Owners Name ~t>'bD('b LAVY\..~
Address 2Sb'1 rY)o.M <::::..-+
City Sr("'I+~d Phone ~1~"'~"2.."12
OWNER iNSTALLATION
The installation is being made on property I own \vhich
is not intended for sale, lease or rent.
Owners Signature:
inspection Request: 726-3769
J.
A.
Service Included
] 000 sq. ft. or less'
Each additional SOO sq. ft or
portion thereof
$106.00
$ 19.00
. Each Manufact'd Home or
Modular Dwelling Service or ..
Feeder ..__. '_. .~. ,-~'" :........".....-- --_.~.--.,.' ~)Q:Q.o.
B.
. . .'I..GeL/on Celli regon un
200 Amp~ 6~,]~fS 952-001 ~oeor. Those rUleSlla>r-eCWet ~ Ity
nqon hJ 10 rnrou h fOlll,
201 Amps e'4~\JrBw\p.~ay Obtain . 9 0A1f@32-G01.
40] Amps ~OJGfNhP!'center. / ~OPles Of~/l1estffie~ t-.
60] AmpPW1i'~ ~!the Or~9( '10le: the ~1Ei~~~n~ 7
Over i 090 AmpstCellflter is J-aO~~I'~ ~0Il
Reconnect Only "'~.~O.OO
c.
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$69.00
$100.00'
Over 600 Amps or 1000 Volts see "8" above. .
D F'Y8' ?;';;S;;;' . ~:.:'.
. ,;,;,.~~I)'t,;, "
~~~]t ~~~XxD't~5~~~~t1~EI~~~E:Z~~
Each ,~~MMfi:rifeEjft)0f)~j~~ ABANDONED FOR
ServicekNt)-ee~uPIDmi'tpERIOD. $ 3.00
E.
Y'{:~;~-;--'~"_! -~.': ..~< ,';-,.::'. " ," '"?~ -~- - '.:.,' ,,':'-,
\)lu(l~d1i~ E'liEh"'I'nitallationii.'
,~; :'~ ,', '" .~- ~,~'-. 'J.:..,~:';~'~ _. if ,,_:' ~o~-'~;_J.'. .:,~~1
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residentia]
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00 ~t;5 ,DO
Minimum Eiectric Permit Inspection Fee is $45.00 + Surcharges
4.
.~S,DO
3.\5
J--j .'~
7% State Surcharge
10% Adminisu'ative Fee
TOTAL
S2,bt:?
Shared DI'ive(T:)/Building Forms/Electrical Permit Application 1-03.doc
CITY O'F SPRlNG~lELD .
Building/Combination Permit
.
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2005-00850
ISSUED: 07/05/2005
APPLIED: 07/05/2005
EXPIRES: 01/05/2006
VALUE:
SITE ADDRESS: 1801 ASTER ST
ASSESSOR'S PARCEL NO.: 1703360000300
Springfield TYPE OF
Electrical Work Only
TYPE OF USE: Addition
Commercial
PROJECT DESCRIPTION: Low voltage for cctv
Owner:
, Address:
ROSBORO LAND ANNEX LLC
PO BOX 20
SPRINGFIELD OR 97477
A NTION: Oregon taw requ'res you. ~o
'ff}~I~~rules aaoplea uy ,i,~ e..:.;:~ '};~~h
CONTRACT. I nose rules are se
i OAR 952-001. thro~gh OAR 952-0~1.
Contractor ~090. Vou~ld1tain c:Eimrmi.M fi'!.1fe YPhone
SELECTRON INC ,.~Ilina tMPd~nter. (Note:~~J~~ ~~~j ... 503-245-9988
'''~~lre uregon uumy ,4J.. ._J..'L
I BUILDING ThIiWI(o!~:tt1N . 1-800-332-2344).
\,It/I n r IS
# of Stories: Lot Size:
Height of Sq Ft 1st Floor:
Type of Heat: 'Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled n/a Occupant Load:
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Yrimary Construction Type
Secondary Construction
# of Bedrooms:
I DEVELOPMENT INFORMATION.
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street
Storm Sewer Available:
Special Instruction:
IPUBLIC IMPROVEMENTS I
IMOJU'HC\E: Sidewalk Type:
THIS PERMIT SHALL EXPIRE IF THE ~~~~ownspoutslDrainS
AUTHORIZED UNDER THIS PERMIT I
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
1 of 2
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRING~lELD .
Building/Combination Permit
PERMIT NO: cOM2005-00850
ISSUED: 07/05/2005
APPLIED: 07/05/2005
EXPIRES: 01/05/2006
VALUE:
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Amount Paid
Date Paid
$4.50
$3.15
$45.00
7/5/05
7/5/05
7/5/05
Receipt Number
1200500000000000943
1200500000000000943
1200500000000000943
Total Amount
$52.65
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.
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.
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
.. SpriIigfield, Oregon 97477 .
541-726-3759 Phone
, . .
rity of Springfield Official Receipt
~velopment Services Department
Public Works Department
Job/Journal Number
COM2005-00850' . .
COM200S-00850
COM200S-00850
P~yments:
Ttpe of Payment
Check
. ,,:'
, .
7/S/2005
"
: ')"',1: .'
REC'EIPT #:
1200500000000000943
Date: 07/05/2005
Description
.'+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Paid By
SELECTRON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 56221 In Person
Payment Total:
:; ;,.." .
1 of 1
1:36:18PM
Amount Due
3.1S
4.50
45.00
$52.65
Amount Paid
$S2.65
$52.65