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Home My WebLink AboutPermit Electrical 2007-8-30 ZON N\ d( INITIALS \'..\ ~ DA TE '5< .,- ?.n- \:.1 SOURCE(Y\. <( "S. ,,/7 . Date -97'16/\:" ~ 8/"] a~ 7 , " SPRINGF.ELD 225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COIA.I\ Zoo 7 -0 (J 0 S- ~ 1, LOCA110NOFINSTALLATION: 3, COMPLETE FEE SCHEDULE BELOW 780 Harlow Road LEGAL DESCRIPTION: )70] ZZ 1'-f Harlow Rd Lift Station OZZOC:> JOB DESCRIPTION: A, New Residential ~ Single orl\1ulti-Family per dwelling unit. Service Included 1000 sq, f1. or less Each additional 500 sq. ft, or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Temporary Service Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for] 80 days. 2. CON11M.CTOR INSTALLATION ONLY B. Services or Feeders - Installation, Altenltions or Relocation: ~ ~,u.;?r' Owners Name ~ __ ~-re-~~ t- Address 7~) CO&N'~C iA- f rl:fE. E. l\1iscellaneous (Servic~/feeder not induded) -Each Installation City 5NfA/"'- Pump or irrigation $ 50,00 Sign/Outline Lighting $ 50,00 OWNER INST ALLA nON ATTENTIO~i~_.r~I~ $ 25,00 :rhe itn,sttalladtiodn}s beilnglm,w, on pmp'rty I own w~:.::n,..'%~.j~Io'::' $ 4500 IS no III en e lor sa e, ease or rent. In OAR~~-'lW'f!.tfd~Wi~fIli~-~is $45,00 + Surcharges Owners Signature: 0090.. YGlY ~BflJtfi~r!1fiQfffl~:~8by -+0 \5 . \;0 calling th9s~filr. lQ=8. 8N88t'ficati n .c . ~ 6 number for lao 8 :n~. 0 I 0 Ce~!1fc n o~ ). ~ ~ 0 1'1)1.1 Electrical Contractor01sson Industrial Electric, 200 Amps or less 201 Amps to 400 Amps Address 1919 Laura Street 401 Amps to 600 Amps NOTICE: 601 Amps to 1000 Amps City Springfield PhoTHIS4pERMIT~ct. EX~r'fOQ'(Hi~~s AUTHORIZED UNDER THI~epmMl'f>1~ NOT 3~~wnENCED OR IS A~NqQ~~R.!r.~~ervices or Feeders ANY 160 DAY PERIOD. Supervisor License Number Expiration Date 10/1/07 Installation, Alteration or Relocation 200 Amps or less 2 201 Amps to 400 Amps 401 Amps to 600 Amps Constr. Contr. Number 63473 Expiration Date 1/26 /09 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 Phone Inspection Request: 726-3769 TOTAL $106.00 $ 19.00 $50.00 $ 63,00 $ 75,00 $125,00 $163,00 $375,00 $ 50,00 5') /10 ~-re-o. \;L, $ 69.00 $100.00 2 $ 43,00 ~ b _G . e; J //6 71/'1 " 80 0"0 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01305 ISSUED: 08/30/2007 APPLIED: 08/30/2007 EXPIRES: 02/29/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 780 HARLOW RD Lift Station ASSESSOR'S PARCEL NO.: 1703223402800 SPRINGFIE TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Temporary service and 2 circuits TYPE OF USE: New Commercial Total: Handicapped: Compact: \0 e" ~()U .~~ ~';)\\ o~ ~ 'O~'(\ ,.,e . ...0:..,,\ rJ' I PUBLIC IMPROVEMENT\le~O~;i \~e;~" e.~ ~~'2.~S 'Oi O~. o.O~\e~~'To. ~e ,~~O~. ~ A'i;.~"\\"'e" 0l ^-\0\' \~~O\0S ~ \0\e~. ce.~O t-\ \ '(\)\ C0" ()~~~~~~~ 'O~~~C'O-\\O~7;~~V O~\~ ~O~ ~\~~'t:. AA'\. ~O\'\ ,,~9':) ~e.'4 roW" r'l.O~ "Q,,7;V \f'\ Or ~o\) '" e0 0\0';:) l'\~;~ ". l\~' \~lg ~e ,.!Ov ~~..., ~X\~~ \0\ ~, \i C'.01 tt' 01\ lI....e\ ,,~'~ ,..... \Iv' I Valuation Description I Owner: SUN RETIREMENT CORPORATION Address: 735 COMMERCIAL ST SE SALEM OR 97301 I CONTRACTOR INFORMATION. Contractor License OLSSON INDUSTRIAL ELECTRIC 63473 ~mwi~NG INFORMATION I ~\~~ ~~ # of Units: ""'-V\~ \\~\ (\~of Stories: Primary occ.up~~~ Grou~~\..\.. ~f"\\\S V~ ~f(,rv ~'1Ieight of Structure: Secondal1:' ~'.I'" ,J~ ~ ~~\\ ~ t>-~rv{J Type of Heat: Primary ~fe' \) \<0 ~~ Water Type: Secondary ~&\)~ Q\\ ,:\{;)\). Range Type: # of Bedroo~~ ~~f(,~~ ~ V~~ Energy Path: C~~ \ro~ Q Sprinkled Building: n/a t'\' I DEVELOPMENT INFORMATION I Contractor Type Electrical Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pa2e 1 of2 Expiration Date 01126/2009 Phone 541-747-8460 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01305 ISSUED: 08/30/2007 APPLIED: 08/30/2007 EXPIRES: 02/29/2008 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 + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Temp Power 200 amps or less Amount Paid Date Paid Receipt Number $11.80 $5.90 $9.44 $8.00 $110.00 8/30/07 8/30/07 8/30/07 8/30/07 8/30/07 1200700000000001121 1200700000000001121 1200700000000001121 1200700000000001121 1200700000000001121 Total Amount Paid $145.14 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 Reouired InsDections I Temporary Electric: Approval required prior to Utility Company energizing pole. 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, 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 Pa2e 2 of2 225 Fifth Street . . Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 1200700000000001121 Date: 08/3012007 Job/Journal Number COM2007-01305 COM2007-01305 COM2007-01305 COM2007-0 1305 COM2007-01305 Description Temp Power 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Check OLSSON INDUSTRIAL djb 46782 In Person ELECTRIC CreditCard OLSSON INDUSTRIAL djb 008573 In Person ELECTRIC Payment Total: Job/Journal Number Description COM2007-01305 Temp Power 200 amps or less COM2007-01305 Add, Alter, Extend Circ Ea Add COM2007-01305 + 5% Technology Fee COM2007-01305 + 8% State Surcharge COM2007-01305 + 10% Administrative Fee Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Check OLSSON INDUSTRIAL djb 46782 In Person ELECTRIC CreditCard OLSSON INDUSTRIAL djb 008573 In Person ELECTRIC Payment Total: cReceint I Page I of I 8:31:28AM Amount Due 110.00 8.00 5,90 9.44 11.80 $145.14 Amount Paid $130.44 $14,70 $145.14 Amount Due 110,00 8.00 5.90 9.44 11.80 $145.14 Amount Paid $130.44 $14,70 $145.14 8/30/2007