HomeMy WebLinkAboutPermit Electrical 2004-9-7
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (5~1}'ng-:r~ p~ .
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ELECTRIG'AL PERIUIT APPLICATION ~0 oV<11 doss fiat. f>>.
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City Job Number CDA.1 ZCrCl{ - rJ II 0 ~ Date /.. /. 'l D <01/. qUire sp d ~<1s tll
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LEGAL DESCRIPTION 170..?::>, 5]' 0
_ &0 5=L,UN~ ~D () (~l 9'00 Service Included ..
JOB DESCRIPTION t.\Ol\CE: !;. .\fB&-W~~H\\
~ PERM\\ SHf\ll EXP a ~HFfn~'b500!sq. ft. or
:J:i.,J~"'.M..~ Dt:.-r,c::..Ht-h.o c.,~ Ir~rl(fi"~1H rtDiO~\t~~e?DR
~,., f'C>\..E.. IF'- ~",.IZ...ltl.\\)1Un L IS f\B~N . 'i
- Permits are non-transferable ancnffilf~~t~eJ\!{}sOR 'Each Manufact'd Home or
not started within 180 days ofiss&tW~~llJt I WQ~,if'ERIOD. Modular Dwelling Service or
Suspended for 180 days. A.N'11B U Feeder
.. ,..,.,
C. . T~~~l?9"S1"~i~rtyj~C~
~t~:M~~IQllll
~,\o'#J~~~,.esthOSe ~:~~R 952-00'. $ 50.00
_ NotiiiC~~..~M~~~~~$ 01 the rules OY $ 69.00
\n o~?49~~m~lt~6~\R.JGp.P\ . the te\eoho~8 $ 100.00
090 'l/oU m ''I INote. , ~.....h.\fir.a\iol\
o . Ove e{,r lIDO ~--.rnove.
~~\il'\
f\Ut1\ ..t.Al \$
New &ftl!rm1on or Extension Per Panel
One Circuit $ 43,00 Y ~ ~-
Each Additional CircUit or with
Service or Feeder Permit $ 3.00
2.
Electrical Contractor N~"" IE:~I tL~.,.(LIC:-
Address Ze> 8-1' N W (A i-N ~ ~
City ~~_.::;) Phone ~(I,!::> _ t.---! \!.. I ?fa?
Supervisor License Number ~ Btt q S
Expiration Date l (:)- ( - 0 '7
Constr, Contr, Number 41 ~t,~
Expiration Date 10 - ( ~ - 0 ~
Signature of Supervising Electrician
'VJJ nJ~
Owners Name K,,\...r~ flJ/)''''~
Address Boo &:t..-iL-1 Ne" Ko.
City ~C-It-)";:\~...o
Phone Zol-. "-t(,~. t,5e>o
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
$106,00
$ 19.00
$50.00
B.
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163,00
$375.00
$ 50.00
E.
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee:::;$4S:00 + ~~JPbarges
4.
U"b~
~.t,.Il
'J j)
<fFU
l.()~
7% State Surcharge
10% Administrative Fee
TOTAL
40~ol
P 5261.-
Shared Drivc(T:)/Building FormslElcctrical Permit Application I-03.doc
-~
CITY OF SPRINGFIELD.
Building/Combination Permit
Status
Issued
PERMIT NO: COM2004-01105
ISSUED: 09/07/2004
APPLIED: 09/07/2004
EXPIRES: 03/07/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 800 BEL TLINE RD
ASSESSOR'S PARCEL NO.: 1703153000900
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION: Add circuit - Kinkos
Owner: SYCAN B CORP
Address: 840 BELTLINE RD STE 202 SPRINGFIELD OR 97477
Contractor Type
Electrical
,"CONTRACTOR INFORMATION I
NO lIC.
Contractor THIS PERMIT SHAll EXPIRE:lUicth\iJNOR~xpiration Date
NEW TECHNOJ\g~$.JHIWiR <E~Gi\M8T IS NOT 10/13/2004
CO~f:J~F IM1(Ht~fti~r run
AN r ""nl~.
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Phone
503-648-1900
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION'
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
-isrm.rneth ~':z:~... taw I'MtJ,hl ~ to
PUBLIC 1M --s ptedbytheOregonUtiUty
Notification c.:..I:~,r. Tb~,,~.Mt@f8 ==
In OAR 952-o01.o010~91f\ OM
0090. You may obtairPa~d-MS by
calling the center. (Note: the ~pt\ont
"umber for the Oregon Utltlty NotifiGatlon
Cenwr.'~O~~~
Notes:
I Valuation Description I
. ;" .C
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pa~e 1 of2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01105
ISSUED: 09/07/2004
APPLIED: 09/07/2004
EXPIRES: 03/07/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
LFees Paid.
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
$4.50
$3.15
$43.00
$2.00
9/7/04
9/7/04
9/7/04
9/7/04
Receipt Number
2200400000000001125
2200400000000001125
2200400000000001125
2200400000000001125
Total Amount Paid
$52.65
I Plan Reviews,
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.
I ReQuired Insoections 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, 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
lelopment Services Department
Public Works Department
RECEIPT #:
2200400000000001125
Date: 09/07/2004
8:44:51AM
Job/Journal Number
COM2004-01105
COM2004-01105
COM2004-0 1105
COM2004-0 11 05
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Add, Alter, Extend Circ.
Minimum! Adjustment Electrical
Payments:
Type of Payment Paid By
CreditCard DANIEL STEELE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 007273 In Person
Payment Total:
Amount Due
3.15
4,50
43.00
2,00
$52.65
Amount Paid
$52,65
$52.65
9/7/2004
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