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Home My WebLink AboutPermit Electrical 2008-2-13 3. ZON INITIALS ~ f""'- DATE ;; - Ie", - t'V SOURC~ ~~~ 2-//.5/O~ I' I COMPLETE FEE SCHEDULE BEWW 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION ("/)~2dO~ -(!Jo2-0 7 City Job Number 1. LOCATION OF INSTALLATION: 875 ~ .%,(FI }~ Jf7~7P LEGAL DESCRIPTION' J~J/Q:1: ~br/./~lflllM) BL- JOB DESCRIPTION: };fkrt /p ~/Jp7Y1e L7 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. CONTRACTOR INSTALLATION ONLY < Electncal Contractor Address City Supervisor License Number Expiration Date Expiration Date Signature of ~rvISing Electncian Owners Name ~n/~.1? K ~ <1:(~ Address d'7S ~,t./3vr/ {rh City *.t:yJ; e!;l ~hone 7 .~7-/ 2 3 9 Inspection Request: 726-3769 Date A. New Resid~~!ial- Single,?r Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling ServIce or Feeder $117.00 $ 21 00 $55 00 B. Services <!~ Feeders - Installation, Alterations or Relocation: >>~ ~>i~-"< , < 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 70 00 $ 83.00 $138.00 $18000 $413 00 t.- $ 55 00 55". c9,o C. Temporary Services or Feeders dw ~ ~, < Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 55.00 $ 76 00 $110.00 Over 600 Amps or 1000 Volts see "B" above. ~ , A > i ' <<' D. Branch'Circuits ' New Alteration or Extension Per Panel One Circuit Each Additional CIrcuit or with Service or Feeder Permit $ 48.00 $ 400 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irngation $ 55.00 SIgn/Outline Lighting $ 55.00 limited EtA~tdilregon law requir&l2'~ to Limited E ltJt~<!~agpted by the Ore($~ 'd~lity . . f\ otffl'tatloJl enter, Ttw::;tl'4J~H M.e S8.U9rth Mm~mum Ele~r~~~~_ P-tR1ftlItfifBJb~-O:J(Fi 95'2_'Offl'!ges 4. ' SUBTfirjM,.O'~tain copies of the rule~ .00 120/1 S JI~!~['lg the center. (Note: the teleJ.,iIIUIIt# / 100; AtadmteflQ11i8~r the Oregon Utility NotlflcatISp.~ 170 /0 mIstratI'G~r is 1-800-332-2344). ' "'"") . C""D 5% Technology Fee 2. .7r TOTAL Iocr. <6>. Shared Dnve(T )/Buddmg Forms/Electncal PermIt ApplicatIOn 1-08 doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00207 ISSUED: 02/11/2008 APPLIED: 02/11/2008 EXPIRES: 08/13/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 875 S 43RD ST ASSESSOR'S PARCEL NO.: JANICE JACKSON PAR SPRINGFIETYPE OF WORK: Plumbing Only TYPE OF USE: New PROJECT DESCRIPTION: Sewer line & reconnect electrical panel to underground Residential Owner: JANICE JACKSON Address: 875 S 43RD SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building' 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 I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: ATTENTISihle*N~'e.w requires you.t,o follow rules adoptea 'by the Oregon Utility StflnQ~f1fe; Available: Notlflcatlo1?~MBP'uffl.ij~ltiJ1.Stes are set forth sp~'iJH IA~&uction: LL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHA OT 0090. You may obtain copies of the rules by No~:rHORIZED UNDER THIS PERMIT IS N calling the center. (Note: the telephone rnMMFNr.ED OR IS ABANDONED FOR number for the Oregon Utility Notification ANY 180 DAY PERIOD. I Center IS l-tiUU-.).)"-,,.,......J. Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2008-00207 ISSUED: 02/11/2008 APPLIED: 02/11/2008 EXPIRES: 08/13/2008 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 + 12% State Surcharge + 5% Technology Fee Storm Sewer - 1st 50 Feet + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Service Reconnect Amount Paid Date Paid Receipt Number $5.00 $6.00 $2.50 $50.00 $5.50 $6.60 $2.75 $55.00 2/11 /08 2/11/08 2/11/08 2/11/08 2/14/08 2/14/08 2/14/08 2/14/08 2200800000000000183 2200800000000000183 2200800000000000183 2200800000000000183 1200800000000000132 1200800000000000132 1200800000000000132 1200800000000000132 Total Amount Paid $133.35 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 Insoections I Sanitary Sewer Line: Prior to filling trench and including required testing. 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 Pa2e 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2008-00207 COM2008-00207 COM2008-00207 COM2008-00207 Payments: Type of Payment Check cRecelOl1 RECEIPT #: DescriptIOn Service Reconnect + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Paid By HARRIS E JACKSON City of Springfield Official Receipt Development Services Department Public Works Department 1200800000000000132 Date: 02/14/2008 Item Total: Check Number AuthorizatIOn Received By Batch Number Number How ReceIved ddk 3666 In Person Payment Total: Page I of I 8:21:15AM Amount Due 5500 275 660 550 $69.85 Amount Paid $69 85 $69.85 2/1 4/2008