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Home My WebLink AboutPermit Electrical 2008-5-9 ZONUV INITIALS t'\(Y) DATE ,"'5 -<::r -0 &" SOURCE'('n ~~/?_ \" '.c..r- 6qlo{ , . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number ~ z...o ~ 8 - 00 b ( f , ~ 1. LOCATION OF INSTALLATION: ')(.1: /;i-;d, Ic&":~leb;" " I LEGAL DESCRIPTION I80Z06Z-L( o~ 700 JOB DESCRIPTION: ~dJ S Ct r~t.A.;~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 1 '5 N ';;.jN\'<f\ti\1Wh, /( , , -.<<l~ 2. :, ,cONTRACTORi]VSTALLAT!9N ONLY:~ 5 D<b<>.-'> ~~ ,~, , " ' , Date '! h'"',, "N 3. COMPLE'fl(: FEE SCHEDULE BEWW ", A. I~ew Residential- Single or Multi-Family per dwelling unit , ~ ,,'l- _-t"v ~ "' 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 $ 2100 $55 00 , ' I B. Sen,iceS"or Feeders - Installation, Alterations or Relo~tion: v" > \"i > Electrical Contractor 200 Amps or less 20 I Amps to 400 Amps Address CY"'0n IcWlr~,,-,;'.x:;8>~g }Qnps ! "ar;~p~ted b)6U1%irps?t?1) )Jt~OIt..Y_ps I I; '. '-~, , I IisefYc fml City Phone ~r,,';::j1Iu') Center ThOmb~h~ lOfpfts OAR 952-001-001 ~ thiRlW6tiri les by ~o, You may obtain COpl~S 0 Ie hone l the center !f.'1ote. the te p :&n...:~' " ' """ , Supervisor License Number ~ calling loI'--tl'le Or~~n (f~ijji~J(les or Feedern" . J ,- numUtll '1-800-332-2344). Expiration Date f:\ \1" Center IS Installation, Alteration or Relocation V 200 Amps or less Constr. Contr Number 201 Amps to 400 Amps 401 Amps to 600 Amps New Alteration or Extension Per Panel One CirCUIt $ 48.00 OTICE: Eac~ Additional Qfy~itJflb~ ~ z. c:.::> c- i N ( H~~~\P&Jfr Wr'inYtv ..> $ 4.00 Owners Name J leu L ~-1.OuA ~'S PERM\T S 0 R THlS PERMIT \S NOT ";' ,'''' Addres,s JC:>:5() j6 /l..J('-7-1 .FJ.(. ~~~~~~D WR,:MiA.,,~~llSeFSa/feedernotincIUded)-EaCh Installation cI~3-8.eJd._ Phone QS - DAY P.dr migation $ 55.00 SIgn/Outline Lighting $ 55.00 Lllmted Energy/Residential $ 2800 Lrnuted Energy/Commercial $ 50 00 Minimum Electric Permit Inspection Fee is $50.00 + Surcharges <" if''':; ~~i%ti1ij@~ i~~ / " / 4. SUBT,OTA( OFABOVE ,,~i, 12% State Surcharge ~ 10% Admmistrative Fee ~ 5% Technology F~"b 't,t' ~ 16'(-' - t{o TOTAL ~ Z~ _ Shared Dnv Idmg FonnsfElectncal Pennlt ApphcatlOn 1-08 doc ExpiratIon Date Signature of Supervlsmg Electnclan OWNER INSTALLATION Inspection Request: 726-3769 Over 600 Amps or 1000 Volts see "B" above. D. Branch CircuitS:: ", ,':' 'I'" $ 70.00 $ 83 00 $138.00 $180.00 $413.00 $ 55 00 " I $ 55 00 $ 76 00 $110.00 z.o e:to :ce- 10.... CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00611 ISSUED: 05/01/2008 APPLIED: 05/01/2008 EXPIRES: 11/09/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1050 KINTZLEY AVE ASSESSOR'S PARCEL NO.: 1802062403700 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: 200amp panel change out and 5 circuits TYPE OF USE: Repair Residential Owner: HOLLIS STEVEN LEROY Address: 1050 KINTZLEY AVE SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor OWNER License BUILDING INFORMATION I # of Units: # of S~<\f~10 Primary Occupancy Group:' "';'~I)N, ~t~gon law reiW~~Ul.fIltVture Secondary Occupancy ~roup:,.les adopted by the ~tDJ:g~tth Primary Construction 1.;y,p~,(\tlon CeiVTf. Those ru {tj'A-K~01. Secondary Constructi,oJlCI;,ypt952-001-001 ~ thr~ui~~1~ by # of Bedrooms: 0090, You may obtain c p. ~8'~i~e calling the center. (~~~til~YJfi.RitIt\cialiUftling, n/a _"\",,h.or fnr the Orag " M:t'\ Center is 1t'B"ftlL{)pMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Phone Number: 541-954-6542 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I NO'T'CE~ "'E ,t: '1ll~ WO~ewalk Type: lH\5 PERM" S,","tl ~5 PERM" \5 NQ;'twnspouts/Drains: AUTHOR\ZEO UN~~: Al3ANOONEO fOR ~~~i~~~~ ~ER\OO. Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Pa2e 1 of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00611 ISSUED: 05/0112008 APPLIED: 05/01/2008 EXPIRES: 11/0912008 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. Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $7.00 $8.40 $3.50 $70.00 $2.00 $2.40 $1.00 $20.00 5/1/08 5/1/08 5/1/08 5/1/08 5/9/08 5/9/08 5/9/08 5/9/08 2200800000000000564 2200800000000000564 2200800000000000564 2200800000000000564 1200800000000000446 1200800000000000446 1200800000000000446 1200800000000000446 Total Amount Paid $114.30 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. l Reauired Insoections . Electric Service: Approval required prior to utility company energizing service. 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 b made of any structure without permission of the Community Services Division, Building Safety. I further certify that only co factors and employees who are in compliance with ORS 701.005 will be used on this project. I further ag ee to ensure th all required inspections are requested at the proper time, that each address is readable from the street, that e permit card s located at the front of the property, and the approved set of plans will remain on the site at all ti es in construction. -5' ct- 08 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 Job/Journal Number COM2008-00611 COM2008-00611 COM2008-00611 COM2008-006] ] Payments: Type of Payment Check cRecemtJ RECEIPT #: 1200800000000000446 Date: 05/09/2008 DescriptIOn Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State Surcharge + ] 0% Administrative Fee Paid By STEVEN HOLLIS Item Total: Check Number AuthOrizatIOn Received By Batch Number Number How ReceIved dJb ]466 In Person Payment Total: Page] of 1 9:45:58AM Amount Due 2000 100 240 200 $25.40 Amount Paid $25 40 $25.40 5/9/2008