HomeMy WebLinkAboutPermit Electrical 2008-7-1
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INITIALS rJ ~
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22S FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726.3753 . FAX (541)726-3689
ELECTRICAL PERMIT APPLICATION
CIty Job Number ~ VIA. ,;;LEo f?'- Co I D "
SupervIsor License Number 37S (.., 5 C i T~~rlIry Se!"lces or Feeders-
.' 'i\'"
j! / p 2~"11i'''
ExpITatlOn Date /0 (") j ~ 10, "0 : B',. 'U'''d J ,lnslalla/,lIlH' AlteratIon or RelocatIOn
'I/('AH9 "lIiFr Th lJ300,,, )l~.to
ODIi(b .02-001 0 oScru/~an t:1f1l1ty_
Constr Contr Number ./ "/ CJ / cf&.i7l" YOU m"y ~~~IO throt1BA ~@1tlelll!lI'/ljHPS
~ I1Umbe~ ~~~ Center. (Nc,~PIt1SIJ\m~1\mps
ExpiratIon Date ----.S: ~"., / (\ _ the n'e e g"", ....~.Aro es ""1000 V It "B" b
Vf:lflle 90n Uti tVer...."PEOus tw 0 s see a ove
1~1~0 '~~~{j& -
Slgnatnre ofSupervlSlng ElectrIcian O-JQ2~1..:-.-,:,lliffllts _ _ . .: _~ . _ _~_. __
r\ cp JJ, New Aiterallon or ExtenSIOn Per Panel
~ ,.vIVO '----- One CrrcUlt $ 48 00
-- Each Add1l10nal CIrcUIt or WIth -?
c:' ,I 1:> _ ServIce or Feeder PeTmlt '- $ 4 00
Owners Name ~~r... 'll-C>YS.
Address 4 '3 s-S S fa........... 1J /... d.
City &.G.- C:1V~ 'lffff/Pt . Pump or rrngatlon $ 55 00
THIS p"c. SIgn/Outlme Llghtmg $ 55 00
OWNER INST ALLA TIO~UTHO ERMIT SHALL EX LUnIted Euergy/Resldentml $ 28 00
The mstallatlOn IS bemg ma<@&~R.j~lVdY/rJ(Jffl;"f//RE IFi'FPI!fr ICommercml $ 50 00
IS not mtended for sale, leasAwe NeED OR IS A ISrRliIii4ff'P ~fl.I; PermIt InspectIOn Fee IS $50 00 + Surcharges
80 DAYp BANDnNE" ..ICi,y" -. - -- ,
Owners SIgnature tRlOD. 'lI J}rPa1l0T. OF ABOVE " - IS
~ ~ '"--~~- - , )
. "6
1(:50
'fO
/ 0 !.fL
,- -~~--
I LOCATION OF INSTALLATION:
~M ""M__ ~'"'_~_ _ _ _ = __~
/ 8'. ~ C-, s:..,. /J? c:. '7'
LEGAL DESCRIPTION
17D>>b>I 67700
JpB DESCRIPTION . ~
ch~ *- t ~k..C LJYf!.p
~{J tc:yr /'/ /",,~/.7'" - J
Permits are non-transferable an~xPJre Ifwork IS
not started wlthlD 180 days of ISsuance or If work IS
Suspended for 180 days
CONTRACr()R INSTALLATION ONLY
2
Electncal co:tractor (1;: {;,~ ~ J
,
Address I~ 3 c..
City _;.ap.
/1,,---1 ~\'"I1.P- ;4...,k
...,
Phone 9cS-\I'. ?stf' J
InspectIOn Request 726-3769
Date -1~O/~o'6
"----,,,~,~ ~, ~ ~-"'~ - ----
3 tCO~PLETE F1!E:.~C!fEDULE ~EWW
~~-- ,
-
A i New Residenbal::Single or MultI-Family per d"elllDg UUlt
1 ~-'~ ~~~ ___""_~,,~_~~~~="" ~~~~""-,, ,,,;;) ~
ServIce Included
1000 sq It or less
Each additIOnal 500 sq It or
portIon thereof
Each Manufact'd Home or
Modular Dwellmg ServIce or
Feeder
$11700
$2100
$55 00
r-"~~ ~ '" ',~T""""",- "'r~
B . Services or FeederS - InstallatIOn, AlteratIOns or RelocatIon.
~~ j 0 _~ _ _ ~- L;;_ _ /,',-
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60] Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 70 00
$ 83 00
$13800
$18000
$413 00
$ 55 00
$ 55 00
$ 76 00
$11000
g
r~ ~ - .
E . M,scellaneous (Servlce/feeder not lDeluded) -Each InstallatIOn
'-~~~ -~-~--.;;~-~~-- ~-j -~~~-"'-*- -
12% State Snrcharge
10% AdJOIDlstratlve Fee
5% Technology Fee
TOTAL
Shared Dnve(T )/BUlldmg FormslElcctncal Pennlt ApplicatIOn 1-08 doc
225 Fifth Street
Spnngfield, Oregon 97477
541-726-3759 Phone
.
~~
CIty of SprIngfield OfficIal ReceIpt
Development Services Department
PublIc Works Department
Job/Journal Number
COM2008-00 I 06
COM2008-00 I 06
COM2008-00 I 06
COM2008-00 I 06
Pdyments
1 vpe of Payment
Check
cRecelOtl
RECEIPT #.
Date: 07/0112008
1200800000000000718
Description
Add, Alter, Extend ClfC Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdmmlStratlve Fee
PaId By
DARRELL ROSIN
Item Tot.1
Check Number AuthorizatIOn
RCl-clved By Batch Number Number How Received
dJb
1135
In Person
Payment Total
Page I of I
917 lOAM
Amount Due
800
040
096
080
$IU 16
Amount Paid
$1016
$1016
711/2008
::/
fa:
Status
Issued
225 FlIth Street, Sprmgfield, OR
54]-726-3753 Phone
541-726-3676 Fdx
541-726-3769 InspectIOn Lme
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO' COM2008-00106
ISSUED. 03124/2008
APPLIED' 01125/2008
EXPIRES. 09124/2008
VALUE'
SITE ADDRESS 1836 S A ST
ASSESSOR'S PARCEL NO 1703363]07300
PROJECT DESCRIPTION Electrical only
Owner ROSSI SANDRA L
Address 4355 SPRING BLVD
EUGENE OR 97405
Contractor Type
Electrical
Contractor
CRAFTSMAN
# ofUllIts
Primary Occupdncy Group
Secolldary Occupancy Group
Plllnary Coustl uctlOn Type
SeconddrY ConstructIOn Type
# of Bedr ooms
Front yard Setbdck
SIde I Sethdck
S,de 2 Setback
RearYdrd Setback
Solar Setbdcks
Street Impl ovement!t
Storm Sewer AVdlldble
Speclallnstrulhon
Notes
De~cnptlOn
Tvpe of Con~tructlOn
Sprmgfield TYPE OF WORK Electrical Work Only
TYPE OF USE
CommercIal
I CONTRACTOR INFORMATION I
LIcense
170]83
BUILDING INFORMATION'
ExpIratIon Date
05/30/2010
Phone
541-954-7589
B
# of Stories Lot Size
..fii'lght ot Structure Sq Ft 1st Floor
NOTIq;pe of UfI\lll EXPIRE IF THE WOR~ Ft 2nd Floor
THIS PMlM.lTr~ 5 PERMIT 15 NOJq Ft Bdsement
AUTHOOli!i{)'UWtlER THINOONEO FOR Sq Ft GaragelCarport
COM~OW'OR IS ABA Sq Ft Other
AN'l1m5'DWf~~I~l)g nla Occupant Load
I DEVELOPMENT INFORMATION I
VN
REQUIRED PARKING
OverldY DI>t
# Street Tree; Rqd
Paved Drive Rqd
% of Lot Coverage
Total
Handlcdpped
Compact
I PUBLIC IMPROVEMENTS I
~rmtm>&IIW requIres yoU to
^TTE IA . do ted by the Oregon Utility
follow rUrr,\t~~'tiW$la'nJles are set forth
Notlficatlon~~1'()010 through OAR 952.()01.
In OAR 952 btaln copies of the rules by
0090. You may 0 (N le' the telephone
calling the center. 0 utllohl Notification
_..~..... th,\ O{egon ", .
.._.11'- - Center Is 1-80U""""........./.
I ValuatIOn DescrmtlOn l
$ Per Sq Ft
or mulhpher
Square Footage
or Bid Amount
Value
Ddte Calculated
Pdgelof2
__R'NR"~
~ J,1. ...
, JIIi:
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO
ISSUED.
APPLIED'
EXPIRES
VALUE'
COM2008-00106
03/2412008
01125/2008
09124/2008
225 Filth Street, SprlngIield, OR
541-726-3753 Pholle
541-726-3676 Fax
541-726-3769 InspectIOn Lme
Tot,ll V dine of Project
Fees Paul I
Fee DescllPtlOn
+ 10% Admllllstratlve Fee
+ 12% State Snrchdrge
+ 5% Technology Fee
Add, Alter, Extend Ore
Add, Alter, Extend Orc Ed Add
Pendlty Fee - BWOP Electrical
+ 10% AdmmlStratlve Fee
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend CII c Ed Add
Amount PaId
Date P dId
RecClpt Number
$1040
$624
$520
$48 00
$400
$52 00
$080
$096
$040
$800
3/24/08
3/24/08
3/24/08
3/24/08
3/24/08
3/24/08
7/1/08
7/1/08
7/1/08
7/1/08
1200800000000000270
1200800000000000270
1200800000000000270
1200800000000000270
1200800000000000270
1200800000000000270
1200800000000000718
1200800000000000718
1200800000000000718
1200800000000000718
Total Amount P dId
$ 136 00
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 ReoulI ed Insnectlons I
Rough Electr IC Prior to Cover
Fmdl Electric When dll electrlcdl WOI k IS complete
By SIgnature, I stdte and dgree, that I have carefully exammed the completed applicatIOn and do hereby certJfy that all
mformatlOn hereon IS true and correct, and I further cerllfy that dny and all wor k performed shall be done ID dccordance With
the Ordmdnces ot the CIty of SprlngIield and the Laws of the State of Oregon pertallllllg to the WOI k described herem, and
that NO OCCUPANCY Will be made 01 any StruCtUl e Without permISsIOn of the Commulllty Sel vIces DIVISIOn, BUlldmg Safety
I turther certlly that only contractors and employees who are m compliance With ORS 701 005 WIll be used on thIS project
I further agree to ensure thdt all reqUIred IDspectlOns are requested dt the proper t.me, that each address IS readable trom the
,treet, that the permit card IS located at the front of the property, and the approved set of plans WIll remam on the SIte at all
times dunng constructIOn
Owner or Contractors Signature
Date
Paee 2 01 2