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Home My WebLink AboutPermit Electrical 2006-12-14sFlil'.Ltt ZON DATE SOURCE225 FIF-TH S'I'REET . SPRINGFIELD, OR 97477 o PH:(5rll)726-3753 o FAX: (541)726-3689 E LECT RT CAL PE RM I T APPLI CATION City Job Number {o*t 6e-o/60 )Date 3.COMPLETE FEE SCHEDULE BELOW- /z- tu-o c I. LOCATION AF 3t ( LEGAL t70 7 /5lo O3l o c> JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 da.vs. Y Electrical Contractor ,O Address o,l\a Phone AflEN \ ru\\roY rhe Supervisor License A. Nerv Residential - Single or Multi-Family per dwetling 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 Services or lieeders - lnstallatitx. $ 106.00 $ 19.00 $s0.00 Alterations or Relocation 2. City 200 Amps or less 201 Amps to 400 Amps 401 to 600 Amps 1000 Amps olts $ 63.00 $ 7s.00 $ 125.00 $163.00 $375.00 $ s0.00 or Fr'cdcrs I Constr. Contr. Number Expiration Date Signature of Electriciap Owners Name I tt ,ti E Address 35'7 O City SP r rr'onC,OSM or Relocation or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel $ 3.00 nnt included) -Each Installation Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 $ 2s.00 s5?- Expiration Date I $ s0.00 $ 69.00 $100.00 $ 43.00 \t\\i SHN \OD NNftDU: OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Li mited Energy/Residential Minimum Electric Permit Inspection 4. SUBTOTALOFABOW 8% State Surcharge l0% Administrative Fee 5olo Technology Fee Limited Energy/Commercial $ 45.00 Fee is $45.00 * Surcharges .\(-) tJ_r Zte r 6r t-e Inspection Request: 726'37 69 TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 8-06'doc . CITY OF s<> or with Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01605ISSUED: 1211412006 APPLIEDz 1211412006 EXPIRESz 0611412007 VALUE: SITE ADDRESS: 3530 GAME FARM RD SPACE 41 ASSESSOR'SPARCELNO.: 1703154003100 PROJECT DESCRIPTION: Service reconnect Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential Owner: Address: Contractor Type Electrical LOWRIE BILL D 3530 GAME FARM RD SPACE 041 SPRINGFIELD OR 97477 Contractor MY ELECTRICIAN INC License 87506 Expiration Date tu20/2007 Phone 541-729-14s4 CONTRACTOR INFORMATION BUILDING INF # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: A I'l Ef!l,orviur Water Type: tolloW ru,es aRange Type: fV,otification Energy Path: ln OA -001Sprinkled Buil$gg6 Center Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o oILot Coverage: VB ,INOEO i j0 0Ay Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: rFsBa&eqgBU. Compact: iv itv Set fortl Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Lj ,,ti,.l }fiffi#,':;l;'t i 1,ryDE ofi /s PER/O $ Per Sq Ft or multiplier Square Footage or Bid AmountDescription Type of Construction Pase I of2 Value Date Calculated Valuation Description I isl rUIES b; t'i Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01605ISSUED: 1211412006APPLIEDz 1211412006 EXPIREST 0611412007 VALUE: Amount Paid Total Value of Project Date Paid Fee Description + l0o Administrative Fee + 57o Technology Fee + 87o State Surcharge Service Reconnect Total Amount Paid $s.00 $2.50 $4.00 $s0.00 t2t14t06 12t14t06 t2n4t06 t2n4t06 Receipt Number r2006000000000017s6 1200600000000001756 1200600000000001756 r200600000000001756 $61.50 ees Paid To Request an inspection call the24 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. Electric Service: Approval required prior to utility company energizing service. Insnections 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 Cify 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 Prye2 of 2 Date 225Bifth Street Springlleld, Oregon 97 477 541-726-3759 Phone Ci+', o1 Springfield Official Receipt t :lopment Services Department Public Works Department RECEIPT #: 120060000000000r756 Date: 1211412006 l0:40:50AM Job/Journal Number coM2006-01605 coM2006-01605 coM2006-01605 coM2006-01605 Description Service Reconnect + 5% Technology Fee + 8% State Surcharge + llYo Administrative Fee Amount Due 50.00 2.50 4.00 5.00 Item Total:$61.s0 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid CreditCard MY ELECTRICIAN djb 000375 In Person Payment Total: s6l .50 -56i3r cReceintl Page I of I 12114t2006 ilmmi*