HomeMy WebLinkAboutPermit Electrical 2008-8-26
SPRINGPIELD ~. ZON . \ fJi!/ .
Wi.::: ' INTTlALSIt_ , - ,W
- DATE C/'(jl~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH,(541)726-3753 . FAX: (541)726-3689 , ." SOURCE ~{V
Date . 1J1 U~ff '.
f
3, I COMPLETE FEE SCHEDULE BELOW
~.,
,
. t CrTY OF SPRINGFrELD, OREGON
ELECTRICAL PERMIT APPLICATION'
City Job Number' 'CoWl ?-C>O r - D I 2- f i
200 Amps or less
20 I Amps to '400'Amps
. 40 I Amps to 600 Amps
Ai-it':iTiON: OrE6(nr~mpsrtO':iIdiitl~mp5, t,o
ii)li;)/~ rules adoPO%i-ibtloeAQ'ilSWJht:Jtllity
1%' Icallon CenterRlc'o\lll€HI()~R-are set forth
i AR 952-001-0010 through OAR 952-001-
0090 You may Qbtai~:~'p'ies'ofJheJules'y,ed
;;llliing the cen't'er.-(NlWOr-YJliheIeIffiM'" e ers .
number for the Orego,l) litility Notifi,calion .
0enler is \~e'iWJl!~~tton or Reloeatton
200 Amps odess
20 I Amps to 400 Amps
40 I Amps to 60() Amps
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
-r b~ Service or Feeder Pennit
Owners "Name --!. t)5J11.--;~ ~,f)('.ntj7cJ-'
Address 6 '0 7"S- mtl" f1 - c:f1- Nrfrlcei;eellaneous (Service/feeder not included) -Each Installation I
City s,r? {i'M,lid J Phone '1l1&"I3 '1.1: THISMlilll".:l'l'rMt EXPIRE IF TIlE '''OA,} 57.00
-="" AUT/-IOOIWliiu~l\"fHJS PERM vv I'J; 57.00
OWNER INSTALLATION COMM~lYUW1~e~tf,mIDONEDI~ IS NOT$ 29,00
The installation is being made on property I own which ANY 1-OOi01'\1f'Jl'f!'lll~mercial I Gn $ 52,00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $52.00 + Surcharges
Owners Signature: 4. I SUB'I"OTAI" OF ABOVE 7 J
!.IlC:-M'//J--<:9,:IJn?/./ 12% State Surcharge 81b-
10% Administrative Fee 7::St:!.
5% Technology Fee >'~
'1 Z 7!-
I. I LOCATIONOFINSTALLATION:
h ( S-S- MAI#'\I~)~
o ~ CfDO
LEGAL DESCRIPTION:
1702- 35"31
JOB DESCRIPTION:
"1>AvtL Ct+At/6-e
Permits are non-transferable and expire if work is
not started within 180 day~ of issuance or if work is
Suspended for 180 days.
2. .1 CONTRACJ"ORINSTALLAT,ION ()NLY I
Electrical Contractor
Address
City
Phone
d\.
Supervisor License Number Il 'e
Expiration Date OJ
Constr, Contr, Number 7
Expiration Date
Signature of Supervising Electrician
Inspection Request: 726-3769
A. I New Residential- Single or 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
$121.00
$ 22.00
$57.00
B. I Services or Feeders - Installation, Alterations 01" Relocatio~:-
..
I
~
$ 86.00
$143.00
$186.00
$426.00
$57.00
,
$ 57.00
$ 79.00
$114.00
Over 600 Amps or 1000 Volts see "B" above.
D. I Branch Circuits
$ 50.00
$ 5.00
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 7-08.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541~726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01289
ISSUED: 08/2612008
APPLIED: 08/26/2008
EXPIRES: 02/26/2009
VALUE:
Springfield TYPE OF WORK: Electrical Work Only
SITE ADDRESS: 6955 Main St
ASSESSOR'S PARCEL NO.: 1702353309400
PROJECT DESCRIPTION: Panel change
Owner:.. Y ASMIN ESPINOZA
Address: 6955 MAIN ST
SPRINGFIELD OR 97478
Contractor Type
Electrical
Contractor
OWNER
TYPE OF USE: Repair
Residential
Phone Nnmber: 541-988-4396
I CONTRACTOR INFORMATION I
License
Expiration Date Phone
"1 .1.......11 .
'.110"1 'ul. BUILDINP. 'INF@RIMA!fI.0N'"
~ ., , , .. "Ul"
i~~2~~~;6~el~t~e~~~~M;~~~ ~~~~et ~~~
OCR~3. You may ,*iE\~l oPSIQuJt\Ml952-001_
calling the ce nr~p.eIJ . ~~ of the rules by
rfli1iber for the ~i\l 0 YI9f,iit e tel~~ho~e
Center i~qoSIl _1IlP-.~-l~tlfJCatlon
Energy P"itli: ).
Sprinkled Building: nla
# of Units:
Primary Occupancy.Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor;
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I ,
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handieapped:
Compact:
I pUBtJCij~OVEMENTS I
..: ;,~ .- tll,'lJTl' "mILL I:"XPJR~J~J.HfW~~K
AUTHORIZED UNDER THIS PERMIT IS or
COMMENCED OR IS ABANo'G'NrrilftlW rains:
. ANY 1BODAY PERIOD. .
I Valuation Des~riDtion I
$ Per Sq Ft
. or multiplier
Square Footage
or Bid Amount
Date Calculated
Value
Paee I of2
_ E;,!l!!IJ!:!':j,~Rlg;J~~1'
I
i
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01289
ISSUED: 08/26/2008
APPLIED: 08/26/2008
EXPIRES:. 02/26/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
F~.~~ .P~i~ I
\
Fee Description
+.to% Administrative Fee
+ 12% State Surcharge
+,5% Technology Fee
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$7:30
$8.76
$3.65
$73.00
8/26/08
8/26108
8126108
8126108
Receipt Number
2200800000000001294
2200800000000001294
2200800000000001294
2200800000000001294
Total Amount P.aid
$92.71
.' 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.
Reouired Tn~necfion'l
Electric Service: Approval required prior to utility company energizing service~
By signature, I state and agree, that T 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 ail. work performed shall he done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Ot:egon 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.
T further agree to ensure that all required inspections are requested at the proper time, that each address is readablefrom 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 constructio'n. . , '
V,4::;lotA/ Ifl ~tO/AJcJ'7 ~A
f( f? G r nR -
Owner or Contractors Signature
Date
-,
Pa2e 2 of2
225 Fifth Street
Spdngfiehl, Oregon 97477
541-726.-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2008-01289
COM2008-0 1289
COM2008-0 1289
COM2008-0 1289
Payments:
Type of Payment
Check
cRcceiotl
RECEIPT #:
Date: 08/26/2008
2200800000000001294
Description
Penn Serv/Fdr 200 amps or less
+ 5%.Technology Fee
+ 12% State Surcharge'
+ 10% AdministrativeFee
Paid By
Y ASMIN ESPINOZA
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
829
In Person
Payment Total:
Pa.ge I of I
1l:21:24AM
Amount Due
73.00
3.65
8.76
7.30
$92.71
Amount Paid
$92,71
$92.71
8/26/2008