HomeMy WebLinkAboutBuilding Electrical 2008-9-16
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DATE. 3..-\\..D.o'O
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22SFIFI1I STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number COWl z..o 0 g- -0 ( l.{ C g Dale
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LEGAL DESCRIPTION: A.' l~~mes\ile,jj.@J"",~.!.,!gl.~IP'r~lS'I;i1.wlliim!Im!.~.Ili.i1,~![lJ~gl!in\ " "
( "7 c'> 27 q ( 0 "3 7 DO' Service Included
Permits are non-transferable and e,xpire if work is
not started within 180 days ofissnance or if work is
Suspeniled for 180 days.
1000 sq. ft. or less '
Each ailditional 500 sq, ft. or
portion thereof
Each Maoufact'd Home or
Modular Dwelling Service or
Feeder
$121.00
JOB DESCRIPTION:
fAP)Clk/rf.pfo.ce Br-fu.w jJc'f\ltl
$ 22.00
"
$57.00
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'(?ONiFIDfGT:@R*INS:FAlJP!AU01'i,ONI:;Y!f{,
2. CkW;if,",i%llI!HI1Wi"""''O'-:0iw.;;$~mll~:\Ijiill\iiiib0i&idijii12f70~7'''A"9'1V';~;;'f',fi);';'8#.1&'.
mftV0E1#&%0i$~"jiliJ:A,tti8)'H,^;>04&'t",d1;,'Wt",w"/)""YY$iim~!@Th'WimW!i!ii%MM::i'i!nItw&!&'#'0W1mmi'Wl1I'%!'lW"f '
B '8--", =, -vvm'-~"d'Y"'""',' .rP'~l"l~".,ti'i"-~],t,~,','..,'t'-''''''''n.~l~,.t' '
. ~..<e~lfj~!j!,.a~ee~~fldL~nsJ,Q ~ o!!,~"er,~"J(",!s;otf~e oca},on:F&
City
Phone
.\-:r::rlTlON: or~8BmR!clWes you to )( $ 73.00
follow rules ado~IlP1!!'a~iUtility $ 86,00
Notification Cente4.orIitGaJlsndMll.r.ertlJjlforth $143,00
In OAR 952-001-0@~~1i!l.l52,~1. $186,00
0090.. You may olvl~n ~ ~ 0 !]lJ'es ~ $426.00
rOil" the cent r. N,. iplfone
nu er for the 1lfI"€It, :tJollfication $ 57.00
~vl' Center is ~m~800~;23U)._,,~__..__~.....,.
'" C. 1F~'Dl"'ra-'Sefu1ices'lli-~~eed-e'rs ,',Wfi .~' ,-liY'.!'_'NI, . '.
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71
Electrical Contraclor
Address
Supervisor License Number
Expiration Dale
Installation, Alteration or Relocation
200 Amps or I~;s
20 I Amps to 400 tunps
401 Amps to 600 ~ps
$ 57.00
$ 79,00
$114.00
'Constr. Contl.. Number
Expiration Date , L
Signature of Supervising ectriciao
Over 600' Amps or 1000 Volts see "B" above.
D.
oWners Name .~ ld- ~k!,!__ "-
,Address IS 35 14./( '! Sf () D f'!"TIC~' .
City ~'1IoP"e(cJ Pbone $"/q-~cxJ~ PERMt;yij~JREIHHEWORK .. $57,00
v AUTHORIZ~QJ:INQ.6IHijlSnPgERMITlS Nu 1,-.. '. $ 57,00
OWNER INSTALLATION . COMMEN~Q@1ffieMMQQhl~QFOR.. -"$ 29,00 .
The installation is being made on property I own whi~Y,180 Qt\Xi.m!Q!;l~/Commercial " $ 52.00 ...,
is not intended for sale, lease or rent. Minimum Electric Permit Inspection' Fee is $52.00 + Surcharges
New Alteration or Extension Per Panel
One Circuit
Eacb Additional Circuit or with
Service or Feeder Permit
$ 50,00
1-
$ 5.00
10,00
Owners ~~ ~/'-.....V'\.
4.
. 12% State. Surcharge
10% Administrative Fee
5% Technology Fee
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Shared Drive(T:)/Building FormslElecbical Permit Application 7-QS.doc
Inspection Request: 726-3769
TOTAL
Status,
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01408
ISSUED: 09/15/2008
APPLIED: 09/15/2008
EXPIRES: 03/15/2009
VALUE: .
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspectiou Line
SITE ADDRESS: 1535 KELLY BLVD
ASSESSOR'S PARCEL NO.: ' 1703274103700
Springfield TYPE OF WORK: Electrical Work Only
"
TYPE.OF USE: Repair
'Residential
PROJECT DESCRIPTION: Upgrade panel
Owner: SCOTT MCLENNAN
Address: 1535 KELLY BLVD
SPRINGFIELD OR 97477
Phone Number: 541-514-3005
"
r CONTRACTOR INFO~ATlON 1
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION 1
# of Units: # of Stories:
Primary Occupancy Group: R-3, Height of Stru8trtt'l
Secondary Occupancy Group: '.Ty~l!lit~ uti\i\'l
Primary Construction Type V~. Olegon ~%~Owlt?nse' IOn"
Secondary Construction TYP'Ji,'\TE';-\\\O ~ ~clO?'ecllR'gggti\lll" II 952..()0'-
# of Bedrooms: lo\'.O'<'J ILI\e'Cel\181. \"'€~5~ : IU\esn.,
,,\o\il\C'i\\IS~_OO~ _001 0 'S'~ffll~61 el' e
. _" n 0.:"1_ _""H\\f\ . \'hPl\ ._ _~i.nn
10"090, '\oU,.:'JrbEl'l"ELPP,KDENT1NfORMATION ,
\' 9'" '" / 11 '~IIr.
ca\ Il\ 101 \l\", ~ _800-,:)""-
umbel tel IS 1
l\ cel\ Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Lot Size:
Sq Ftlst Floor:
Sq.Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
, n/a
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
-REQUIRED PARKING
Total:
Handicapped:
Compact:
Street hriprovements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS ~ ,_;,
.. ',...-'" _.~
. .---------:-Sidewalk Type: '/..
, ;'D~,,~~),Iffi~V
~~~~~~~i~ ~:ii~~~~~~~~g f~:
b.\litlQ~~, en O~ \s r>:, i
"'1.......:1:. --"'\,10.
I \.IV .\-- nll.1 P'",
V aluatitilll\1)1te&mfIon
"
Notes:
...~
Description
Tvpe of Construction
$ Per Sq Ft .
or multiplier
Square 'Footage
or Bid Amount
Value
Date Calculated
Page I of 2
_~~IIoI<lI"'I:IlI"C\i
~
, ,
CITY OF ::'lrtuNGFIELD
Building/Combination Permit
PlmMIT NO: COM2008-01408
ISSUED: 09/15/2008
APPLIED: 09/1512008
EXPIRES: 03/15/2009
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726'3769 Inspection Line
,., < ...
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Total Value of Project
Fees Paid 1
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
$8.30
$9.96
$4.15
$10.00
$73.00
Date Paid .I,
9/15/08
9/15/08
9/15/08
9/15/08'
9/15/08
Receipt Number
2200800000000001390
2200800000000001390
~200800000000001390
2200800000000001390
2200800000000001390
Total Amount Paid
$105.41
I Plan Reviews 1
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 ~equested after 7:00 a.m. will be made the following
work day. '
I Reouired 1 nsnections I
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Fin'al Electric: When all electrical' work is complete,
By signature, I state and agree, that I have carefully examiued the completed ap~lication and do hereby certify that all
information hereon is true, and correct, and 1 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 l:;ommunity 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 prope~ 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. .
~J1t~
': 9-1S-0'j{
Owner or Contractors Signat~re
I,
Date
I
Page 2 01'2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-0 1408
COM2008-0 1408
COM2008-0 1408
COM2008-0 1408
COM2008-0 1408
Payments:
Type of Payment
CreditCard
cReccintl
RECEIPT #:
Description
, Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee .
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
SCOTT MCLENNAN
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200800000000001390
Date: 09/15/2008
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 194608 In Person
Payment Total:
Page I of 1
II: 17:32AM
Amount Due
73.00
10,00
4.15
9,96
8.30
$IU5.41
Amount Paid
$105.41
$105,41
9/15/2008