HomeMy WebLinkAboutPermit Electrical 2008-12-18
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225 FIFIH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 '. FAX: (541)726-3689
ELECTRICAL PERMIT APPIJCATION
City Job Number COl41l..OOr- Of7f' (Date
New Alteration or Extension Per Panel' 50
One Circuit I $ ~o S D
Each Additional Circuit or with -; (J: .... r
Service or Feeder Permit ' , $;<1.00 ~ .>
/ NorlC j~~~"~ii3~bSM~~fi~~riM'tilift(im~la~~YamI~1Ti~ti~~
,THIS Pc. 't'.""-""~--"-""~,-",~~~--",,q",,,,#_,._-,,,)_q_#.0_._..,, ~l1Ji1
~urHolp ~tion $ 55.00
'-OMMEN :fi!j;(}f.j~iJjfiltJ"4E $ 55.00
ANy 180 flh~~'W.fH871if!!.E WOh'1( $ 28.00 '
!he in;'talllition is being made on property I own which . ~~1fJli~'ilI1:/S N().,;, $ 50.00 ,
IS not mtended for sale, lease or rent Minimum Electric Permit Insp~GllP Fee is $50.00 + Surcharges
1. .~EOGATiON~OEfNST",ri1!J;~:'PldN~;i!!.
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LEGAL DESCRIPTION:
\705 Z2(2-
cC 200
JOB DESCRIPTION:
ADD I<J1""v~ C<'eeJ:"" / WA.SflGr--t
Permits are non-transfertble and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2.
,.-,
Electrical Contractor ..:::- TEiJE
t.j.A.~t.
Address
f 0, B~-,: 7-/54 I
City . bel
;;{;<,- ;. (;,H
Phone
Supervisor License Number
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...;') c:; 11- S
- ((j
Expiration Date
i ,
Id- /
Expiration Date
1'-11(,/9
(( 3;: - (n
Conslr. Conlf. Number
Signature of Supervising ~cian
, J~-IIv,-_
. II
Owners Name },,,,bDr""I.-~kt.~lJ-c...
Address b 7l( LJ Zc{-U.. I L
City etA-G-,
Phone
OWNER INSTALLATION
Owners Signature:
Inspection Request: 726-3769
3. ~~i}Ef:t;;~E]Se;@~mJ';i!iEtOW'!'
A l~N' ,kn~Rw"~.0'a::0mit#lt7~IIS:'.Ii::.iJl#0'~T' itMiwl"~t'":'WF~A"'r'I'lli;;,'.~a*W'fil-I.' J111%01!11
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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
$21.00
$55.00
B.
$ 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
6Qh~p,~ to 1000 Amps
O,,<gI;'~?~IfiJl1p5Y.olts .
^ReconneW0nl~ regon la
in OA,'v"'~OI1 C; OPted b W re U'
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. ""~ 0 ,~" ,C .Ill':'" &(1:,
ca " , ~" ,._if: ".~"
nunc.!:: Ih~ CrP.r~blain ~h Q~e sel fO'J
1\y~IPn$ t~rl'fJOle' ~I?he ~-OOI.
200~~J%~gon Ut'. Ihe tele rUles ~ $ 55.00
201 Amps to 4b'OWirws;llty NOllf/one $ 76.00
401 Amps to 600 Amps -<344), CqUOf/ $110.00
Over 600 Amps or 1000 Volts see "B" above.
D.
4.
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,
107 ~
12% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application l-QS.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726'3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01781
ISSUED: 12/17/2008
APPLIED: 12/1712008
EXPIRES: 06/1712009
VALUE:
Springfield TYPE OF WORK:Electrical Work Oniy.
SITE ADDRESS: 480 COLONIAL DR
ASSESSOR'S PARCEL NO.: . 1703221200200
PROJECT DESCRIPTION: 8 circnits
Owner: STROCHLIC DEBORAH
Address: 674 W 24TH PL
EUGENE OR 97405
Contractor Type
Electrical
Contractor
STEVE HAUCK
# of Units:
Primary Occupancy Group:
SecondalyOccupancy Group:
Primary Construction Type
. Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
TYPE OF tJ~;E: Addition
Residential
ATTENTION' Or I .
follow rules ~do;t~~n b a~h~eqUlres you to
Notification Center Tho~e ru,Oregon Utility
:_,.... ^,...., ~__ . es arp. ~t fnrth
'1A';0~' ~:~~ yu, -vv I U tnrougn OAR 952-001-
I CONTBACTOWINlFB. RMJ\QQON3jJfthe rules by
, , ~ "r I I.. Ie J
number fo; ih-~O;~iq~J~;ygy ~~:r~~, . D t
Genter is l-tijJJl,$-2344). ~4/0~~2~09 a e
BUILDING INFORMATION I
Phone
541-221-2665
R-3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
VB
n/a
I DEVELOPMENT INFORMATION I
NOTICE:
overl~~II' tp ~IT SHALL EXPIRE IF THE ~~:
# Stree .fIT~ '0 UNDER THIS PERMIT I ~ capped:
Paved iVe'1t < om act:
% ofl~O I 0 OR IS ABANDONED FO
ANY 180 DAY PERIOD.
REQUIRED PARKING
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
Downspouts/Drains:
I y aluation DescriDtio~ I
$ Per Sq Ft
. or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
,
Paee I of 2
Status
Issued
CITY OF ~rKll'lGFIELD
Building/Combination Permit
'PERMIT NO: COM2008-01781
ISSUED: 12/1712008
APPLIED: 12/1712008
EXPIRES: 06/1712009
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 I
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee'
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
. Date.Paid
$8.50
$10,20
$4,25
$50,00 .
$35.00
12/17/08
12/17108
12/17/08
12/17/08
12117/08 I
Receipt Number
2200800000000001748
2200800000000001748
2200800000000001748
2200800000000001748
2200800000000001748
Total Amount Paid
$107.95
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 Reouired Insneetions .
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 ali
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 be made of any structure withont 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.
nurther 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
Date
. ,
Page 2 of2
225 Fifth Street
Sprin~field, Oregon 97477
541 c 726-3759 ,Phone
City of Springfield Official Receipt
Development Services Department'
Public Works Depart.ment
RECEIPT #:
2200800000000001748
Date: 12/17/2008
11 : 19:30AM
Payments:
Type of Payment. Paid By
Item Total:
Checle Number Authorization
Received By Batch Number Number How Received
Amount Due
50.00
35.00
4.25
10.20
8.50.
$107.95
Job/Journal Number
COM2008-0 1781
COM2008-0 1781
COM2008-0 1781
COM2008-0 1781
COM2008-01781
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Amount Paid
CreditCard
STEVE HAUCK
djb
04059C In Person
Payment Total:
$107.95
$107,95
, .
cReceintl
Page 1 of 1
12117/2008