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Home My WebLink AboutPermit Electrical 2009-4-16 .~,-':i\ E!~trical Permit Application CITy OF SPRINGFIELD, OREGON:, - . y. '" . '" ". .' - . 225 Fifth Streett Springfield, OR 97477tPH(54I)726-3.7S3tFAX(541)726-3689 ,-;'" ?,~, SPR'NG....... [, D.EPARTMENT USE ONLY iii.: ~ I CoM z.e.e '(- . Permit no,: ee;S J Z- I Date: 1-/ Lt / ec( [ "J,'Y I (;i\' I This 'permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days, I . LOCAL GOVERNMENT, APPROVAL:, 'I FEE'SCHEDULE I Zoning approval verified? DYes D No I ',Nulltber of in~p,ec.tiol!~,peritem d IQty.j I " CATEGORY'OF,;CONSTRUCTION I I I I I I R~idential, per unit, service included: o Residential -gj Government 0 Commercial I , JOB SITE',INFORMATIONAND ,LOCATION I 1,000sq, It, or less (4) I Job site address: 250 S. 3 Z. ,d, I I ~~~01ditionaJ 500 sq. It or portion I City:SI"R(l'>C F(~c" I State: DJ<.. I ZIP:q,c,..'yEi I Limitedene,gy(2) I Subdivision: 1 Lot no.: I Each manufactured home or modular I DESCRIPTION' OJ:, WORK dwelling service or feeder (2) I R 1'""'\ Services or feeders: instal/ation, alteration, relocation INST'"ALL 'C,..cef'.rAcLL5 Dtv r-AR./<,~ (~-T- I L.le HT 'PDL.6 I ' " PROpERTY ,OWNER' , I Name: \.v ULA"^,,,(,A'''''' 'PA"-/<.t f-c'Y' ?'IlSTR,cr I Address: ZSc> 'S. <.2""1\. I City:SPR''''''->:I.<<Il', I State:C>12- I ZIP:'17Cr'7f3. I Phone:5"i1-7~ 4<;-?~ I Fax: I E-mail: This installation is being made on residential or farm l'.vt'....~j owned by me ora member of my immediate family. This property is not'intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: I CONTRACTOR INSTALLATION I Business name: I Address: I City: I Phone: I E-mail: I CCB license no,: I BCD license no,: I Signing supervisor's license no.: ~02:S S I Print name of signing supervisor: t<t'.. ",""'l'JT~ D. KA !..:>DAU ~ r I Signature of signing supervisor: ;(',~~ dA D, -1?~aJ I State: I Fax: I ZIP: ~\CJ .0\ ~\~ ~, 440-2584-1 (9108ICOM) , Cost Total ea, cost $134.00 $ $ 25.00 $ $ 32.00 $ $ 63.00 $ 200 amps or less (2) $ 81.00 $ I I 201 to 400 amps (2) $ 95.00 $ I I 401 to 600 amps (2) $158.00 $ I I 60 I to 1,000 amps (2) $205,00 $ I lOver 1,000 amps or volts (2) $469,00 $ I I Reconned only (2) $ 63.00 $ I I Temporary services or feeders: installation, alteration, relocation I I 200 amps or less (2) $ 63,00 $ I I 201 to 400 amps (2) $ 87.00 $ I I 401 to 600 amps (2) $126.00 $ I lOver 600 amps or 1,000 volts, see services or feeders section above I I Brancb circuits: new, alteration, extension per fXme/ I I a. Fee for branch circuits with purchase of a service or feeder fee: I I Each branch circuit I $ 6.00 I $ I I I b. Fee for branch circuits without purchase of a service or feeder fee: I I I First branch circuit (2) II I $ 5500 I $ S5 --r I Each additional branch circuit . $ 6.~0 $ I I Miscellaneous fees: service or feeder not included I I Each pwnp or irrigation circle (2) $ 63.00 I $ I I Each sign or outline lighting (2) I $ 63.00 I $ I I Signal circuit or a limited-energy panel, $ 63.00 I $ I alteration, or extension (2) I Each additional inspection: (I) I $58.00 I $ I I:' '" APPLICANT' USE (A) Enter subtotal of above fees (Minimum Permit Fee SS8JMJ) I (B) Enter 12% surcharge (,12 x [A]) I (e) Technology Fee (5% offAl) I TOTAL fees and surcharges (A through C): $SB~ $ (,."\(,1 $ 2-'1DI $b 7~8bl S~~INGf.'lllIJ.,t), -;- "" t'.' ." -,~,.(.., . ~I: Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00512 ISSUED: 04/16/2009 APPLIED: 04/16/2009 EXPIRES: 10/16/2009 VALUE: $ 750.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line J SITE ADDRESS: 250 S 32nd St ASSESSOR'S PARCEL NO.: 1702310000502 Springfield TYPE OF WORK: \ TYPE OF USE: PROJECT DESCRIPTION: Adding one circuit for exterior USe of electrical vehicles, Owner: Address: 28TH ST PROPERTIES LLC PO BOX 117 , WALTERVILLE OR 97489 I CONTRACTOR INFORMA TION . Contractor Type Electrical Contractor KENNETH RANDALL I BUILDING INFORMATION ~ License Expiration Date Phone # of Units: Primary Occupancy Gronp: Secondary Occupancy Gronp: Primary Conslruction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Height of Slructure Type of Heat: Walei' Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft I sl Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Fl Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq FI or multiplier Square Footage or Bid Amount Value Date Calculated Paee I of2 Sta tus Issued 225 Fifth Street, Springtield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project , Fe,es, Paid I Fee Description Amount Paid " Total Amount Paid $0.00 Plan Reviews I Date Paid CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00512 ISSUED: 04/16/2009 APPLIED: 04/16/2009 EXPIRES: 10/16/2009 VALUE: $ 750.00 Receipl Number 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. Reollired Insnectinns I Rough Electric: Prior 10 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 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 City of Springtield and Ihe 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 slreel, 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 7~g=t;;~JlIJ Owner or Contractors Signature Paee 2 of 2 Cj -/ b - Z,(Ji> <j Date 'T 225 Fifth Street Sprj.ngfie1U, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00512 COM2009-005l2 COM2009-005l2 COM2009-005 I 2 Payments: Type of Payment Check cReccintl RECEIPT #: CitY of Springfield Official Receipt Development Services Department Public Works Department 2200900000000000395 Date: 04/16/2009 Description Add, Alter, Extend Cire Minimum/Adjustment Electrical + 5% Technology Fee + 12% State Surcharge Paid By WILLAMALANE Item Total: Check Number Authorization Received By Batch Number Number How Received KLK 76805 In Person Payment Total: " Page I of I 11:51:IOAM Amount Due 55,00 3,00 2,90 6,96 $67.86 Al!lount Paid $67,86 $67.86 4/16/2009