HomeMy WebLinkAboutPermit Electrical 2009-4-17
Electrical Permit Application
1l~';~EF!'gRTMENT;!tiS-Er0Nfi.Y)'~1
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, pe~?t:.~O 9-o0SI J'
I Date: 'i -/7- 0 ~
215 Fifth StreettSpringfieId, OR 97477.PH(541)726-3753.FAX(541)726~3689
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.
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Zoning approval verified? 0 Yes 0 No I
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:fst. Residential I D Government I D Commercial I
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I Job site address: 'Z-bo S. Sf "t- I'L I
I City: '5 P,:;) I State: ()(L I ZIP: 97C( 7 g I
I Subdivision: /702- 533> I Lotno.:ooYOO I
1~~QE$~8.IF,i;t;l()NIi()FJIW()R~~~~1
I. 5t:Utc..e kcO'-'.....(:'T_T
$134.00
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.1 Residentia!. per unit, service included:
11,000 sq. ft. or less (4)
I Each additional 500 sq. ft, or portion
th ereo f
Limited energy (2)
Each manufactured home or modular
dwelling serviCe or feeder (2)
I Services or feeders: installation, alt,?ration, relocation
. I 200 amps or less (2) $ 81.00 $
~~~~~I,:r"'~P..R'O' 'P..E. R;r~ii;T0'W' NE R"->iZY#11~f~",-,,,,:;r.l"\1,.1i, . I 20 J to 400 amps (2) $ 95.00 $
=C;H0;E),$~.zres:L__~"., __ '- ," '_10,1~", __" ",'" ;~,,,;~c.;t:4>:Y;f.l,,,,'J~~,~,i~,,,,!l'J.f~
Name:, ~f!'Y\..o.(' ...-A/J/f Vi (" :,: '111: Oreqon I~", _ I 401 to 600 amps (2) $158.00 $
I Address~::z. 60 [, Cine. f~J~:;c&p,;c:~,~:te_d bl'thr~Il'6bl't9'hQo,9)amps(2) $205.00 $
I City .I//t'/fi If! aJ- flJd"1 Sta:te;C0~j]~~j:ZIPDcii 0 ;~~~~~~l/eJ 9~~fl!t~~'rps or volts (2) $469.00 $
I PhoneJ-, ,e...jc~ _,-7 G vA Fax'!ing '.'1 ~y Obtain CO ," I' S dRes<mlJ_'fihqlrly (2) I $ 63.00 $
/, l:;" 1,.1f _ Ie, QM_ Pre!; tf, cn _"
.\ E-mail:. ' "Ul/IO~~for the 'O;~n~~O!~.:..~ e If''f:.~4~~:ElI1Yl}erViCes or feeders: installation, alteration, relocation
This installation is being made onresidentialcM'fifrffl pr<imj~32"~' ^ c.rl9~~~~or less (2) $ 63.00 $
owned b~ me or a member of my lffimedJate famIly. ThIS -"" 341/):201 to 406 amps (2) $ 8700 $'
~:;~;)~~;;::xc~ent~ ::~,., . i ~~:rt::~:::::~~ooo volts, see se~ic~s or fee:~:'6s:~tion :bove
1~~"".!,:()Nm~!':JT:()R#INST:Jl:\!!IfAml()N~;iy.F!J~'ii~1i't. I Branch CIrCUItS: new, alteratIOn, extension per panel
I Business name: I!-c,f/IA/I J...() if ~U~A~ I I a. Fee for branch circuits with purchase ofa service or feeder fee:
I Address: .J I I Each branch circuit I $ 6,00 I $
I City: I State:. I ZIP: I I b. Fee for branch circuits without purchase of a service or feeder fee:
I Phone: . I Fax: I I First branch circuit (2) I $ 55,00 $
I E.mail: , ,..j 6tbT/CE: 'I I Each additional branch circuit I $ 6.00 $
I CCB license no.:()1/ . ! H!J'i'diiB6il!ln&Mll EXPIRF II: ~H~ W~'nI/Jneous fees: servIce or feeder not Included
I Signing supervisor's license~BL~~_~I~~D UNDER THIS PERMIT L~'Yihffmp or lIT/gabon circle (2) $ 63.00
I Print name of signing supe~~ru;:'~VlCIVut~ U.Ii'~ ~BANDONEt'1 F )ffch- sign or outline lighting (2) $ 63.00
I .. . SC ::lA\ f'ffi,uu I S' I" r' d I
Signature of signing supervisor: . . 19na . cIrcuit or a l~lte -energy panel, $ 63.00 $
, alteratIon, or extenSJOn (2)
I Each additional inspection: (1) I
$ 25.00
$ 32,00
I
$ 63.00
$
$
$58.00
$
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(A) Enter subtotal of above fees .
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 x [AD.
I (C) Technology Fee (5% of[A])
I TOTAL fees and surcharges (A through C):
6.3
$. 75'(,
$ "$IF
$ 73~
$
440,2584,) (9/08ICOM)
$
$
$
Status
Iss u ed
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: COM2009-00S18
ISSUED: 04/17/2009
APPLIED: 04/17/2009
EXPIRES: 10/17/2009
VALUE:.
Springtield TYPE OF WORK: Electrical Work Only
SITE ADDRESS: 260 S 51ST PL
ASSESSOR'S PARCEL NO,: 1702333300400
TYPE OF USE: Repair
Residential
PROJECT DESCRiPTION: Service reconnect
. Phone Number: 541,726,7994
Owner: DA VIS,JAMES ALTON & MARY-ALICE
Address: 260 S 51ST ST '
SPRINGFIELD OR 97478
Contractor Type
Electrical
Contractor
OWNER
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback: ,
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improv~l11ents:.
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
I CONTRAC!OR INFORMATION'
License 'Expiration Date' Phone
'/'1"1 f:BUIIJDING,INFORMAnON'IIOU to
. j, ;:,'w rUles adopted by the Oregon Utility
i;uiiticqtio# of,Stories:hose rules are set forth
R,3 in OAf, 95;HeigbCOf,Stiiuctu!:'!l OAR 952-001,
0090. YOUType 6fJHeat:;opies of the rules by
VB calling t1W:itcf.frypeNote: the telephone
number tR'ar.ge 'Fype:Jn Utility Notiticalion
, C'E]jef~ Path'1p-332'2344),
Sprinkled Building: n/a
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Total:
Handicapped:
Compact:
, !!'JT'f'\:' -, 'C"J'
I.,.:: -' '+ EXPIKt Ir I nL I.v'"'
I PUBLIC <P !;lMEmlS
~i'MIrl1' .\.' h THIS PERMIT IS NOT
AUTHORI u UI~UL Si"" NElJ'ffiR
COMMENCED OR IS ABAI'.fUU
ANY 180 DAY PERIOD, DownspoutslDr"ins:
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I 01'2
, Status
Issued
225 Fifth Street, Springfield, OR
541,726-3753 Phone'
541,726,3676 Fax
541,726-3769 Inspection Line
Fee Descripti~n
+ 12% State Snrch'1rge
+ 5% Technology Fee
Service Reconnect
Total Amonnt Paid
Aulount Paid
$7.56
$3.15
$63,00
$73.71
Total Value of Project
Fees. P~i~ I
Date Paid
4/17/09
4/17/09
4/17/09
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00518
ISSUED: 04/17/2009
APPLIED: 04/17/2009
EXPIRES: 10/17/2009
VALUE:
Receipt Number
2200900000000000403
2200900000000000403
2200900000000000403
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 Re(Juiredlnsne~ti(JJ1s I
Electric Serviee: Approval required prior to utility company euergizing service.
By signature, I state ,~nd 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 Springfield aud 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 oHhe Community Services Division, Building Safety.
I further certify that only contractors aud 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 propel' 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.
ff-rAl'd'J:) ~ ~ P-evWJ
Ob/Der or Contractors Signature
Pa2e 2 01'2
LJ-/'-/;" oq
Date
225 Fifth ,Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009,005 J 8
COM2009-00518
COM2009-00518
Payments:
Type of Payment
CreditCard
cReceintJ
RECEIPT #:
Description
Service Reconnect,
+ 5% Technology Fee
-+ 12% State Surcharge
Paid By ,
JAMES DAVIS
City of Springfield'Official Receipt
Development Services Department
Public Works Department
2200900000000000403
Date: 04/17/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How. Received
djb
150200 In Person
Payment Total:
Page I of I
1 :56:49PM
Amount Due
63,00
3.15
7,56
$73.71
Amount Paid
$73,71
$73.71
4117/2009