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Home My WebLink AboutPermit Electrical 2009-6-8 Electrical Permit Application D 225 Fifth Street+Springfield, OR 97477.PH(541)726-3753.FAX(541)726~3689 1~~,;.;~')~~Ee,~T~ENfo~E, oNt~".~ ;1 '/1 Permit noCO/Yl2fi} 9 ~ 1:!01 Date .~,,- 8" / 8f This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuanee or if work is suspended for 180 days. I ;''f'' "~c. 'f\'100CAL::,G0VERNM E N'E\f~P'.PROYA~~f~'f~1'~iN1~'~\'r,1 II.l~;;J,n,~:~,p'~~;CovAaTI. 'EveG'iOfieRdy. ?.ir.iO":0c"oDNYS~sRU.C"'IO..DN~~~..''''':((;'.1'.i,t,l. ~";;.,'~.-. ..l':>Ji.""~T~."_;~". __.. _' _ ,- ,ifl.'- ..11:",." ... ..._ 11;, ',,, ;1,,, _ _ ;:':~'~'_"''''''''''fl,,,,. "';~.."J f~~~~~~:~:s'~~E~N:~~~m7~k1~c~t[~~~~~~~!ill. I CityS"t: td I State:OQ.. I ZIP:97'-h71 I Re~":~:~~:".'~~~~~I~~ON2~F?;wJ;~'~:~~~~~'!f1 1 L.<... '? G,.-.cLL TO 20D I}. SelrV IC~ I I I I . ;;PRbp,ERTY"OWNER;~." ',." ..., . I I Name: Go-"'1 t':{..,... b~ I I Address. 3 g 5.6 ~ .> r I I City: .J'j<} P / Q I State.O IC-. I ZIP:<77'! 71 I -74,-2cT{, I Fax 1 E-mail. I Th.. II' . b . d .d. I Ii 200 amps or less (2) $ 63.00 $ IS lTIsta atJOn IS emg ma e on reS! entIa or arm property owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $ I property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). 1 401 to 600 amps (2) $126.00 $ I Signature: I Over60q amps or 1,000 volts, see services or feeders section above I . :';..T'-,[:;cbNTRAC110R;~INSTAL':l::ATION' , . ... ,:1 Branch circuits: new, a/laOllon, exlenslonperpane/ I I Business name: G' .A \ \ ~ ~ '\ G ~V'Z\vd..e.Latr ,a. Fee for branch circuits with purchase of a service or feeder fee: I I Address: 2q 54 /fa..l.{ cJ.--, &... tzd I I Each branch circuit I ~ $ 6.00 I $ /2- I City. ,Ji;J G f cL I State:O!<Z... I ZIP1 7ct 11 I I b. Fedor branch circuits without pur,chase of a service orfeeder fee: I Phone. . - C/'I/ ~z.5q /, I Fax: I First branch.circuit (2) $ 55.00 $ I E-mail: I Each additional branch circuit $ 6.00 $ I CCB license no...9'? I '4 5 I BCD license no.:.2b -Z.li '-/.c- I 1 Miscellaneous fees: service or feeder notincluded Signing supervisor's license no.. 36 S"-l S I 1 Each pump or irrigation circle (2) $ 63.00 Print name of signing supervisor: C "'-"'i. A \ II e- I I Each sign or outline lighting (2) $ 63.00 Signature of signing supervisor./t J ~ I I ~it~~:~i~~,c~;te';:;:nJ;~~t(~jenergy pariel, $ 63.00 $ ~ \\^ ~.()C\ 'lj ~ci<~ ~ Phone. ~ r;..~fiih~ 0 '01" . \\;.~ ~ 440-2584-) (9!08/COM) 1~~~~,h1~::\m~q:'i!~frtt~~ir;~:;t'I;EE-~.SC.Ht=JjJ.n]EI~~~~~{\~~f~~1 I",., .': .~.,,,. :.';,,,:..,(::'.:'~".,...'<;n..:':. .""\"'1..'''.''1.' cost"tl. . To'lal .1 -,Number'of.Jns ectlons\ er.:ltem, :;. ",.-i;::,,' t ~ ",':""1"',,;.1.: ',~:;'" '''' .;.... '::;::!,;j'i-'-':~:"."";;:-:;",,},~.B')f,;~:.(;n,"'!.P:::;,'.'t!(~''''i{l,,~2~[''..'\. :8..1., .i)j;\,<~~~~~'" + I~, "CJ)st_; ,I:" I Residential, per unit, service included: I 11,000 sq. ft. or less (4) $134.00 $ I I Each additional 500 sq. n. or portion' $ 25.00 $ I thereof '. I Limited energy (2) $ 32.00 $ I I Each manufactured home or modular, $ 63.00 $ I dwelling service or feeder (2) I Services l?r feeders: installation, aLteration, relocation I 1 200 amps or less(2) j- $ 81.00 $ 61 I I 201 to 400 a;"ps (2) $ 95.00 $ 1 I 40 I to 600 amps (2) $158.00 $ I I 601.to 1,000 amps (2) $205.00 $ I lOver 1,000 amps or volts (2) $469.00 $ I I Reconnect only (2) $ 63.00 $ I Temporary services or feeders: installation, alteration, reLocation 1 I I 1 I I I Each additional inspection: (I), $58.00 $ 1 1~~~1~~~1~B~1';~~1E~~!AR..~i1T~:~Nt~~J}J$1:1iK'f:~;G~$~4li:0\7![~f~~:~~1 I (A) Enter sUbtotal. of above fees $ tl). OU (Minimum Permit Fee $58.00) 7<,..) .1 (B) Enter 12% surcharge (.12 x [AD" I (C) Technology Fee (6% of [AD I TOTAL fees and surcharges (A through C): $ $ $l2."p_ $ <,I,~,' $ /1.1';" , / () 6'~ 8'1 Status Iss u ed CITY OF SPRINGFIELD Building/Ct>mbination Permit PERMIT NO: (iJOM2009-00807 ISSUED: 06/08/2009 APPLIED: 06/08/2009 EXPIRES: i2/08/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3856 E ST ASSESSOR'S PARCEL NO.: 1702311301000 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential 'PROJECT DESCRIPTION: New service and two circuits Owner: HAMBRICK GILBERT G & SUE Address: . 3856 NEST SPRINGFIELD OR 97477 Phone Number: 541-741-2596 I CONTRACTOR INFORMATION I Contractor. Type Electrical Contractor G MILLER ENTERPRISES INC License 87145 , Expiration Date 11/1012010 Phone 541-741-2596 I BUlLDI~G INFORMATION. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type , . Secondary Construction Type: # of Bedrooms: # 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 GaragelCarport Sq Ft Otber: Occupant Load: nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: . Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: . Compact: I PUBLIC IMPROV~MENTS , Street Improvements: Sidewalk Type: Storm SeWe"~vailable: special'limY.'~~l\~l!lIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT Notes: COMMENCED OR IS ABANDONED FOR -,., ~"''''''''''''''r\ ,-\l\ll IOU Ut\l 11...111.......... Description Type of Construction DownspoutslDrains: ATTENTION: Oregon law requires you to foHow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001- nnof"l v""" ~_,. _,-, . . --, --'~'" ".....t-"'-'v VI Ult::' rUIt:::i oy I calling rne c't1ter (Note' th t I h Valuation Hescdution.,' '.. e e ep one , , ,,," .. '. Oregon Utility Notification Center IS 1-800-332-2344) $ Per Sq Ft Square Footage. . . It' I' B'd A Value or mu Ip lef or I mount Date Calculated Paee 1 of 2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Valne of Project Fe~~ P~id . Fee Description + 12% State Sureharge + 5% Technology Fee Add, Alter, Extend Circ Ea Add Perm ServlFdr 200 amps or less Amount Paid Date Paid $11.16 $4.65 $12.00 $81.00 6/8/09 6/8/09 6/8/09 6/8/09 Total Amount Paid $108.81 I Plan Reviews , CITY OF SrKl1~L.FIELD Building/Combination Permit PERMIT NO: dOM2009-00807 ISSUED: 06/08/2009 APPLIED: 06/08/2009 EXPIRES: 12/08/2009 VALUE: Receipt Number 320q900000000000430 3200900000000000430 3200900000000000430 3200900000000000430 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 Rell~lir~d I~sp~ctions I Rough Electric: Prinr to Cover .Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical wor~ is complete. By signature, I state and agree, that 1 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 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 Community Services Division, Building Safety. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 wil! 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 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 Page 2 of 2 Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone t}.i::jj . . ....... .A!i ~,. .,....,"~.......... - ....... - . City of Spri'ngfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-00807 COM2009-00807 COM2009-00807 COM2009-00807 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Date: 06/08/2009 3200900000000000430 Description Penn Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add . + 5% Technology Fee + 12% State Surcharge Paid By GARY MILLER. Item Total: Check Number Authorization Received By Batch Number Number HowJReceived njm 042765 In P.erson Payment Total: Page I of I 2:11 :47PM Amount Due 81.00 12.00 4.65 11.16 $108.81 Amount Paid $108.81. $10H.81 6/8/2009