HomeMy WebLinkAboutPermit Electrical 2009-6-8
Electrical Permit Application
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225 Fifth Street+Springfield, OR 97477.PH(541)726-3753.FAX(541)726~3689
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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.
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I CityS"t: td I State:OQ.. I ZIP:97'-h71
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1 L.<... '? G,.-.cLL TO 20D I}. SelrV IC~ I
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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 $
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Phone.
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r;..~fiih~ 0
'01" . \\;.~ ~
440-2584-) (9!08/COM)
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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
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I
1
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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