HomeMy WebLinkAboutPermit Electrical 2009-6-16
;,Electrical Permit Application
225 Fifth Street. Springfield, OR 97477tPH(541)726-3753t FAX(541)726-3689
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I pe~itnoL?q- F;r;s-
I'Date: ~//?/!J'1
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire ~fwork is not started within 180
days of issuance or if work is suspended for 180 days.
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I Name: U",^,rvA
I Address: '? '" ()
I City:rb7 rt
Phone:
E-mail:
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;PROpERifV,,'OVVNER .,.
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Rnjt-712. D a.
I State: CJ ;z:.
I Fax:
This installation is being made on residential or farm property
owned by me or a 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. . ')C0NTRACl'O,nNSTALC:ATl0N.~:";:'"
I Business name: flth ~ \i:; tL;- (.i.j <-
Address: 27ttY)'VI"',..,.,." A.
City: >fl<-n I State: QY'\.=- I ZIP: q ? ~ 77
I PhoneJ'ZI[ - Sll - ,)('lu . I Fax:
I E-mail: il1dciIS/'i:<"CH',? Q,-v,(-'>vY"
I CCB license no.: /LIG7L" 'I BCD license no.: 20_<11/1 G
I Signing supervisor's license no.: 477). 5
I Print name of signing supervisor: M ,'1rJ-IEi( L f?c,4.rr--
I Signature of signing supervisor: ~ ~rA_=--
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440-2584-) (9/08/COM)
Branch circuits: new, alteration. extension per panel
I a. Fee for branch circuits ,with purchase of a service or feeder fee:
I Each branch circuit I $ 6.00 I $
I b, Fee for branch circuits,~ithout purchase of a service or feeder fee:
I First branch circuit (2)
I Each additional branch'circuit $ 6.00 $
I Miscellaneous fees: service or feede~ '!ot included
I Each pump or irrigation circle (2) $ 63.00
I Each sign or outline lighting (2) $ 63.00
I Signal circuit or a Iimited~energy panel, $ 63.00 $
~]teratJOn, or eX,tension (2) ,. .
I Each additional inspection: (I) $58.00 $ I
I "$;;F"~'J'~"~:~lli:-'if,~~:iij;/:;;;;"s;~'.": "''',' )'':'" ',',-- ."., - '--'t\"~ ""\'l~Z;;J;;,\~;~"'~' . !l~",.',Oe"'\";:': ...-.,,~ :'~'I
0:~,9Jd!~W15~~,}.'i~ly~i1211rr), 'A~e.IlICANI~.vS.r:::5~1iif.*~iS!!~~ifi;'jj,'iilii'~KiWf1tBt,~
$ 55,00
$
$
$
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
.1 (B) Enter 12%surcharge.(.12 x [A])
1 (C) Technology Fee (5% of [A])
I TOTAL fees and surcharges (A through C):
$ r~( -
$ /001{
$ {,?!!- I
$/5/A ifl.
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00865
ISSUED: 06/16/2009
APPLIED: 06/16/2009
EXPIRES: 12/16/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phonti
541-726-3676 Fax
. 541-726-3769 Inspection Line
SITE ADDRESS: 3325 PHEASANT BLVD
ASSESSOR'S PARCEL NO.: 1703221202200
Springfield TYPE OF WORK: Sing.'e Family Residence
. TYPE OF USE: Remodel
Residential
PROJECT DESCRIPTION: Rewire entire hose
Owner: BITTER BRADFORD E
Address: 860 BELAIR DR
EUGENE OR 97404
Owner:
Address:
HANNA TAMSIN
860 BELAIR DR
EUGENE OR 97404
ATTENTION: Ore gO!) law requires youto .
foilow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
. _ .. '. ..... ^ r", ncn rHi1_
IOUf-\I1'::;10!:-VUI-VVIV"',.....~:::l.. -
OO:lllCONrrRW€TOR;TN.FORM="ATiON:li~ebY
(,o."'b'>! 'i'-lh~Oregon Utilitv Notification
. Contractor num err, or t r is 1_800-332-ki~l;p.se Expiration Date
MITCHS ELECTRIC INC-en e 146745 01/1812011
Phone
541-521-5690
Contractor Type
Electrical
. BUILDING INFORMATION'
#. of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
# of Stories:
Height of Structure
Type of Heat:
VB Water Type:
NOTICE: Range Type: .
THIS PERfI,Ene~~thEXPIRE IF THE WORK
AUTHORlftllf~N5'1:~uj'fli~gPERMIT l!l/WOT.
CCli'DEY:Ei0PMENt lNF'dkMATl6NI
Af\il IUU' unf1\....J.....{..
I Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Front yard Setback:
Side I Setback:
Side 2 Sethack:
Re,.ryard Set hack:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING'
Total:
Handicapped:
Compact:
I PUBLIC IMPROV~MENTS I
Street Improvements:
Storm Sewer Available:
Speciallnstruetion:
Sidewalk Type:
Downspouts/Dra.ins:
Notes:
Page I of 2
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Status
Issued
, CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00865
ISSUED: 06/16/2009
APPLIED: 06/16/2009
EXPIRES: 12/16/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
,
Date Calculated
Total Value of Project
Fees P~irl I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Residence Wiring 1000 Sq Ft
Amount Paid
Date Paid
Receipt Number
$16.08
$6.70
$134.00
6/16/09
6/16/09
6/16/09
1200900000000000692
1200900000000000692
1200900000000000692
Total Amount Paid
$156.78
I Plan ReYie~s ,
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 RerJuirerllnsnections,
, lllflil,1
Rongh Electric: Prior to Cover
Ele~tric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all
information hereon is true and correct, and I fUI.ther 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.
I further certify that only contractors and employees who are in compliance with ORS 791.005 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 readahle from the
street, that the permit card is located at the front of the property, aud the approved set 6fp1ans will remain on the site at all
times during construction.
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Owner o/Contractors Signature
IX'. ( t .-[) .~
Date
Pa2e 2 on
225.Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
o
Job/Journal Number
COM2009-00865 .
COM2009-00865
COM2009-00865
Payments:
Type of Payment
CreditCard.
cReceil'ltl
CitY of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #: . 1200900000000000692
Date: 06/16/2009
Description
Residence Wiring 1000 Sq Ft
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
MlTCHES ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
CJC
053106 In Person
Payment Total:
Page 1 of 1
8:35:42AM
Amount Due
134.00
6.70
16.08
$156.78
Amount Paid
$156.78
$156.78
6/16/2009