HomeMy WebLinkAboutPermit Electrical 2009-6-18
Electrical Permit Application
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
1'1&~;~)'<-_'i<-c':"';:;;;r?'~"~\:V"J""'''''-'"''~...''_"''';~~. ,~~.~,,~..,<,~
l.;\;:;",DEPAR"[MENJ.~USE;,ONlhY, ,"'
i;.;:,;:i'f-',-,'.';':..::-;;?:O_-;.';.'\';;~,;u"~;:'"f'.Y1::::;ct~i'U'.n~~~tL'W.~.., . """
I ,,/ltJ -- Vc,-1 ' I
Pennit n~.: ~ 1"- oe) .
I Date: ,: 0 ~ /f - () 71
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.
1_R:l!!!9=G:~~\f~-:-O_\Z.EBf\lMI':~Tj'#fNR9,"'~~'!llii
1 Zoning approval verified? 0 Yes 0 No I
I~G:.\mEl3=QRYli9F,1Q:{i)N~mBI!.!QJ.ifIQr~I.~~1 r;.,,,,_ ~,~.~
t.-I I Residential, per unit, service inclu~e'd:
Ii.<J Residential I D Government I D Commercial
.1l!'!l0I3[SJjjfEJlfiii~QBIYi~ijJQN_I'}j;N~IJr9:0'p';jJIQI'ii~~,,.~! 11,000 sq. ft. or less (4)
1 / I Each additional 500 sq. ft. or portion
Job site address: /3 '/ /J,t.. )/MA /:> / r thereof
1 City: S/C;-r.....7:> j State: ore. 1 ZIP: 77f"77 1 Limited energy (2) I I $ 32.00 $
MU';";O;"': lrlUb9..~3G. I Lotno.:lD1CP I Eachmanufa~turedhomeormodular I I
"'~~~DESeRIPnlT~E?Ni[<:!EIW~R~~~.~W~ dwelling service or feeder (2) $ 63.00 $
1=,~.:;~~li:~:::2:~;-"~~"'='k'::::. .:
1 Name: M",A/<. /'5/,7_ /C/H /' 1 I 401 to 600 amps (2) $158.00 $
1 Address: /3'7/ o/... Y-:.... ,,0/ c.... 1 I 601 to 1,000 amps (2) $205.00 $
1 City: S/ C; F ~!/ I State: 1 ZIP: 'I lOver 1,000 amps or volts (2) $469.00 $
1 Phone:sy/ -f?7/.-oJz91 Fax: 1 I Reconnect only (2) $ 63.00 I $
I E-mail: I I Temporary services or feeders: in~tallation, alteration, relocation
This installation is being made on residential or farm property I 200 amps or less (2) ,: $ 63.00 $
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR 1
479.540(1) and 479.560(1). 401 to 600 amps (2) I $126.00 $
Signature: lOver 600 amps or 1,000 volts) see :S~rvices or feeders section above
1~0:(i)f\J11l~!:;:110.a"~I!Ilsm~I!IE~'jfleN~i,~,*1N(1 Branch circuits: new, alteration. extension per panel
I Business name~l"f'~ /4-t /?.L.6~ GL5i:;:7;4? /r I a. Fee for branch circuits with purch~e of a service or feeder fee:
1 Address: S"5 s.;?,f' /~ ~ ;.Lit) ~"?Z; 4/ 1 I Each hranch circuit I I $ 6.00 I $
1 City: r..x65().JaLL.. I State: c:>A'1 ZIP: ::r?'/.?~'I 1 h. Feeforbranch circuits without purchase ofa service or feeder fee:
I Phone:..0Y' - ,f=?;~'-:"?'c6' 6 I~ - I I First branch circuit (2) $ 55.00 $
I E-mail: Ct3:i-L 157 - S"55'Y I I Each additional branch circuit $ 6.00 $
I CCB license no.: 62.3 77 I BCD license no.: I I Miscellaneous fees: service or fted~: not included
1 Signing supervisor's license no.: ?z.2.J? 5" . 1 I Each pump or irrigation circle (2) , $ 63.00
1 Print name of signing supervisor:c:N4 r~??/#";-.4' IX' m/uVEach sign or outline lighting (2) $. 63.00
I Signature of signing supervisorv-Y d 4, .// I ", Signal circuit or a limited-energy Pariel, . $ 63.00 $
r ~4'..&:: //~/ __ alteratIon, or extensIOn (2) I
./
~~
f\ ~~ , ~\S)
~ \~.-(j
~oO\
~ cQ.~
~~
440-2584-1 (9108ICOM)
$134.00
$ 25.00
$
$
$
$
Each additional inspection: (1) $58.00 ' $
1~~Ji;EFil!il!i~Nif.m\Ti~~
(A) Enter subtotal of ahove fees' I ~7' cJiJ
(Minimum Permit Fee $58.00) $ 0 /. I_
I (B) Enter 12% surcharge (.12x [A]):' $ ~"Oll-
I (C) Technology Fee (5% of[A]) i' $ '1;, 17 2..-
I TOTAL fees and surcharges (A ihrough C): $ n t7
CITY OF ~rKIJ~GFIELD
- "
Status
Issued
Building/C~mbination Permit
PERMIT NO: COM2009-00889
ISSUED: 06/18/2009
APPLIED: 06/18/2009
EXPIRES: 12/18/2009
VALUE:
225 Fifth Street, Springlield, OR
541,726-3753 Phone
541-726-3676 Fax
541,726-3769 Inspection Line
SITE ADDRESS: 1391 OLYMPIC ST
ASSESSOR'S PARCEL NO.: 1703253210700
,
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New,
Residential
PROJECT DESCRIPTION: Service Change
Owner:. B'RIGHT MARl{ A-
Address: 1391 OJ.:YMPIC ST
.SPRINGFIELD OR 97477
. f
I CONTRACTOR INFOR~~TION I
,
"
Contractor Type
Electrical
Contractor
CHRIS MILLERS ELECTRIC INC
License
62377
ExpiraHon Date
12121'120 I 0
Phone
541-895-3660
BUILDING INFORMA,,,:ION I
# 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:
LotSii,,:
Sq Ft,lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
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 IMPROVEMENTS I
Street Improvements: Sidewalk Type:
Storm Sewer Available: /TTENTb6~n'S\)oUtsIDrains:qUires you j~
Specialjlnsti'uction: oll.ow rules adopted by the Oregon Utilil)'
. :: 'PERMIT SHALL rr:XPIRE IF THrr: WORK ~otlfrcatlon Center. Those rules are set forth
Notes: I:HORIZm UNDER THIS PERMIT IS NOT In OAR 952-001-0010 thro~gh OAR 952-001-
, ._"M~ nn 1(' ^" ^~JnmIFO FOR OO:_~;,.Yo~ may obtain cor;-ies of the rules by
...\jJ\lli\lIL-I'lVL....... .........- . ----....::J ...... "".....,,,...... \,..uu:;;" lllt:: ltm;/JriOne
ANY i 80 DAY Prr:RIOD.' I ValuaHoli DescriotioJl1nber for the. Oregon l.!filify Notification
, , . Center IS 1-800-3:32-2344).
"
$ Per Sq Ft Square Footage
or multiplier. or Bid Amount
Description
.Type of Construction
Value'
Date Calculated
'I
Pa2e I of 2
Status
Issued
en" OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00889
ISSUED: 06/18/2009
APPLIED: 06/18/2009
EXPIRES: 12/18/2009
VALUE:
225 Fifth Street, Springtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769Inspection Line
Total Value of Project
Fees P~id I
Fee Description
+ 12% State Surcharge
" + 5% Technology Fee
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$9.72
$4.05
$81.00
6118/09
6118/09
6118109
1200900000000000709
1200900000000000709
1209900000000000709
Total Amount Paid
$94.77
I Plan Reviews I
,
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. wj]];be made the following
work day.
I Rellllired Insnections I
Electric Service: Approval required prior to utility company energizing service.
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 witb
the Ordinances ofthe 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 701.005 will be used on this project.
I further agree to ensure t~at all required inspections are requested at the proper time, that each ~~dress is readable from the;
street, that the permit card is located at the f,:ont of the property, and the approved set of plans wi,!l remain on the site at all
times during construction. .
//?~~L y~
/
Owner or Contractors Signature
If ~70A'
Date
2.<:><"0 9
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journai Number
COM2009-00889
COM2009-00889
COM2009-00889
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
1200900000000000709
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
CHRISTOPHER MILLER
Received By
nJm
Check Number
Blitch Number
Page I of I
City of Spri.Dgfield Official Receipt
. Developme!1t Services Department"
Public Works Department"
Date: 06/1812009
,
2:27:06PM
Item Total:
Authorization
Number
Amount Due
81.00
4.05'
9.72.
$94.77'
How:Received
Amount Paid
05407c [n ~erson
Payment Total:
$94.77
$94.77
I
6!1812009