HomeMy WebLinkAboutPermit Electrical 2009-6-26
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225 Fifth Strect+Springfield, OR 97477. PH(541)726.3753+ FAX(541)726-3689
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\ Electrical Permit Application
D I'
I permitn~: ('q- Gt4S
I Date: Co ICl~ 10 q
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 daJs. '
1#7":!!7!!14i!::''''OC'A'::'GO V ERNMEN":!A'''''ROVA'',''','1&!ldc>c",
>{;:2.,.,,;ft:1':'i~7':;S.L;;. '.".' 1,;;'__' .. __... ".. .............,," lib, ., r;r,:,,, "'" __ L,;;.T\.)ii~,,:o:~~,.N!tj1U
I Zoning approval verified? DYes D No
IG!);!W!ii;!:l!:'ii',~CA1iEGORY!GbF,)[CONS1iRU,CTlbN;G::G::;Gr;;:jj!;iQi~ I
Residential, per unit, sen.-ice inclu'ded:
1:~~:~;!~~~~~I1iEI:IN~~R~~~~;~~~ND!h~c~o;I';~~~;~r~!III,000 sq, ft, or less (4) $134.00 $
I " "W I I Each additionalSOO sq. ft. or portion
Job site address: I \ Z a I..-1A srn YYl ' Cv-t ' thereof .$ 25,00 $
I City:S9r\VlD.fieJ.ol I State: (JR I zlpiqf-41-~ I Limited energy (2) $ 32.00 $
1",~:~~~~.~,c~,~;,~2 ^~. .1~Ta~!~~.:" ,,~._,,_,,_,,^,I I ~~~71~:nS~~~~~r~~Fe~~:r(~rodul~ $ 63.00 $
:~~:Jz~~i~S:\;~~N~~~'~~~;~'t~-;~.~5'l I Services or feeders: installation, a/leratian, relocation
I ri~Df WCM4.U I !200ampsorless(2) \- , $ 81.00 $:
11t2Ql~1-lr~jl~~TGm;Th);jf;L2J;JN;15~,RROPERl1Y\fOWNER;1%4t70iG0R~~2Sf:~ili,:;.,,\;??{j~~il I 201 to-400 amps (2) $ 95.00 $
:::::s~+;~-~<;rY;~f,', 1~---'-~--~--~ II ~1~;~,~~:~:~~i~~~n ~:~h,','!~~iC ~~~:~~: :
.,;:..:::........" ....,....,.,........ I Lv....c; lun:,:) alt :;:'1':;'1 IV..Jdll
I City: I State: I ZIP: I <i!Y'l':JJ\f!\ll!laweIJPf1V_?I!'i{f)th,..,,,nh .60 )~",6~~",- $
I Phone: I Fax: I I !!lOOlhecYOnllli!(,ly obtain copies ,lit ihE r~ie:to.9v $ tiC I
I E-mail I I Te_Jipb~!.'~ lJWictlifi\~fueJ.!'r4.?\ilst~li,ftibn,I\llle'r8~bn, relocation
I 2d~'1UTIp'ft~ t~s dlG. v. ctju" U!"UYI,I'Ulj"\.'dllUrJ I
This installation is being made on residential or farm property r:cntcr.Y.~ LQ()rL'J'Jf) f) AA\ :ti 63.00 $
owned by me or a member of my immediate family. This I 201 to 400 ~ps (2) -"- -r ."/ $ 87.00 $
property "is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479,560(1). I 401 to 600 amps (2l I I $126,00 1$
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
1:~~~~:;~~~N~:~;:r;'1:~::N )g!f"T1r"'~~~:~~1: :r;::~o:i~:~:: :::~~~:~~::r:::s:":,~~::e~r feeder fee:
I Address: ~.1 +)W'1S-g I Each branch circuit I $ 6,00 I $
[,City: ~i!i:~i:;~" I State(Jte _ I zIP:L)-=t4D51 I h, Fcefor branch circuits without purchase of a service or feeder fee:
I Phone '?'.W~f;:tjf~/'lJax:S41141 ,~4 L/ ~ I I Fi"t bmnch ci,cuit (2) I I $ 55.00 I $
I E-maiI:C~!fIp!f!!tifffi~~ I I Each additional branch circuit , I $' 6.00 $
I CCB l!:~'n~e1rr@{)'dfJf;~ 18~r[E,fI;1il~~lJlf!iff!.~~ I ~iscellaneousfees: ~ervke or feeder not included
I Signing supervisor's liceri;;&I@[) 3!I~liEfl t:' ,) NOT I Each pump or lITIgatIOn CIrcle (2) $ 63,00 $
I Print name of signing supervisor:T: m ~Il I I Each sign or outline lighting (2) $ 63.00 $
I. f . . '. -f' ~ I I Signal circuit or a limited-energy panel.
Signature 0 slgnmg supervIsor. '-.Jl.M.- __ _ alteration, or extension (2) . $ 63.00 $
I Each additional inspection: (1) $58.00 $
I (A) Enter subtotal of above fees
(Minimum Permit Fee S58.00)
I (Bl Enter 12% surcharge (.12 x fA])
I (C)Technology Fee (5%0f[A])
I TOTAL fees and surcharges (A through C):
$~
$ ;il. 5:\.P1
$\3.1~1
$"43:1 "
440-2584,1 (9/08/COM)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: GOM2009-00945'
ISSUED: 06/26/2009
APPLIED: 06/26/2009
EXPIRES: 12/26/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1180 CUSTOM WAY Signal
ASSESSOR'S PARCEL NO.: ROW-MISC
SPRINGFIETYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION:
TYPE OF USE: New'
Relocate irrigation contro/cfefTo'ii^Rig..'iMf Way' ,
^/~!I?W rU/~" ~^,~regan law ,__ _
in C;A'R"I/an Cent;;;'~U oy the 0;;; os You fa
0090. y~52'001_0oiJ~ase rUles a~eon Utility
n~~!/!ng t~:~~M~~tain c~~~oh_~~R 9~~:~o;Jh
. ---. lor thp r\~: I'VOle: Ihp -"G IUJes b'
I CONTRACT8RlINEORM'A;'fI0Nt'I~~/ephone y
, - ~,:ud-234 tlflCatlon
License 4)Expiration Date
84679 07/14/2010
Puhlic
Owner:
Address:
Contractor Type
Electrical
Contractor
LANTZ ELECTRIC
Phone
541-726-0659
4'0};
# of Units: l',y/S IC~. # of Stories:
Primary OccupancvG'.r}'}\P%:~ . Height of Structure
Secondary occupai;;'c}dtr611~: Itt;l' Type of Heat:
, Primary constr.lUJUl'T-XBt5; <>~O S,y1, Water Type:
Secondary construct!oll.J~~b U,z,O '1./ ~-t Range Type:
# of Bedrooms: '4y O0'I.:t0' J; ;D/,o)>~ Energy Path:
p~~/ :s 1,,, tSls ^ /,('Sorillkled Building:
In" <J,,() II. ,......t:"~ 11..,...
.... tI,"_ .,,,... . J-
. I i))EN.EltOeMflNT INFORMATION I
' - -)'0 /?O ' -
0' l' '
Overlay Dist: . .
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
BUILDING IN~ORMA T10N I
Lot Size:
,Sq Ft 1st Floor:
Sq Ft ind Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Qther:
Occupant Load:
II/a
Frontyard Setback:
Side I Sethack:
Side 2 Setback:
,Rearyard Setback:
Solar Sethacks:
_ REQUIRED PARKING
Total:
Handicapped:
, Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer A "ailahle:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Descriotion I
Description
~ Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
,-
Value:
Date Calculated
Page 1 of 2
_~~!!,I.!:'~Jil!~1 ..
....j:
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,4
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
. !i
PERMIT NO: COM2009-00945
ISSUED: 06/26/2009 '
APPLIED: 06/26/2009
EXPIRES: 1'2/26/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone'
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amount Paid
Date Paid
Receipt Number
, $7.56
$3.15
$63.00
, 6/26/09
6/26/09
6/26/09
2200900000000000723
2200900000000000723
2200900000000000723
Total Amount Paid
$73.71
I Plan Reviews .1
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. wiII'be made the following
work day.
I, Reljl\lireg I~~fu~~tio~s I
Electric Service: Approval required pri~r to utility company energizing service.
By signature, I state aud 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 Springtield and the Laws of the State of Oregon pertaining to the work described herein; and
that NO OCCUPANCY will he'made of any structure without permission ofthe 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 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. :' 1
Owner or Contractors Signature
Date
Paee 2 01'2
22S"Fifth Street
Springfield, Oregon 97477
54I~m6-3759 Phone
Job/Journal Number
COM2009-00945
COM2009-00945
COM2009-00945
Payments:
Type of Payment
CreditCard
cReceintl
. RECEIPT #:
Description
Service Reconnect
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
TIFFANY LANTZ-HALBROOK
City of Springfield Official Receipt
Development Services Department
Public Works Department
..,
2200900000000000723
Date: 06/26/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
KR
00542C In Person
Payment Total:
Pa.ge 1 of 1
3:04:56PM
Amount Due
63.00
3.15
7.56
$73.71
Amount Paid
$73.71
$73.71
6/26/2009