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Home My WebLink AboutPermit Electrical 2009-7-7 0'~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726.3689 ELECTRICAL I;PAMIT !l?ftLICATION City Job Number ~\...\- C\ \...\' t::> Date I'. ~~qeA:lif6N((;jE'iNSTjiTiiT:!)tTjON,Jl!IiJi1~1fil ff€(;jMHiJEf:E"1JJEE1ScifEi5,{:fiilliiiJi:IJ6w~Cl~P \ \.;tL1;--'~:e:\i\\l)~,~,-_",'l!~ 3. ~'"-",,,,~h,_w,_, ,..~~,,,&~.'''''~.,' ,,,,.,,,,,_"h~ LEGAL DESCRIPTION A. 1[&~~~!;r:fj~IL~M~1~~rrYke~:~~!J19~~t!II \In?{L\~~ o1.\cx:::> Service Included JOB DESCRIPTION ~Mri. \ 0A)\i'H~.lb Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. , 1000 sq_ ft. or less Each additional 500 sq. ft. or portion thereof Each Manufacl'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 '~"'iW'Mi"*(~~1li_"""'''''i'':I;<\"",,,e;.1~;~1f'~''ilfi'l!l;lW<;;;''''~,' iit~~~Jl!Th;'~"~;'f.~_;~io';Wlt:1~2f;,;:'i.io:~~;..iP}~1~~5lili\f~";>~~_i~l~ 2. .fflil2N!lJjNlf!Ill!:!t!,~riPiJf:1'!JQN!ONL~Yd B. ~~e~~~S~J2!i~~r,~1~ln~~!1~ttO~~~U~r.~~~g,~~!2,s~W:&Jg Electrical Contractor ~r!d E/M:Ir,~(L 200 Amps or less $63_00 201 Amps to 400 Amps $ 75.00 Address .?c;/:,5'7 S#61rpWf2tAJ 1J.t:. 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 City DO t/',&>A-J '1 Phone ,.I)'~I -9'Yz.-13SzSJver 1000 AmpsIVolts $375.00 Reconnect Only $ 50.00 Supervisor License Number 117 "'l h <;' Expiration Date q 0,'7 Constr. Contr. Number / (5" ~ 009' Expiration Date / L:? /'/:J ,... / Signature of Supervising Electrician sK5~/ -# ..k~ , " , Owners Name \1$1 N\ L ~'(() nde.l Address \ \0 L~ \JI. 0 (\ \ D City~~ lil~~e OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~ ~m , ,~~ ~~'\ .\\ f\: ~t.R.~ Vcr- . -S Inspection Request: 726.3769 'JJt<( ~ ~' \$'\" c. "1f~~po~~~S~~~^~~'lQ"i'r~1a~~~_..,~ Installation, Alteration or Relocation 200' Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps , $100.00 Over 600 Amps or 1000 Volts see "B" above. D. New Alteration or Extension Per Panel One Circuit t Each Additional Circuit or with, Service or Feeder Permit fSKnCf).()J $ 3.00 1l"""""""'~;f'J;.ti,";j>;t"')0:*'i);;"0W;jiiiJ\l;AMijjp*,*,hJtiWlki0lr$'Wf_,",~l",;,..;;;':Jt'k\~'_~.;.1'w"',"~'."" EM'~""'I'I""~''''''4(S''-''''''''''d'=''~'' "''''['''''*d j'''EP"h I'~-I'-l'" .~' . '" Isee aneousi" er.vlce,lee er,:Dofmc Que :,....:ac" nsta atlon ""...."..,_...,'~~,~"''''''. """"'["_""'"_,~"W=~,,*,,,,'0ill"';-': "\~~'~km,_"''"'~''''''''''~"'''' Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergyIResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is S451l0 + S rcharges stk"9fo,"'~Xh1Op&JOVEi'.~l~f". ," 5?J ,cO 4. , ""f"'i.K",vh'lf~,~'~~'l..,.,,=,... ,. '1 ~I~"!l' ?'h'm ...7,.,..<n~"WMt".."".,.,c",nil:~_t \P .C\tp i) .C\n to\. !b.o , State Surcharge I~L:__:"~.".:.,......... ~Ole.t.lr\. TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application I.03.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00993 ISSUED: 07/07/2009 APPLIED: 07/07/2009 EXPIRES: 01/07/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1623 Menlo Lp ASSESSOR'S PARCEL NO.:' 1703273302100 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Residential PROJECT DESCRIPTION: Extend One Circuit For Spa Owner: Address: BRONDEL DIANNE K 1623 MENLO LOOP SPRINGFIELD OR 97477.._,,,,,._ _ ,~,.u1= WORK ,~u...II!.:" "\:I/I\\.-t"t'In~~'.. lsNO\ 1\-115 pq~1ta';\€iliOR\fJ\lJi'0RM\.l]lQN I . AU1\-1O\",_~L - ABA~LJr~LJ!- ContractorcOMMENCED ORD\~D License KIDD ELEC!/WlIro:DA'i PEn' 154009 I ~UlLDING INFORMATION I Expiration Date 01/27/2011 Phone 541-942-1352 Contractor Type Electrical # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R3 # of Stories: Height of Strncture Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: VB n/a Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Sethacks: I DEVELOPMENT INFORMA nON I . "au to , 'eqUlleS, 'I"" 'c9.~!lrla~~ISI: e on Uti 1\, f>..iiENiION~J6~![e:el)T~o!S,i~~e set 1011\1_ 'alloW rules Rayeil iDrivelRo<l:'D 95'2-001 I ' n eet,l- ' IQn'v,-,n ' b" NolilicatlO 01ol.q)o~tLo'i\'elive~'ij\'1!.le lules , in Of>..F\ 95'2-0 obtain caple e telep\1one ~^n" 'Iou may .__ INote: 1\1 .._,il'r~tiOl\ - . -^ .....$j ......,.- - . '''''J'' . -- call\J'puji41~ iMP,Rowt(Vl.~m~1 nUl", ' centel 10 . - REQUIRED PARKlNG Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00993 ISSUED: 07/07/2009 APPLIED: 07/07/2009 EXPIRES: 01107/2010 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 Amount Paid Date Paid Receipt Number Total Amount Paid $0.00 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. will be made the following work day. I Relluired Insnections I Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, 1 state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 further certify that any and all work performed shall he 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, Buildiug 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. '\ ~~ ~ ~~J 1- 7- ocr Owner or Contractors Signature Date Page 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number' COM2009-00993 COM2009-00993 COM2009-00993 COM2009-00993 Payments: Type of Payment CreditCard cReceintl RECEIPT #: ~~~ City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000000764 Date: 07/07/2009 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 12% State Surcharge Paid By BLAID A KIDD Item Total: Check Number Authorization . Received By Batch Number Number How Received 21707 A In Person Payment Total: Page I of 1 10:38:51AM Amount Due 55.00 3.00 2.90 6.96 $67.86 Amount Paid $67.86 $67.86 7/7/2009