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Home My WebLink AboutPermit Electrical 2009-8-19 225 Fifth.Street+Springfield, OR 97477. PH(541}726~3753. FAX(541}726-3689 1~;,:~:~~B&~T,flliENfu~E, ON[~,:. '.'1 [permit no: (]q -1:2-1 D I I Date: 611<7/ iJ? I , t This permitis issued uuder OAR 918-309-0000. Permits are uontransferable, Permits expire if work i; not started within 180 days of issuance or if work is suspended for 180 days, SPRINGFIELD ~ Eleetrical Permit Application I ~~\:t::OCALi::GOVERf\JMENT\f'AR~R.OYAU:~ti!;:tW~:j\i)'i.~;:1 1:$~:'jft":lffl\~jj,i':t,"-ii\;j!i~:i!!\FEE~SCHE[)l:lI!lE!;~~~t1~~;~~~~~~1 I Zoning approval verified? 0 Yes 0 No 1.,~u~~ej;~f~in~~~~!t~~~,IR~[ilf~:~;(.)~;;kl~t~,I,;F6s~:~;:ly:rootat'I:1 I'" - '''''',>;' l" "CATEGO Yr 'Of, "'CONSl: .. erION""" .,' '..,,, " "1' ",..'~'!;...,,,.....,,f.;,~~,,. _t..~;" ',;.";.,1'.;",r,,,..,.,.,{ ..~.\;C "'-'..,;..'.'.. ".',-",. AI..,,_~.T''''," '. c....~ ".1'0' >'i!1i~):r,:i;:.:,,!';i,. ;,' R.;1;{' ,.0' m '" ,'RIJ', .~;i;.",,;,:,i!),,':""," I Residential, per unit, service included: I 11)11 Residential I 0 Government I 0 Commercial ' I~J0I3:ltSJJ<E;1INI;QR.NiA"'fQNt'AN(j!l~()C'Mjl0N~'*Y,1i'~! /1,0.0.0. sq ft, or less (4) $134,00 $ I i,~~~:~I~~~::~~;~~ I r;~;~~;.;:;;,~;::::~ : ::: : I r II ~ t ~ 0 C}~ 'r\ t'!rf\~ I, Services or feeders: installation, alteration, relocation V 1 20.0. amps or less (2) $ 81,00 $ I I,' : ,PROF>,ERW"OvvNER," , ' I 20.1 to 400. amps (2) $ 95,00 $ I I Name: V) n..1\/ ,\"\l'l\o\h -t~ 401 to 60.0. amps (2) $158,00 $ I Address: ~l.. fl'4h 'St 60.1 to 1,0.0.0. amps (2) $205,00 $ I '~..t\ I nO I n""''"11 I Over 1,000. amps or volts (2) $469,00 $ C, ' ' rv . Statq AL./ ZIP:"\. n \ I Phone: _ " - I Fax: ' 1 Reconnect only (2) $ 63,00 $ I E-mail: I Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or farm property 1 200. amps or less (2) I $ 63,00 $ owned by me or a member of my immediate family, This I 20.1 to 40.0. amps (2) $ 87.00 $ I property is not intended for sale, exchange, lease, or rent. OAR 479,540(1) and 479,560(1), 140.1 to 60.0 amps (2) I $126,00 $ I Signature: lOver 600 amps or 1,000 volts, see services or feeders se~tion above I , '",' ,,';;1CONTRACTOR{lNSTAl:l::AT:ION',.,. '!" I Branch circuits: new, alleration, exlension per panel 1 I Business name: ~ TY\.v 't. \Q~J'--C.rl'_fr,~ \ \Ij c, 1 a, Fee for.branch circuits with purchase of a service or feeder fee:, I I Address: C.:2.-.&.~,!i'!~f1J re\l'~,,() I Each branch circuit 1 $ 6,00 I $ I .1 City: rc:oitu:1<' c;;, OJ(" ~\ State: 0 ill I ZIP:' q 7Lf;;21{ lib, Fee for branch circuits without purchase of a service or feeder fee: I I Phone:$(jJ,'1,lif I~S\f I FaxJ'l[(-)P b~I::'- I 1 First branch circuit (2) 1 I $ 5'50.0.1 $ I I E-mail:m ,/p\ €C,+v,,,'c,'I'\~ ll\ \e P CrVf1cJJ..c.otl'/\ I Each additional branch circuit $ 6,00 $ I' I CCB license no,: 1(; S- n b I BCD license nel': ::20 -3:57(. 1 Miscellaneous fees: service or feeder ~ot included , I Signing supervisor's license no,: 34;:).3 ,~ I I Each pump or irrigation circle (2) $ 63,00 $ I I Print name of signing supervisor: F~ ~ 'It RJ) N Jiv. I'd "'j I Each sign or outline lighting (2) $ 63,00 $ I I SIgnature of slgnmg supervISor: (;)_.n, ,r,) //\, ()J /'): I Signal circuit or a limited-energy panel, $ 63,00 $ I ~... I\.J ~Y4. alteration, or extension (2) I Each additional inspection: (I) $58,00 $ I ~~6" '~e'V .~cS\ l'i'lBj"':ii~"lj\ll"''''-'''''''*,",'A'ni'iij~lc'7,'N''''T''''i('S'''E'''G'',^,,,,,~v""^'''''i''''',j'''''1 W... ';:DAV.<;%;;*~~r~M~J}.{~~!'~~~~/::\f~;GiL; '~I';\.,' ;;,%,~",. Ytj.;f:;,'i:~;;:~A!'~~;;J:fl~{i~,l!.Ji~,:~c~';: (A) Enter subtotal of above fees (Minimum Permit Fee $58,0.0) $ !J7 ~ ,,(J ~ ,I (B) Enter 12% surcharge (.12 x [A]) $ qrrl:1 , ~ \)"' ~\\ I (C) Technology Fee (5% of[A]) $ t(dn \J'" I TOTAL fees and surcharges (A through C): $ '1'1 'J.!ll' 440,2584,J (9/08/COM) Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01210 ISSUED: 08/19/2009 APPLIED: 08/19/2009 EXPIRES: 02/19/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 402 17TH ST ASSESSOR'S PARCEL NO.: 1703362405300 Springfield TYPE OF WORK: Electrical Work Only Owner: Address: TYPE OF USE: PROJECT DESCRIPTION: SERVICE PANEL CHANGE-OUT '(eo yOU to I"f' (ea.l'l ,v . ','i\ity ., .. r' ~C'on 0. ~ ~.P~of\ v- ..1_ r-~--r", :'30 v)' ..,.- r re 5tl\ 1"""'- VIAN TIMOTHY A & B(m',ITA G {?r 1\1')5(: \u\e;:;~R 952-00~- 402 N 17TH-BT ,.'.." " e '~O 1\,\(oU9\'\ ~ e (ules bY SPRINGFIELD OR 9747:n~ ~,' " ~.: ~;:~~ta:ln CDP~e~h~ ~~\ep\1O~~~ Oc.,S:J. ,IV", ,-. rp.ntef. \,......-\ \+\\ihl NOl\\\\.J......- ca\\I'eON.'I:RAOfOR:INE0RMAifION I nUI1','-- cenler 1'0 ' ~-' License 87506 Alteration Contractor Type Electrical Contractor MY ELECTRICIAN INC Expiration Date 11120/2009 Phone 541-729-1454 BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: \-It \NOR\\sq Ft 2nd Floor: 1'\c~ater TY~f t~?IRt II' , IS NO,Sq Ft Basement: NO ?~ange:type\\. ,\-lIS ?tRW\\\ OR Sq Ft GaragelCarport ,\-lIS E'ri~r~ ~alii~R P. NDONtD I' Sq Ft Other: fl,\.l,\-IC'S1Ih~kled'Bu\fdi~gJ\ nla Occupant Load: _ "",,,nt\l\\=N.\.;\:.\J v~".....,n.n _ AH ...., ...- I DE,',\EL0PMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC '~PROVEMENTS , Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I V al~ation Descril1tion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Page I of 2 _-lii!l:!iI~~'~'i!'1 !I ' CITY OF SPRIN\'d'H.LU Building/Combination Permit Status Issued PERMIT NO: COM2009-01210 ISSUED: 08/19/2009 APPLIED: 08/19/2009 EXPIRES: 02/19/2010 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 + 12% State Surcharge + 5% Technology Fee Perm ServlFdr 200 amps or less Amount Paid Date Paid Receipt Number $9,72 $4.05 $81:00 8/19/09 8/19/09 8/19/09 2200900000000000936 2200900000000000936 2200900000000000936 Total Amount Paid, $94,77 I Plan Reviews , 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, Reollired Insnection~ I Electric Service: Approval required prior to utility company energizing service, Final Electric: When all electrical work is complete. By signature, r state and agree, that r have carefully examined the completed application and do h~reby certify that all information hereon is true and correct, and 1 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, r 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 tbe street, that the permit card is located at the front of tbe property, and tbe approved set of plans will remain on the site at all ";~.":=~'~)Oto ~ ~ 15-/1 ?! 0 ~ Owner or Contractors Signature Date Paee 2 of2 225 Fifth Street ' ,-- Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-01210 COM2009-01210 COM2009-0121O Payments: Type of Payment Cred itCard cReceil1t 1 RECEIPT #: City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000000936 Date: 08/19/2009 Description Perm ServlFdr 200 amps or less + 5% Technology Fee + ] 2% State Surcharge Paid By EDWARD GUIDRY Item Total: Check Number Authorization Received By Batch Number Number How Received CJC 70381A In Person Payment Total: Page 1 of 1 2:31:56PM Amount Due 81.00 4,05 9,72 $94,77 Amount Paid $94,77 $94,77 8/19/2009