HomeMy WebLinkAboutPermit Electrical 2009-9-2
SPRINGFIELD ZON ~
~'~. E~~::~~j~.~
Date q /!o '1
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number c.oM PO 0'] - f1)-[ 7_ q e-
1. LOCA'fION OF INSTALLATION:
/ 7 ,(};S :J.. ':>;2.-3 01 g-t') /
LEGAL DESCRIPTION:
/~~.& / :5 '2.;I
JOB DESCRIPTION:
5'e-IZI/LC'0 th..antjc :~Lj
, , '
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2,
CONTRACTOR INSTALLATION ONLY
u,:I-
~, I' If'..;
Electrical Contractor~) J
Address,5f 7'7 So' (71;..., 1.7 Qr
City
2....'4
(
Phone s'Il S D/ s~ro
Supervisor L;icense Number
CfR()
,\,
Expiration Date ! 0 - f ,- 0 7
Constr. Contr, Number ,::1 ( :5 S- (
Expiration Date 4/...:::L 9'- r'J?
/\J;%t'''~';~
~v ----- ~>
<JltJf/IA
0.. 1 S"<;',
City 'l,Ci
Address
U);p,
7-t)?
L L/7 'F7tJ ((
t:s
Owners Name'
Phone
OWNER INSTALLATION
T~e installation is being,made 00;u3; e~Gtm which
is not intended for sale, lease or r .' .
'k '.
~.\)t.~~
Inspection Request: ,726-3769
3. COMPLETE FEE SCHEDUI,E BELOW
A. New Residential- Si~gle.or Multi.:'Family pel" dwelling unit.
Service Included
1000 sq, ft, or less
Each additional 500 sq. ft. or
portion thereof
$117,00
$ 21.00
Each Manufac!' d Home or
Modular Dwelling Service or
Feeder
B. S'e~ices or Feeders- Installation; Alte-rations~~
, ," gl.@&.
200 Amps or less . 1-, $Jll:6tl
201 Amps to 400 Amps $ 83,00
401 Amps to 600Amps $138,00
601 Amps to 1000 Amps $180,00
Over 1000 AmpsNolts $413,00
Recpnnect Only $ 55,00
$55,00
C,. Temporary'Se~t:vice~ .o'r .~eeders
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 55.00
$ 76,00
$110,00
. Over 600 Amps or 1000 Volts see "B" above,
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Peimit
$ 48,00
$ 4,00
E.
iVliscellaneous (Service/feeder not.includetl) -Elich instilllation
Pump or irrigation $ 55,00
Sign/Outline Lighting $ 55,00
. Limited Energy/Residential $ 28,00
Limited Energy/Commercial $ 50,00
Minimum Electric Permit Inspection Fee is $50.00 + Surcharges
4. SUBTOTAL OF ABOVE
8% State Surcharge
~~ .lIl% Administrative Fee
5% Technology Fee
't .7-2-
4-.- .R5"
q 1-. :;.- Z--
TOTAL
Shared D~Ve(T:)/BUilding Forms1Electrical Permit Applic~tion 7-01.d4
Status
Iss u ed
CITY OF SPRINut<l~LD
Building/Combination Permit
PERMIT NO: COM2009-01290
ISSUED: 09/0112009
APPLIED: 09/0112009
EXPIRES: 03/01120]0
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726.3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1361 S ST Springfield TYPE OF WORK: Conimercial Miscellaneons
ASSESSOR'S PARCEL NO.: 1703252301801
.". NT\ON' Oregon law rffi.YP.EfOF)Il,~~: Alteration Commercial
PROJECT DESCRIPTION: Moving ElectriAI S~rvice to~UndergronriiIe Oregon UtllitYh
follow rulllS uu~'~Th-;;se rules are set fort
...,_,:.l:l"ntU".,n ~p.nter. _..-. ,.,,........ ('\1''11
Owner: WIRFS THOMAS G & DIANE \ViOAR 952-001-~~~~~~~~i~~ ~i th'e'r'ules by
Address: PO BOX 237 0090" You may (Note: the telephone
SPRINGFIELD OR 97477 . calling the chen~;~gon Utility Notification
............hor for t e _ _..... ~ A\
i/enter ISI-O"V-vv~ -- ' .,
I CONTRACTOR INFORMATION I
Contractor Type
Contractor
License
Expiration Date Phone
BUILDING INFORMA nON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
A2
# of Stories:
Height of Structure
Type of Heat:
Water Type:
. Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Fllst Floor:
Sq Ft 2nd Floor:
Sq FI Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
VB
No
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION'
NOTICE:
THIS PERMIT S~ljl~Dist:
AUTHORIZED U q e'et'f~Ji~qll;\jE WORK
COMMENCED 0 r dTiJtlVfflft~q{T IS NOT
ANY 180 DAY PE~fJ~trffil&ff1!ID'J:OR
REQUIRED PARKING
Total:
Handicapped:
, Compact:
I ~UBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
. ,
I V aluati~n Descriotion I
Description
Type of Construction
$ Per Sq FI
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I of2
-~~!.~c;,E;!,fll";~J'L',...
~'.:. ','.' ~"
Status
Issued
CITY OF SPRINGFIELD
. Building/Combination Permit
PERMIT NO: COM2009-0I290
ISSUED: 09/0112009
APPLIED: 09/0112009
EXPIRES: 03/0112010
VALUE:
.
225 Fifth Street, Springfield, OR
541.726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Total Value of Project
F~~.~. Pai.d 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 Reouired T nsnections I
Electric Service: Approval required prior to utility company energizing service. '
Fiual Electric: When all electrical work is complete.
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 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 permissiou of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 wilFbe 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 plaus will remain on the site at all
times during construction.
~
Owner or Contractors Signature
Date
qf / PI
{ {
Page 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541"726-3759 Phone
....mP.:"I!~Q-:'J..lU.D... _14.. "', ......
Jl:AA
,,'111 .
';"'~.".> .i
,~ "
<~'.'._'.'''.''" ...., ~".:: ^""
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-0 1290
COM2009-0 1290
COM2009-0 1290
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Date: 09/0112009
1200900000000001015
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
TOM WIRFS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
7239 klk In Person
Payment Total:
Page 1 of 1
9:18:16AM
Amount Due
81.00
4.05
9.72
$94.77
Amount Paid
$94.77
$94.77
9/1 /2009