HomeMy WebLinkAboutPermit Electrical 2009-9-3
Electrical Permit Application
8
225 F;fth SlreettSpringfield, OR 97477tPH(541)726:3753t FAX(541)726-3689
1,':"':' ""k"""",-"" .'.......".',..." '",,'
~",.,'DERARTMENTUSEONLY;..' "
~:,::~D ,~,;. 'I"'C ;;::~'~ ;;t;':'~ ,i'<x:,
\"",";)'; aJ-'" Penmtno.. .
, , I Date; 7- J -0 i
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 I>:ork is suspended for 180 days.
1;;'';';'''' ",-';110CAL~G0VERfIIMEfIIT<~P.I"ROVAL2~~"~~!;;;J1'P~;;(1
I Zoning approval verified? 0 Yes 0 No 1
l;'i:M$\'Ni;,iidCArEGOR"t;OF,XC()NSTRUCTlONt';~i":';," , ",:,~:I
I gl Residential I 0 Government I. 0 Commercial 1
~:::~:~~~~I:E;N;::A~~~i;t:)[j~(f0-::~~~~~1~i I i~;~O;d:i:~~:i~S~o(:~ ft or ponion :1::::::
!";.~Ie~~.: :~rt~~Xta::.:-S~~{J~~~,-l ~~~~:;~~;~~;;~ ~e~~~r (~rodular : ::::: :
I. 'r?J:::J'/l-( fl- Mfl~ r _ ~~I ~[,.seryicesor feeders: installation, alteration, relocation .
I / 200 amps or less (2) $ 81.00 $
I ;PROP,ERTY;OWfIIER,' 1201 to 400 amps (2) $ 95,00 $
1 Name: Y /l.,sAJJ.;..lJ _):'<;' 9;.ll~lF'WE:, 1 40.1 t~ ~~o_",:,ps (2) $158.00 $
1 Address r::; q r::, c." M.4J~}SJ5-~~[lALL EXPIRE 11=1 ~~iEto!I;.~~~I,ampS(2) $205.00 $
1 City;.,,>? _ sWJ 0 I~~ Z'\p!~~,*,~,.Hlr?,\T:::~ooamps or volts (2) 1 1 $469.00 $ .>
1 Phone; t:, .,Jj J-, 9 f? 8'-/..<% :~W ;V~~! t;~ U:..,I,~~ It\II:Reconneet only (2) 1 (I $ 63,00 $ f-.;.,
I E-mail: - - - 1\11 I UU un\ rL.IIIV::L j Temporary services or feeders: installation, alteration, relocation
Th" II' . b ' d 'd' I ' I 200 amps or less (2) $ 6300 $
IS msta at10n IS emg ma e on rest entia or l~rm property .
owned by me or a member of my immediate family. This I 20] to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR I
~79.540(1) and;79.560(1), " ' 401 to 600 amps (2) ,$126,00. $
-- Signature; W.;!:;.;;u; ;1/ ~:yp; Jth/::j"?' 1 Over 600 amps or 1,000 volts, see semees or feeders section above
I ': '. ' ;:"CQNTRAC'[OR' INST Al:L'A'l'lbN,,,. ", 1 Branch circuits: new, alteration, extension per panel
I Business name: O~ _, .~I ~ a. Fee for br~nch circuits with purchase of a service or feeder fee:
Address; Each hranch circuit 1 $ 6.00 I $
City: State:" I ZIP: I b. Fee fO~~~~~~~c{r8~tKWithout purchase of a service or fee~er fee:
1 1 I n'R'IV ,....""\-- 1}\~\l'Y
Phone: Fax: - .,...,..ct..rnON: 0 e~ 0, f!~sh~.r.a~cr:.clrcijit'\2j.....th $ 55.00 $
1 E-mail; ~ ;fO'\'\O'W Jules aO"~"Tu'E~chlldditib~~f'b~;;;;Ch.~jiGuit ' $ 6.00 $
"'".....- ef 1......- ....".,~ .......-.".-v""
1 1 '1~\mca\\Ul' ....-. C 1M' ~""rr.-II'\all"""f'" ,-;> b'\1 fi d' . / d d
CCB license no.: . BCD license nO.:.I.... ,., n at;?~OO\ 0 Isce~ !.~J>';l~, s~~:'servlce Or ee er ~OllnC u e
I II'~'''' Y otJlPE",;'N"" . ,,',,'o"nu','~c.1 (2
Signing supervisor's license no.; . nn(1Q. 'IoU mac_ \' _ ai1",R~mp,orclmg~tl?.!'oC,,\L,f ) $ 63.00
. '" ,,-, \ l'i\ltV l"v~"'-
I Print name of signing supervisor; ca\\i~~_l:;:; t~ e )p_aEh''"!l,n_9< ?,u.Hll, lighting (2) $ 63.00
I S. f" '. HU\I".'--'centei i~ sig\\il)cYrc~h~r'al;mited-energypanel, I
Ignature 0 sIgnmg supervIsor. I alteration, or extension (2) $ 63.00 $
I.:;:~~::::~~;~i~,:, ~c,tion:,~)",,,_,,,,, ,.1" "<,,,.~5~:~~( L~ _",' ",1
li{tl~1W~~:,'fki~~fff~)~~'AR~UIC~NI~U5E~~~~~~~fti~h:1'{f~~1~:1i;::;,~
(A) Enter subtotal of above fees $ b7
(Minimum Permit Fee $58.00) ~
,I (B) Enter 12% surcharge (.12 x [Al) $ 7 sE.
I (C) Technology Fee (5% of[Al) $ 30-
I TOTAL fees and'surcharges (A through C): $ ,"'( -.' (
~~
~.~
~~
440-2584-) (9/08/COM)
1,,;;n"'!?l~~""I1',t"'t!FEE"SCH' EDU"E'''l1?1.''''<''',#m1~''i$''''~
"';';'::;'~~E.~.~-:'.:m'::tB~.:~/-':'.~:}i.( ,: ~ _.' _.' &:.; . ;::{,M'qdP~;jl~~;g.,,~,!,.~~~1;_',
1':~Urri6~~':Of~i~~'Se~ti~~ri;~ :'~{it~~:~::' "'~.'::{'I~'"'r' ~~I "~.~q~f";~'I<~:I:o#if :
..,,"P..,'~-' -''t'',' ..P'>,.".. P. ...."'..'-o.,,~..,lt,..t: ."...,.... '" ()1"~l';," ~Q. y u,',. ~ ea;'J:t,.- :.,....cost' ,','
. . .~, ,. ~ ' '. ',,, ~ ,. '.,......_',..N "., .< '- t ,. .. _ ,,'.' " '''-'.'," ......"... ...- " , . -- - " ','
Residential, per unit, service.included: I .
I
I
$
$
, -
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-0I306
ISSUED: 09/0312009
APPLIED: 09/03/2009
EXPIRES: 03/03120]0
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6955 MAIN ST
ASSESSOR'S PARCEL NO.: 1702353309400
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Repair service mast - reconnect only
Owner: ESPINOZA Y ASMIN
Address: 6955 MAIN ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION 1
Contractor Type
Electrical
Contractor License
OWNER NOTICE: . ,_ _ \"""11
THIS Pel FJ"~ili'" &'r:~'T~JA.:rf L~';n~
AUTHORIL~J I...~.!!, T'-,lfh1f".~~6
COMMENCED #lbf !So~'1#lOOUB~ ~6Fl-
tm1180 DAY aaglalac Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
Residential
Expiration Date Phone
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION 1
, , , u \tREQUlRED PARKING
, e'O~O .,'1"
Overlay Dist: '1'1 leo.U\1 01' \.\\\T,ttli'l:
# Street Trees Rqd:. OleQOI' \,0: \\le O\e~le 'Oe\ :il'il.,wicapped:
Paved Drive~\l!l)"" ~O\lW~ \;)~'Oe \u\e~p..1'\ 9,,'2.~~lI.!1pact:
% of L~gverage: a: I'W\. ,\I "-louQ\I ~ \\le IU\ I'e
\\0'1'1 '':' I' Ce G~G \,' \e'O 0 \e\l\lO. -
\?~I\\\Oa.\\~..,_OG~-G,_,?o\1' oo?~. \ne \~ _..\\0a.\\01'
I PUBLIC 1MP~Oy:E'M:ENTq;;WI'e~~;\.\\\i:l~A~)'
vo-' \'I''J''" neOI ('II""''''
oa.\ \ I \01 \ \'0 Sidewalk Type:
u\ll\;)e cel'\el
'(\ DownspoutslDrains:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
,I Valuation Description I
Description
$ Per Sq Ft
or multiplier
Square Foo.tage
or Bid Amount
Type of Construction
Paee 1 of2
Value
Date Calculated
CITY OF I'lrKll~GFIELD
Building/Combination Permit
PERMIT NO: COM2009-0I306
ISSUED: 09/03/2009
APPLIED: 09/0312009
EXPIRES: 03/03120]0
VALUE:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid n
$7.56
$3.15
$63.00
9/3/09
9/3/09
9/3/09
Receipt Number
1200900000000001023
1200900000000001023
1200900000000001023
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amount Paid
Date Paid
Total Amount Paid
$73.71
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 R~{]uired Insn~ctions 1
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 with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, aud
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 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.
,V4-n/,';,LI j:-c.,-I~A/(?)7,j9-
Owner or Contractors Signature
1-<~o rj-
Date
PlIee 2 of 2
225' Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1306
COM2009-0 1306
COM2009-0 1306
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Service Reconnect
+ 5% Technology Fee
+ 12% State Surcharge
Paid,By
Y ASMIN ESPINO ESPINOZA
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001023
Date: 09/03/2009
Il :53:08AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 922 In Person
Payment Total:
Amount Due
63,00
3,15
7,56
$73.7]
Amount Paid
$73.71
$73.7]
Page I of I
9/3/2009