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Home My WebLink AboutPermit Electrical 2009-9-16 Electric,al Permit Application 225 Fifth Street+Sp"ngfield. OR 97477+PH(541)726-3753+FAX(541)726,3689 l~i~,:~;,~~~~~'f~~'N'f;u~~,o.t{~'t:;", I CocA-.-z.OO? - I Pennit no.: . C> ,36 7 I Date: 7-/6-09 This permit is issued under OAR 918-309~0000. Permits are noutransferable. Permits expire if.work is not started withiu 180 days of issuance or if work is suspended for 180 days. l,:!>,"".O"",jl{o.CAL:.Go.VERJllNlENTf(Af1R:R.OYAl!!,i't;t:;~'tii$:jif)XIEI IY:l!i!1f~l~i~~rzijllg~I"FEE~SCHE[juU1Eiiiis1:l!W~~,~~i\I(~~{1m'4lR~I' 1 Zoning approval verified? 0 Yes D No I l,r~:~fu~el;lf)l~SBA~lg~~\e~riXi}~~?i~d~1:9i~;;I;U~~~!!\~UJ";ltW,,'. l!i\'!M#i.tf,;,";i:;~GATEG.ORYfioF"'tC.o.NSJI'R.UCTI0N(1,~)g";ii~\';\,~')I r Residential,per unit, service included: f~~~~:~~I~E~I~g:?~~~~:~N[j~&~C~T1~;~~~i~tdit! '1 i~;;o;:i:~~:i:s~o(:~ ft. or portion 1 City: lifnV'; F"'G~ I State: ot<- 1 ZIP: 11'11\1 I Limited energy (2) . 1 Reference: 'tf) 3.'Sh I ( I Taxlot.: C) (; !"O_~ Each manufactured home or modular .,.,....."'.."ES C'R'I". ",10. N'.i.0 .F' 'Wo.'.R"K' ..',.....,'''. "".". ',....'.'. ','u'''''''''.''.ln rdwellmg service or feeder (2) "~""'~~'~':IJ . .F.":." h'." ...i,.... ....{.i:f>'~~\H:,,/h'':.<~>if0'Jt'..:;:,,' . u,,,'r, . I . (. l '.f' I" ,," (. . \.,' .....~ ',' .N.~t'I.'.,.I. I.., ,IUlI~ser.Yk~~~Pf'eJders:Einstallation, alteration, relocation eO c{(..u ./lr cC"....r/{a?L....... I;C!lI" ~""'UJ",....~I, . .111'11-..._ .,........, t7 t!' I' I P[",l~ .;- - <..( V'l' ." -......JlfT. . -~""yoU! I (';.1 1 00' qVP,H 91;2 n~0"01ll!1)psi~\Ae;~(2) OreOon ".,...0 ! $ 81.00 $ l'> . n ,-' 1-......-111).."1' - ".tljSa -"'llY I, . ~,:PRbJ'ERTY:-,:OWNER:Ga"i;~'~v. f n IciW!,~.~Qo amp~,~~), r, ^!e settOrlh $ 95.00 $ I Name: AItJ...~ rOSk"'-'f nUmbe~; ~e C40JIL~~6qqJblpii(2)of'th~ ~~~'OOI_' $158.00 $ 1 Address:' z..~ ~b G '% Ci :t )1>j-i"'GOQ9' ~mpr(2Jfeleph:,~: oy $20500 $ City: ~or,w,h~1J State: O~ I ZIP: r?'117 ci~e( i~Oo-ii'mRs.iBX9Jlt2-~tion $469,00 $ Phone: ~I -,0 _ Lj? 0./ l? 1 Fax: 1 Reconnect only (2) $ 63.00 $ ) E-.mail: I Temporary services or feeders: instaflatio:., alteration, relocation Th" II' . b . d 'd' I c I 200 amps or less (2) I "" $ 6300 $ IS msta atlOn IS emg ma eon reSI entIa or.larrn,property ~ . owned by me or a member of my immediate family. Tbis I 201 to 400 amps (2) 1 $ 87.00 $ property is not intended for sale~exchan , lease, or rent. OAR I 1 479.540(1) and 479.560(IY 401 to 600 amps (2) $126.00 $ Signature: ~,~ .,; lOver 600 amps or 1,000 volts, see services or feeders section above ~..;',:;;':'t.tbNTRACYOR;:iNSTAtt;;$I()"'0:;'';:'':'': .,: "I I Branch circuits: new, alterarion, extension per panel Business name: 0 L v 1-lICt"L Tk~~ ~';..~.~ _._ I I a. Fee for branch circuits with'purchase~ofa service or feeder fee: - . ~'''vr'l i:>H,ULI I 1 1 AUTHnRI?rT) "..:I' t E~p.lIIRI1r'l)!'''Njrt"\I,~__... . $ 6.00 $ , C~!l~l:ii,Hfr.~0 '6';L[t1 J[lq~ iI''tY\n'n~Cif,C~!6''Pthout purchase of a service or feeder fee: .ANY 180 DAY Pr:~ 6J:tif\i~ID9a~0Cc~R'iW) I $ 5500 $ l Each additional branch circuit I $ 6.00 $ I Miscellaneous fees: service or feeder not included I Eac'h pump or irrigation circle (2) $ 63.00 1 Each sign or outline lighting (2) $ 63.00 I. Signal circuit or a limited-energy panel, $ 63.00 $ - alteration, or extens!on (2) . 1,,~<:,~...~~~~::~~~:I,i;~:ct~on :,~ )~". ..,'" '. ....".,.'~. ;8:~0.,,, ".'~.'''"' ""1 c~'ct;~~4b~#~'4~&5'i$k~ARI?LmC-ANJ"$LSE;f;1i'~;5ti~~i:f!.W~~s~}K,~]lti (A) Enter subtotal of above fees (Minimnm Permit Fee $58.00) .1 (B) Enter 12% surcharge (.12x [A]) 1 (C) Technology Fee (5% of [AD 1 TOTAL fees aud surcbarges (A through C): Address: I State: I Fax: City: I Phone: I E-mail: 1 CCB license no.: 1 BCD license no.: I Signing supervisor's license no.: I Print name of signing supervisor: ] Signature of signing supervisor: ~"V' ~ rJ'- ~\\Q W' ~ 440-2584,) (9!08/COM) $134.00 I I I $ $ 25.00 . $ $ 32.00 $ $ 63.00 $ 1 1 I $ $ $gl $ 't 7 LI $ {{O)T $7l{71( _I'i , '/.1'-)1 ....... _IG..L Q( 05()Y {\{\ " ~'1 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-0I367 ISSUED: 09/1612009 APPLIED: 09/16/2009 . EXPIRES: 03/16/2010 VALUE: Status Issued 225 Fifth Street, Spriugfield, OR 541-726-3753 Phoue 541-726-3676 Fax 541-726-3769 Inspectiou Liue SITE ADDRESS: 2480 G ST ASSESSOR'S PARCEL NO.: 1703361106900 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace panel Owuer: FOSHAY ANDY & HILLlARY Address: 2480 G ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Electrica] Contractor OWNER ATTEN" .fOlio liON: Ore ,.. Wrlllo.... . .oOn J....... inl~ij'ui~D1NGfN.FORMA:iI:ioN.{eS you to 0090 ,,-~uu, .1-0.010 t"~o" rUles ~on Utility . 10'J ~ hr are Calling#.f!fStori~~ilin OUgh O'R sefforth n ':it;> ,. . ('n~, ,., 9520 UtnberHe,ghtlof'Structure9s Ofth - GI_ U)r 'h-. '.. I/VOte. th e rUI CType otIH~~t:'n U'.. e tele h es by ~,I,,,,.. <JV fJ/t P on WalerJTYPSiJO'33 I y Notific . e Range Type: 2-2344). atlon Euergy Path: Spriuk]ed Building: License Expiration Date Phone # of Units: Primary Occupancy Group: R-3 Secoudary Occupancy Group:. Primary Constructiou Type VB Secoudary Constructiou Type: # of Bedrooms: Lot Size: Sq FI ]sl Floor: Sq FI 2nd Floor: Sq FI Basemeut: Sq FI Garage/Carport Sq FI Olher: Occupaut Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Street Improvemeuts: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: NO % of Lol Coverage: TleE' If.ilr:> ~_ . AL, 'liP,.U~Ljj;'IMl}RONJj:i':J.ENTS. AL~:IIMENCED ~~~ER THisrp~~ THE ~~WKlk Type: 80 DAY PERlgDA8ANDONE~/;~S~'c!iJifspoutslDrains: . . yR Total: Handicapped: Compact: Frontyard Selback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Selbacks: Notes: I Valua.tion Descdpti~n I Description Type of Construction $ Per Sq Ft or mulliplier Square Footage or Bid Amount Value Date Calculated Page 1 of2 Status Issued 225 Fifth Street, Spriugfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Descriptiou + 12% State Surcbarge + 5% Tecbnology Fee Perm Serv/Fdr 200 amps or less Total Amouut Paid Total Value of Project 1 ,.':~e~ P~i~, I AlIIouut Paid Date Paid CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01367 ISSUED: 09/16/2009 APPLIED: 09/16/2009 EXPIRES: 03/16/2010 VALUE: Receipt Number 2200900000000001048 2200900000000001048 2200900000000001048 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. $9.72 $4.05 $81.00 9/16/09 9/16/09 9/16/09 Electric Service: Approval required prior to utility company energiziug service. $94.77 Plan Reviews I ,I R~'1~i~e~ Insnec~i,?~~ I By siguature, I state and agree, tbat I bave carefully examined the completed application aud do hereby certify that all iuformation hereon is true aud correct, and I furtber certify that auy aud all work performed shall be doue iu' accordauce with Ihe Ordiuauces of the City of Spriugfield aud the Laws of Ihe State of Oregon pertaining to tbe work described herein, and tbat NO OCCUPANCY will be made of auy structure without permissiou of the Commuuity Services Division, Buildiug Safety. I further certify that only contractors aud employees who are in compliauce with ORS 701.005 will be used on tbis project. I further agree to eUSure that all required inspectious are requested al the proper time, that each address is readable from the street, that the permit card is located al e frout the property, aud the approved set of plaus will remain ou the sile at all times during constructi . ~wuer or coutrac~ Signature / Paee 2 of 2 f~/rf ~t:J Dale 225 Fifth Street SpringfitiJd',Oregon97477 541-726-3759 Phorie-'--~-uu City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-01367 COM2009-0 1367 COM2009-01367 Paymenls: Type of Payment Check cReceintl RECEIPT #: 2200900000000001048 Date: 09/16/2009 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge Paid By ANDREW FOSHA Y Item Total: Check Number Authorization Received By Batch Number Number How Received djb 1144 In Person Payment Total: Page 1 of 1 12:00:21PM Amount Due 81.00 4.05 9.72 $94.77 Amount Paid $94.77 $94.77 9/16/2009