HomeMy WebLinkAboutPermit Electrical 2009-9-23
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Electrical Permit Application
225 Fifth Street. Springfield, OR 97477tPH(541)726,3753t FAX(54t)726,3689
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I Pennit no.: L! 1-/4/ / I
I Date: '1/;1"3/09
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This permit is issued u~der OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance. or if work is suspended for 180 days.
1'li~L!()e~L:;;GOVE:RIiII\IIElilm*~~J>ROYA'L1!%",'\;'t~i~r;():\~;',1
I Zoning approval verified? . " DYes " D No I 1~~'niiie~if'i~S:'~~ti6:;U"'bf:ii~~~cJ.$t;\IQt;1 ';PS's};;;'IX,ifiltal:.'I
1:!j(;~~q~/:!;\;,;,'*::";'~CA'f;EGOFtf:';'_0FiIhC:Q NSl;Rt((;[ldN~-t~;':.','l~.\tf'_;:-'--':t:J'1 ",:'~ ,~~~~:~",~",'-':~/~'..i;,:~ ~:~:'~i!~,~RlH>,~I;/. ':'~'ld,'_:,,~,:;:;\',: ,......J
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(~:;~;~;;al" .' . I Q'~o~:~ment' , I' 0 C~::~;::I"'X 1 I Residential, per unit, service included,
l~lJ0I3j;iSlmE?lINI;ORMAlIilolil~AIiII5~I!:()G~AiI1l<:>IiI~~~.,j11 11.000 sq. ft. or less (4) $134.00 $
I ] b. dd -,....," v I Each additional 500 sq, ft. or portion $ 25.00 $ I
o SIte a ress: S {'$o;" /--1~')vf <;, . thereof
!3;~~~;~::I~~~~~:F;:L~~~;;;~;~i~,~~1 ~~~~:;~~~~~~~~~~~ ~e~~:r (~)odular : ::.::: i .
I '11, _ I I Services or feeders: installation, alteration, relocation 1
~ 7UvJ'>.€ ,,'I\A.."V I/'mv\-.
I I I I 200 amps or less (2) '2.. $ 81.00 $/&,2--1
I ;PR()P,ERl'Y.;OWIiIER" I 1201 to 400 amps (2) $ 95.00 $ I
I Name: L~ FlfY' I 401 to 600 amps (2) $158.00 $ 1
I Address: \lo' ~ lo"'\k I 601 to 1,000 amps (2) $205.00 $ I
I City:lJ..(lX"ro\eL- I State: ()Q... I ZIP: ct14~ lOver 1.000 amps or volts (2) $469.00 $ I
Phon~: "I Fax: I Reconnect only (2) $ 63.00 $ I
E-mail: I Temporary services or feeders: installation, alteration, relocation I
This installation is being made on residential or farm property 1 200 amps or less (2) $ 63.00 $ I
owned by me or a memb'er of my immediate family, This I 201 to 400 amps (2) $ 87.00 $ I
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and ~79.560(J). I 401 to 600 amps (2) $126.00 $
Signature: '; lOver 600 amps or 1,000 volts, see services or feeders section above
I ."'::fC()NTRACif:<:>R:;:INSTALtA.TI<:>N\,';:: , 1 Branch circuits: new, alteration, extension per panel
I Business name: MitcH"'5 ~~ .J ;VL I a. Fee for branch circuits with purchase ofa service or feeder fee:
I Address: 'J,.I'V ~ Ph. I Each branch circuit I !Sf I $ 6.00 I $ $' ';j' 0
I City: ~ '-0 I State: &/ZiE' I ZIP: "i?'r7't I b. Fee for branch circuits without purchase of a semce or feeder fee:
I Phone5'J I -SZI ~ Sb'7o 1 Fax: 1 First branch circuit (2) I I $ 55.00 I $
I E-mail: t1I i-icIf~FLE~) (V~. 0->'\ . I Each additional branch circuit $ 6,00 $
I CCB license no.:/'r( 74r 'I BCD Ii_cense no.: Zo-.4(j:fi c. I Miscellaneous fees: service or feeder not included
I Signing supervisor's license no.: "-17 7:J.:> . I Each pump or irrigation circle (2) $ 63,00
I Print name of signing su~ervisor: .111 r'-/t.ifg<. c..,?M..- Each sign or outline lighting (2) $ 63.00
I Signature of sign.,.ing supervisor: ~ ~ I"vL- 2- _ Signal circuit or a limited-energy panel, $ 63.00 $
. . /'b-? _~,_ alteration, or extension (2)
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Each additional inspection: (I) $58.00 $ [
1~~~L4f!~~Al~~tfi~'J,\~N~m~~(jS'E~t~~~t~;f:~fE~~J;~~~}:I~1i:~'~'l;~'l
I (A) Enter subtotal of above fees I
(Minimum Permit Fee $58.00) $
,I (B) Enter 12% surcharge (.12 x [AD $ :30 >-'/ I
I (C) Technology Fee (5% of [AD $ ()~ &.J2.j
1 TOTAL fees and surcharges (A through C): $ 2 W li'l1'
$
$
440,2584,) (9108ICOM)
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CITY OF SPRINGFIELD
" Building/Combination Permit
ATTENTION: Oreaon law reouires vnrl tn
Status Issued IUliUVV rUles aooprea oy ine uregon Util""
Notification Cel']ter. Those rules are set fc~~]<;RMIT NO:
225 Fifth Street, Sprin~field, OR; ir OAR 952-001-0010 through OAR 952'O~A,~SULEIDE'D' .
541-726-3753 Phone.. I.. , ,0090. You may obtam caples of the rules ,.gP .
541-726-3676 Fax:' :~' '. calling the center. (Note: the telephon~XPIRES:
541-726-3769 I';-spection Line number for the Oregon Utility Notificatio);ALUE:
': .:,. Center is 1-AOO,<l<l?,?<l"'d\
CO M2009-0 1411
09/23/2009
09/23/2009
03/23/2010
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SITE ADDRESS: 3755 KATHRYN AVE
ASSESSOR'S PARCEL NO.: 1702304302901
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: . New service and panel
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Owner:
Address:
,,' -< 11
: FHY LARRY E,& VERNE;r-T,E L ' .
POBOX 674 , . 1~\JliloE:
MARCOI1A OR 974541/5 PERMIT SHALL EXPIRE IF THE WORK
FHY LAky E & vE'1ill~f'fi7~D UNDER THIS PERMIT IS NOT
PO BOX 674 GUlVlfVll:NGED OR IS ABANDONED FOR
MARCOM OR 97454;o.JY 1 SO DAY PERIOD.
Owner:
Address:
~.
I, CONTRACTOR INFORMA nON I
Contractor Type
Electrical
Contractor
MITCHS ELECTRIC INC
License
146745
Expiration Date
01118/2011
Phone
541-521-5690
BUILDING INFORMA nON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy" Group:
Primary Construction:iType
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Rauge Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMEN! INFORMA nON I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback: ' .
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPR?VEMENTS I
Street Improvements:
. Storm Sewer Available:.,
Special InstruCtion:
. 1
Sidewalk Type:
DownspoutslDrains: .
Notes:
Paee I of 2
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CITY OF ~t'Kll~tJl'lJ!,LV
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Status Issued; :", ' '
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225 Fifth Street; .Springfield, OR
. 541,726"3753 Phone .
541,726,3676 Fax .'::
541,726,37691nspection Line
Building/Combination Permit
PERMIT NO: COM2009-01411
ISSUED: 09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/23/2010
VALUE:
I Valuation De.scription I
.'
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Type of Construction
. ~ I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
.. Description
Total Value of Project
Fees P"id I
Fee Descriptioil. :~
+ 12% State Surcharge
+ 5% Technology Fee ..
Add, Alter, Extend Circ E~' Add
Perm ServfFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$30.24
$12.60
$90.00
$162.00
9/23f09
9/23f09
9/23f09
9f23109
2200900000000001082
2200900000000001082
2200900000000001082
2200900000000001082
Total Amount Paid
I
$294.84
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.
ReOllired Insnections I
, " ,,1'
Electric Service: Approval required prior to utility company energizing service.
Rough Electric: Prior to Co,:er
Final Electric: I,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 ,~rue aDd 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 permission of the 'Community Services Division, Building Safety.
I further certify that JDly contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to eDsure that all required inspections are requested at the proper time, that each address is readable from the
street, that the'permiti'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.
Owner or Contractors Sign~ture
Date
Page 2.01'2
225 Fifth Street
Springfield, Oregon 97477 .
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-0 1411
COM2009"01411
COM2009-0141 I
COM2009-01411
Payments:
Type of Payment
CreditCard
cReceintl
: RECEIPT #:
2200900000000001082
Date: 09/23/2009
De~cription. ...
. ~~nn Serv/Fdr 200 amps or less'
:~dd, Alter, Extend Circ Ea Add
-+i:S'Yo 1:echnology Fee
, ; '"i: 12% State Surcharge
,
,
,
, Paid By
MITCH'S ELEC .
i!
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
CJC
091279 In Person
Payment Total:
".,":
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Page I of 1
10:37:04AM
Amount Due
162.00
90.00
12.60
30.24
$294.84
Amount Paid
$294.84
$294.84
9/23/2009