HomeMy WebLinkAboutPermit Electrical 2009-10-1
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INTIlALS
DATE
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225 FIFTH STREET'. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL;:ERMIT APPUCATIqN . j\
City;obNumber l:OI:- lJl LfS~ (Cq . It/56 )
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LEGAL DESCRIPTION: ~"",~,,,,,,,_..,,_,,,,g,~_l:!,~,,~,_,, )'.1'." " ..,g, "
170) '3 <{- '2..40 37UO
JOB DESCRIPTION:
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not started within 180 days of issuarice or if work is
Suspe~ded for 180 days. ' .
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EleC~Cal Contractor EveryTh~
Address '1'74CJ2' ~ rL..e..
City ::j{ W\c:tN-. (\1~ 1: Phone 9/2.:- J 9'S '7
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4~o?'s
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ConstI-. Contr. Number '/ J (., ]'71
~/01 /5'-/1--201 \
Supervisor License Number
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E,;;ationD~le
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Exprration Date
Signature of Supervising Electrician
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Owners NG:t,^ .nll/ CILP)}' M..-f)
Address cr~u.J~+on V0r5
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OWNER INSTALLATION _
The instaUation is being made on property I ~
is not intended for sale, lease or rent, ~
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Owners Signature: ~~ 10 ,fv'
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Phone
Inspection Request: 726-~769
. SPRINGFIELD
~.-
10-0/'-01
Date
Service Included
1000 sq. ft. or jess
Each additional 500 sq. ft. or
portion thereof
$121.00
$ 22.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder.
$57.00
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200 Amps or less ~ '
201 Amps to 400 Amps $ 86.00
401 Amps to 600 Amps $143.00
601 Amps to 1000 Amps $186.00
Over 1000 Amps/Volts $426.00
Reconnect Only $ 57.00
1",i4MIWlli~M'='11k"'"'r:M&ili,,;,H(lli2~'0M'~0\ffi~P"-""!1"Rtlfli31_" ~'", 1 !IIIlI'. ,',',re.Ji'"~,".;~fr',~
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, follow rules adopi8d by the Oregon Utility
Installat!'!!HiN!!,.",~,o.J1,;\lr.~~lo~,'!.t.!'!.~'ules are set forth
200 Amrislo,?,jtfss952.001.001 0 through OA:$ {;7,0601.
20]Amp9Qg(4ooWMPsqy obtain caples 01 [1'$'79:0"0' by
401 Am ca6'JO'n09.t.!le center. (NUl~, "'~ lel$cl~lh40.0nO"
; ps to .1:UllPSh Ore ~ II~:I:~.. '" . ~ ~
nUIIlU~l IU, legaL ~"'''J . .Oum.;c.lIun
Over 600 Amps OI(}OOmVoltS see~'B'<JiibOve.4).
D.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 50.00
$ 5.00
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U I lit:
Pump or iiriga!:i.9~JERMIT SHALL "'YOIDC $.5'7,OQ V\'~""I
. '. -." ..._ Ir I nt VI '"
Sign/Outlin,e,gig/ftWg,ZED UNDED TUIC "E$.o57,00lS ';~T
L. .. ........ nlVll1 I~'-' t
LimitedEn~rgyfflMi!\e.!'!!!9 OR IS M16~J"n~E~AOJR . '
Limited EnBIgy/G~fl'ia))ERIOn $ 52.00
Minimum Electric Permit Inspection Fee is $52.00 + Surcharges
o/,6D
9,'72-
01.Q<:
4.
12% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL QLf.17
Shared Drive(T:)/Building FormslElccttical Permit Application 7-Q8.doc
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01458
ISSUED: IO/01f2009
APPLIED: IO/01f2009
EXPIRES: 04/01f2010
VALUE:
.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax .
541-726-3769 Inspec'tion Line
f -( _ .
SITE ADDRESS: . 6i99 Thnrston Rd
ASSESSOR'S PARCEL NO.: 1702342403700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: 200 AMP service change ont
Owner: PAMELA GUESFORD
Address: 6199 THURSTON ROAD
SPRINGFIELD OR
! CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
EVERYDAY ELECTRICAL SERVICE
License
136371
Expiration Date
08/1212011
Phone
541-607-6908
BUILDING INFORMATION I
# of Units:
Primary Occnpancy Group:
Secondary Occnpancy Group:
Primary Construction Type'
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Stroctnre
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I, DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive,Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Sidewalk Type:
Downspouts/Drains:
ATTENTION: Oregon law requires youto
follow rules adopted by the Oregon Utility
Notification Center, Those rules are set forth
in C1AR 952-001-0010 through OAR 952-001-
. ~c no. You may oDtam CUJJIl::::> VI II Ie; I u........ ... J
NOTICE' I Valuation Descriotion Jailing the center. (Note: the telephone
. . - number for the Oregon Utility NotlflcatJon
. . ~H'S PER~IT SHA~L ~XPIRE IF 1fi=e,Y'~081{ S uare Foota .center is 1-800-332-2344). .
DescnPtIODJTHOF:UYPe10li!jt;1OJjst~"ctinDPER'"lf 1"lt~:fII":~ q B'd A g . Value Date Calculated
"'---', N~~.r ...'(J 'ormll Ip er or I mount .
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Storm Sewer Available:
SpeciallDstruction:
Notes:
Paee'l of 2
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-01458
ISSUED: 10/01/2009
APPLIED: 10/01/2009
EXPIRES: 04/01/2010
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 Serv/Fdr 200 amps or less
Amount Paid '
Date Paid
Receipt Number
$9.72
$4.05
$81.00
10/1/09
10/1/09
10/1/09
2200900000000001124
2200900000000001124
2200900000000001124
Total Amount Paid
$94.77
"
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, .
R~rl!ired Insrections I
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 herehy certify that all
information hereon is true and correct, and I further certify thai 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 wilLhe made of any structure without permission ot' the Community Services Division, Building Safety.
I further certify that ouly co:ittractors and employees who are incompliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspectious are requested at the proper time, that each address is readahle from the
street, that the permit card "is located at the front of the property, aud the approved set of plaus will remain on the site at all
times during construction. :. I . " .
Owner or Contractors Signature
Date
Paee 2 of2
225 Fifth Street ,
Springfield,'Oregon 97477
541-726-3759 Phone'
Job/JournaliNumber .
COM2009-01458
COM2009-01458
COM2009-01458
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001124
Date: 10/0112009
Description
Penn Serv/Fdr 200 amps or less
',+ 5% Technology Fee
'+ 12% State Surcharge
Paid By
WAYNE ANTONE III
\.'
Item Total: .
Check Number Authorization
Received By Batch Number Number How Received
NJM 017702 Phone
Payment Total:
Page 1 of I
9:10:38AM
Amount Due
81.00
4.05
9,72
$94.77
Amount Paid
$94.77
$94.77
10/1 /2009