HomeMy WebLinkAboutPermit Electrical 2009-9-29
Electrical Permit Application
225 Fifth St~eet+Spd"gfield, OR 97477+PH(541)726:3753+FAX(541)726.3689
1~',:;;:;D~~~RTM;ENf"U~ifEON6',";, I
..<'. ,. . '; '_. ...,~"" .. .~_ .._... -, . .,.'-' '__' ',' - I.
I Perin it no {I~ -- (J/"71:A
,I Date 9/d9/07
This permit is issued under OAR 918-309-0000. Permits are nuntransfe~able. Permits expire ifwurk is nut started within 180
days uf issuance ur if wurk is suspended fur 180 days.
1""jWt~"~S"',{l;Ic.1.fFi"'FE-E- "'S.C'H'ED-U""E;W:4~"""""'!Gi20:ffiP.""'l'j"
f<;:.'!:.;":<,;ti:_';~'l>f"i\",~}l,)ii":"J':::,'~< . (0._ .',' . __-,L;;_f~'}:~1~Vl~;,,:::tr{y,~j?-!r<~'!:t~f~W\:r~
1~,:_~,~,~~:~t~~"iE~B~~'ilg~)J.~~Y;i'~:~~t~';~~Il.~I'gi~~:I~',:;:;:&~~'~}}il:~~:.~1~~t{;
I Residential, per unit, service included: I,
11,000 sq, ft, or less (4) $134,00 $ I
I Each,additional 500 sq. ft. or portion I
thereof $ 25,00 $
I Limited energy (2) $ 32,00 $ I
I EaCh.,manUfaClUred home or modular, I
dwelling service or feeder (2) $ 63.00 $
I Servi,ces or feeders: installation, alt~'ration, relocation I
I 200 ~mps or less (2) $ 81,00 $ I
I 201 to 400 amps (2) $ 95,00 $ I
I 401 to 600 amps (2) $158,00 $ I
I 60 I to 1,000 amps (2) $205,00 $ I
lOver 1,000 amps or volts (2) $469,00 $ I
I Reconnect only (2) $ 63,00 $ I
I Temporary services or feeders: insiallation, alteration, relocation I
I 200 amps or less (2) $ 63,00 $ I
I 20 I !o 400 amps (2) $ 87,00 $ I
I 401 to 600 amps (2) $126,00 $ I
I Over.,600 amps or 1,000 volts, see se~ices or feeders section above I
. ,':1 I Bran'ch circuits: new, alteration, extension per panel I
I I a. Fee for branch circuits with purch~se of a service or feeder fee: I
I, I Each branch circuit I I $ 6,00 I $ I
I I b. Fee for branch circuits witho.ut purchase of a service or feeder fee: I
I I First branch circuit (2) " V;/" $ 55.00 $ I
I I Ea'ch additional branch circuit ".1 L $ 6.00 $ I
I I Mis~'ellaneous fees: service or feede'J. ':lot included I
I I Each pump or irrigation circle (2) $ 63.00 $
I I Each' sign or outline lighting (2) $ 63.00 $
I I Sign~L circuit or a li~ited-energy panel, $ 63 00 $ I
~ 1\ alteration, or extensIOn (2) .
1 \';'.'i'{JI.1'OCAL;:.GO\1ERtIIMENT>,'~f1F!ROVAI5~iAr-if!;;<~ln:;W';T;I
I Zoning approval verified? 0 Yes 0 No I
li{h1%:;.~t,;;;;iif;cA IE G 0 R.Y.lf'01'.i(C0 fIIST:RUCTl0N%;;1-<;:j~~,' "j.~\ I
I ~esidentjal I 0 Government I 0 Commercial I
~~~ir':(OBiSrl1E~1IN~ORNi,6;ml()tIIi~~fII0~\1!0:CAti0f11~~~':iI:~1j,1
I Job site address: ::2..to Sip 3. ~ (' . I
I City:S(?-C(.)- I StateO..-'C I ZIP: Ql'07!
I Referen~e: ~ 'l{)'2.\ c{'3\ 1 Taxluta1\~ I
f',':'""':" ~::> "" '0 ESCR./PT/ON 'O.F ':W. 0.. R K'I:.,,::p.;,";,;q""''''''''''''1
.. ", ,..< _ <'._ -,,:', -, _-_,,_-'~'r_:~1~U,:.;,~\_:;,,;.,_,_~::!:,,"
.T>..t.c...+-te.<;;s l-kcd-'~ ,^"p I
I ~ ClV"CLL\.+r I
I " ;PR0RERTY'..OWfIIER ' . 'I
I Namel2.cc V\.... tC-e,t? ~ I'T I
I Address ;)...&, S'lo 3, ~ ,...~ I
I City c:.v7h. J - I StateOrH_ I ZIP:q'7'l7< I
I Phune:'54 L-7'(1" 2...P-'1 I Fax: I
I E-mail: I
This installation is being made on residential or fann property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, ur rent. OAR
479,540(1) and 479,560(1),
Signature:
I. '.:;CONTRACi;oR'INSTALlf!..T:I\DN' "
I Business name: DWK--e.r
I Address:
I City
I Phone:
I E-mail:
I CCB license no,: I BCD license nu,:
Signing supervisor's license no.:
Print name of signing supervisor:
State:
I Fax:
I ZIP
Signature of signing supervisor:
\5J~0~
0~~
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMH NO: COM2009-01412
ISSUED: 09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/29/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 P~une'
541-726-3676 Fax ,
541-726-3769 In~pe,c;tiun Liue
SITE ADDRESS: 2656 33RD ST
ASSESSOR'S PARCEL NO.: 1702193100908
"
Springfield TYPE OF WORK: Heating System
,
"
PROJECT DESCRIPTION: Install ductless heat pump in residence.
TYPE OF USE: New
Residential
Owuer:
Address:
KEPHART RONALD G & MINDY A
2656 33RD ST ',"
SPRINGFIELD OR 97477
Phune Number: 541-729-0470
I. CONTRACTOR INFORMATION I
Contractor Type
Electrical
, Mechanical
Contractor
OWNER
J COO INC
License
Expiration Date Phone
169209
BUILDING INFORMATION ~
04/12/2010 541-746-7065
# uf Units:
Primary Occupancy Gruup:
Secundary Occupancy Gruup:
Primary Cunstructiun Type
Secundary Cuustructiun Type:
#uf Bedruums: '
# uf Sturies:.
Height uf Structure
. Type ilf Heat:
Water Type:
Rauge Type:
Energy Path:
Sprinkled Building:
Lut Si~e:
Sq Ft1st Fluur:
Sq Ft 2nd Fluur:
Sq Ft Basement:
Sq Ft Carage/Carpurt
Sq Ft Other:
Occup~nt Luad:
ula
I DEVELOPMENT INFORMATION I
Fruntyard Setback:
Side 1 Setback:
Side 2 Setback: '
Rearyard Setback:
Sular Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd: '
% uf Lut Cuverage:
REQUIRED PARKING
Tutal:
Handicapped: I
Cumpact:
I ~UBLIC IMPROVEMENTS'
Street lmpruvements:
Sturm Sewer Available:
Special Instructiun:
Sidewalk Type: to
' '(es ,/o\l.,
Duwnspuuts/Drain-s:\\l1 gon utIlI\'! h
\'\. o(egO\l ,~. tne ON set 101t"
, p-"\'I\:.\,\\IO ~clollted O'/se l\lles ale 95'2,,00'\"
10110~J 1~~~Scente(. ,\~~~(O\lgn Oit~e (\lIes 0'/
. \,\ollllca '5'2.00'\ .00 'I' collies 0 telellnone
In OP-R ,7 \lllla,/ ootal I\,\ote: tne \'\otlii$:at\on
090. ,0 entel. \ utIli\'!
o callIng t~e( ~ne 0Ie~~~.33'2.'2344)'
. n\lI(\Oel c~ntel Is '\-
""f'('E
Notes:.... Ii.... :.. .
'IS PERMIT SHALL EXPIRE IF THE WORK
JTHOfllZED LJND,'ER THIS PERMIT IS NOT
Oiv1:JiENCED OR ISABANDQNED FOR
.NY 180 DAY PERIOD,
Page 1 uf3
..
Status . Issued,
.:.. ,
225 Fifth Street,'Springfield, OR '
541-726-3753 Phune
541-726-3676 Fax'
541-726-3769 Inspectiun Line
I V ~Iuation De.~crintion ,
,,.'
"-', .
Descriptiun "', Tvpe of Cunstructiun
$ Per Sq Ft
ur multiplier
Square Footage
ur Bid Amuunt
Tutal Value uf Pruject
L.Fl'ffl P,il\J
Fee Description., .. \
. '. \. ~.
+ 12% State Surcharge
+ 5% TechnulugyFee
1st Appliauce
+ 12% State Surcharge
+ 5% Technulugy Fee
Add, Alter, Extend Circ
Add, Alter, Ex~end Circ Ea Add
Amuuut Paid
$9.48
$3.95
$79.00
$7.32
$3.05
$55.00
$6.00
Tutal Amuunt Paid
" . .
$163.80
I Plan Reviews I
Date Paid
9/23/09
9/23/09
9/23/09
9/29/09
9/29/09
'9/29/09
9/29/09
CITY Ot< ~J:'RINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01412
ISSUED: 09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/29/2010
VALUE:
Value
Date Calculated
Receipt Number
,
1200900000000001088
1200900000000001088
1200900000000001088
2200900000000001110
2200900000000001110
2200900000000001110
2200900000000001110
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 ,
~n/~nl'l'tiow
Ruugh Mechanical: Priur to. Cuver
Final Mecha,!ical: When all mechauical wurk is cumplete.
Ruugh Electric: Priur to. Cuver
Final Electric: ' Wheu all electrical wurk is cumplete.
Paee 2 uf 3
Status
Iss u ed
,
225 Fifth Street, Springfield, OR
541-726-3753 Phune
541-726-3676 Fax
541-726-3769 Inspectiun Line
"I:
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01412
ISSUED: ,09/23/2009
APPLIED: 09/23/2009
EXPIRES: 03/29/2010
VALUE:
By signature, I state and agree, that I have carefully examined the cumpJeted applicatiun and do. hereby certify that all
infurmatiun hereun is true and currect, and I further certify that auy and all wurk perfurmed shall be dune in accurdance with
the Ordinances uf the City uf Springfield and the Laws uf the State uf Oregun pertainiug to. the wurk described herein, and
that NO OCCUPANCY will be made uf any structure withuut permissiun uf the Cummunity Services Divisiuu, Building Safety.
I further certify that unly cuntracturs and empluyees who. are in cumpliance with ORS 701.005 will be used un this pruject.
I further agree to. ensure that all requiredinspectiuns are requested at the pruper time, that each address is readable frum the
street, that the permit card is lucat~d at the frunt ufthe pruperty, and the appruved set ufplanswill remain un the site at all
times during co.nstructioMn. !
~ol-d Ci/~f\0~
Owuer ur Cuntracturs Signature
j.(
"
Paee 3 uf 3
q~ 2f-() Y
Date
225 Fifth Street
Springfield, Oregon ?,?,477 .
541-726-3759 Phon~ .
Job/Journal Number
COM2009-01412
COM2009-01412
COM2009-01412
COM2009-01412
Payments:
Type of Payment
Check
cReceint 1
....'
" .. . RECEIPT #:
2200900000000001110,
. Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5,% Technulogy Fee
',+'12% State Surcharge
:;
l:heck Number
Batch N,umber
;PaidBy' ,.
KEPHART CONSTRUCTION
Received By
NJM
'.
"
Page 1 uf 1
City of Springfield Officiill Receipt
.Development Services Department
Public Works Department
Date: 09/2912009
Item Total:
Authorization
Number How Received
7782
In Person
,
Payment Tutal:
1:42:56PM
Amount Due
55,00
6,00
3,05
7,32
$71.37
Amount Paid
$71.37
$71.37
9/29/2009