HomeMy WebLinkAboutPermit Electrical 2009-10-22
Electrical Permit Application
18:~;}:P~E~B'i'M.Ei'ff:u~:K ONty;;, ,';. '
I fe~t:1,lOb r- 0' Z- ~c)
I Date: /0 - Z l . 0 7
225 Fifth St",'+Springfield, OR 97477+PH(541)726-3753+FAX(541)726.3689
This permit is issued under OAR 918-309-0000, Permits are nontransferable, Permits expire if work is not started witbin 180
days of issuance or if work is suspended, for 180 days,
I:!':,";: ';"", H":orO' C, A., L;,'.,,:.GOV- ER N: M.E N"'. <',','A., 'PP.,.'R. '.O'._V.. A. 'L;-',;.,,~,,_,."',-",.,!it.{~!1,;_',!_'.:,,:,:,S'Y.'1 1"i':,1'\'i'1'if!t..:g'!-:r;~:!,""'S:t"'EE.I:S'CH'
E D.u"E:7V"Wf''''''''-'''\:ll!'';:;'''''~''~
L.;.; .' . . _. .... m "I . . L _ .. '...~", _ """'~'L' 'Y1!;,Bil::;:f2~.~",,'~'i-,.!i;:t.,j'~\b,,' r;~ _":&_ ,___ __' .,,?L:;;: _i4.::-,'ij,if,;W?\:r.!,;r;"EP.'j~$f!r!~';<-'\~;:'~if~~.1-!
'
I Zoning approval verified? DYes D No I I" ':.,',.-, ',' ,".,,",..,.,.,. """;""""'''''Io''-''TI ." cr"1 ''1' 't'l' .:'
:.,NilJriber\)f:insjieciio'n'rp'ttrjtern~C)';':X~ Qty.;' '\i.- ?~:;o,>~,;~ :'~/\.fJ __3, :,~" i
\'~:~~~h~R:~:~~:1?!}3~.CAtE G,O RY{~<:)F,~~,C()NS]RlJC;mbN~J:i%f:;~,R~'~~~i~.\i~ ,'~~~I ,',,";;"I!'; ,\"~,.,,,; ;,~~0:CL:'~,,', ~~~>t"j;>j~,.,~Y;,"(1?'"i:',j!;. y.:'\ip,>.?,~ ~.., ::,-,
',d:;;~.~!!''1,'''''': '< ': CPSt';.1':': ;'
. J Residential, per unit, service included: I".
~Residential I D Government I D Commercial I
!!'ii~JIiJ.oBliLSI;TIE~~INI;QRIIiI~JiI.oN~;'ANDml!b~A'lj10N;~~~~i1'1 11,000 sq It, or less (4) I $134,00 $ /1$11
1 .:iT I Each additional',500 sq. ft. or portion ( ~.
, Job site address; /tR ~ 5/ _ 'I thereof . $ 25,00 $ Z J I
I City: _ Jill'/) I State; !J I!... I ZIP; ?1'7'?-'1-8' I I Limited energy (2) $ 32,00 $
Referenc~,r~~s~~~ot'E)F,wd~K~~~:;,0;~,~~~i I ;~~~li~~nS~;~~~~r~~ ~~~:r (~)odular $ 63,00 $
l \ Services or feeders: installation, alteration, relocation
REme f)L~ AJ/D ft!/,{ll/)C.E.u::r :iJf/7E1> er,ec.:n'T.h1Yr
I I 200 amps or less (2) $ 81,00 $
''''C.bV?rff:-A-Z' 11.V1t2rpC:: '
;:f>ROI"ERJiY,:OWNER ",,-,,I I 201 to 400 amps (2) $ 95,00 $
I Name:a)EPt' C //rLPc-/?5 /:;TTfNr/~ 401 to 600 amps (2) $158,00 $
I Address;! (p of $/ a No;:~::~ule~~, ~901\,9~~.a::ps (2) $205,00 $
I City; S.;J f JJ 1 State: !lIe.. I ZIf;,~'i;/j}~el iWJB~~~~gl#tellt~..~ $469,00 $
~J.7;- "')1 ~lo~p l1~"/'/Ol1ho'- I
I Phone5if -91f--003Z.. I Fax' _ _ C811;~~OUrnav~~./4JIiiii'j;,.!!;. vlilm, $ 63,00 $
I E_mail;.-.._f~I:.U~rnU...b...11I9C>II1I~.f.flP-l4if--..;..il16llt..lns/allatlOn.alleraIlOn. relocallon
1N'-lLJ1)/aerS{VJC.u2Qn,c>Jre,rJii!.7" erfn." Jf.1 ''';.1\11 ~f'
ThiS installation is bemg made on residennal or farm proP~t '. / (~~."'(lIiffei" rules '.Is' $ 63,00 $
owned by me or a member of my Immed13te family This er ~ 1"WJai! If~NOll!I1Ol1e $ 8700 $
property IS not mtended for sale, exchange, lease, or rent. OAR ~1'll4:Q1iut, ,
479,540(1) and 4')9,560{l), /1 ' 401 to 600 ampyl..2) $126,00 $
Signature; ~Q{ -" ~ \ ~~ A Over 600 amps or. 1,000 v'oits; see services or feeders section above
I ,... "';"CQNTR.;C:j;OR"INSrJl.ttA:rION:", ':' ,:': ;'1 Branch circuits: new, alleralion, extension per panel
I Business name: I a. Fee for branch circuits wi,th purchase of a service'or feeder fee:
I Address: Itle-'t.- I 1 Each branch circuit 1 $ 6,00 1 $
1 City: OV I State: 1 ZIP: I I b. Fee for branch circuits without purchase of a service or feeder fee:
I Phone: I Fax: I I' - First branch circuit (2) $ 55.00 $
I E-mail: NOTlr.f:. I I Each additional branch circuit $ '6,00 $
CCB license no,: 1 BCD licen~Jl,S PER~A_': I Miscellan~opS.f:e~:,s,:,rvice or.feeder not included
Signing supervisor's license no,: " I HORllE l ~atJon C1fcle (2) , $ 63,00 $
I Print name of signing supervisor: A~'Ivt~NCED OR I R TII:N8~lih~'l.WQt;U~g (2) $ 63,00 '$
I Signature of signing supervisor; ., 1-Ju UAY PERI D~ ~lt~W@~m~~tenergy panel, $ 63,00 $ I
I Each additional inspection: (1) I. $58,00 I $ I
.1~;~lL~~~f!ff~~~~~'R~iHc~Nt~lOs~Ewt~i~li~ffJ~~~8r4~:i,~{~~;~I
(A) Enter subtotal of above fees
(Minimum Permit Fee $sf:lt6)"
,/ (8) Enter ]2% surcharge (,12 x [A])
I (C) Technology Fee (5% of[AJ)
I TOTAL fees and surcharges (A through C),
,.,....,l~(.:: Tv collet"+
, V S%
,.z%
~~~.O\
\~:V~
~~
440-2584-1 (9/08/COM)
$ /5;
$ 11 0 ~
$ 7"~
$ / Bhl~
I~,o~,
'Z.'~
_~I';!c\J"'!I!1l1F,'!,~;,
~. ..,
Status
Issued
CITY OF ~rtuNGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01280
ISSUED: 10/14/2009
APPLIED: 08/31/2009
EXPIRES: 04/15/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspectiou Line
SITE ADDRESS: 160 51ST ST
ASSESSOR'S PARCEL NO.: 1702333203700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Hazardous Wiring Complaint
Owner: CHILDERS MICHAEL R & WENDY D Phone Number: 541-914.0032
Address: 160 N 51ST ST ATTENTION: Oregon Jaw requires you to
SPRINGFIELD OR 97478 follow rules adopted by the Oregon Utility
__ .... . _. ."-__ "'1...__.. ...,,1.~............~"""""''''
I''-'U''.........~.'.... ..._.~._.. .---.-
"'~,3-;i,;;;~2-001.
~'~"AV~le8bY
calling the center. (Note: the telephone
Contractor Type Contractor number for the Oregon utflli~catlib:piration Date Phone
Electrical OWNER Center is HI00-332-2344).
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Coustruction Type
, Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories: Lot Size:
Height of Stru,cture Sq Ft 1st Floor:
Type of Heat:, ' Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
, '
Range Type: Sq FtGarage/Carport
Energy Path: '. ,', _,-",'p;",;iji,';,:""'i"'" Sq Ft Other:
NOT,~.inkled Btii.iding: .. \1= 1'R! WOl\'&ccupant Load:
~...'..u~'jXIrC\ :-!,If.M-=- ':"tll~r ~,M\J ",16:1' '
I JIII'l\<ELtJ iji[NiI\,~Tl.('}i,:lfOR
IJI, ,c~r, '--- IS ABM~0LI~f:...
COMtA~~~ED 9RRIOO.
ANY 1A!Ir~S'Rqd:
Paved Drive Rqd:""-.,, ,
% of Lot Coverage: '
REQUIRED PARKING
Total:
..u.~pdicapped:
, ~o,mpact:
.~.. .
I PUBLIC I~PROVEMENTS I
Street Improvements: Sidewalk Type:
Storm Sewer Available: DowuspoutslDrains:
Special Instructiou:
Notes: \~
Iv ~luatio~ Descriotioo I
Description
Type of Construction
$ PeT Sq Ft
or multiplier
Square 'Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of2
Status
Issued,
CITY OF ~rK1N\jf<lJ<.,LD,
Building/Combination Permit
PERMIT NO: COM2009-01280
ISSUED: 10/14/2009
APPLIED: 08/31/2009
EXPIRES: 04/15/2010
. 'VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total V~lue of Project
F~e~ P~id I
Fee Description
+ 12% State Surcharge
'I- 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
+ 12% State-8urcharge
+ 5% Technology Fee
Other Electrical Permit
Amouut Paid
Date Paid
Receipt Number
$16.92
$7.05
$60.00
$81.00
$2,16
$0,90
$18,00
10/14/09
10/14109
10/14/09
10/14/09
10/22/09
10/22/09
10/22/09
1200900000000001142
1200900000000001142
1200900000000001142
1200900000000001142
2200900000000001207
2200900000000001207
2200900000000001207
Total Amouut Paid
$186.03
I Plan Reviews ,
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 Reouired Tnsneetions'
111.1 I I Y
Rnugh Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Electric Service: Approval required prior to utility company energizing service.
By signature, I state aud 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 Ordiuances 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 only contractors and employees who arecin 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.
dd~.,d aj7~
. Owner orCo~tractors Signature
/O~09
Date
Paee 2 of2
22~ Fifth .street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 J 280
COM2009-0 1280
COM2009-01280
Payments:
Type of Payment
Check
cReccintl
- "i~O.,y"..IlU>.',_'......, ."...
~., ,
. ; ; ,
~._..' .... ,." ~L .'
, _ ."_.. ,~.,.L .
City of Springfield Official Receipt'
Development Services Department
Public Works Department..
RECEIPT #:
2200900000000001207
Date: 10/22/2009
Description
Other Electrical Penn it
+ 5% Technology Fee
+ 12o/~ State Surcharge
Paid By
WENDY D CHILDERS
Received By
djb
r
Page I of I
Item Total:
Check Number' Authorization
Batch Number Number How Received
2023
In Person
Payment Total:
8:43:13AM'
Amount Due
18,00'
0,90
2,16
$21.06
Amount Paid
$21.06'
$21.06
10122/2009
'/
~/ '~
.7
/l&rical Permit Application
-
225 Fifth Streett Springfield, OR 97477. PH(541)726-3753t FAX(541)726-3689
r[~ffDE~p;;TMENi1;\us'Efo. N~.y,:~1lll1
~i!"~:~'i' ',;1'3"iiM~t.,~.::,.",Y'w"/:"'(~"~""'~'-"'~':;'J"'i",v#.t,~&'3:i
I I; /) tAi I
' /'( ----U, ).~v
Permit no.: l.. 'I ::;/ c' .
'Date: / () /I'l/ () c) I
This permit is'issued underOAR 918-309-0000, Permits are nontransferahle. Permits expire if work is not started within 180
days ofissu~nce orif~o~k is suspended for 180 days.
I
I
I
I
I
I
I
I
I
I
I a. Fee for branch circuits with purchase of a service or feeder fee; J
Each branch circuit I tt) I $ 6,00 I $ 6> (}i. LTV
I b. FeeJorbr~ch circuits wit.hout purchase of a service or feeder fee: I
First branch circuit (2) I' $ 55,00 I $ I
Each additional branch circuit I $ 6.00 I $ 1
I I Miscellaneous fees: service or feeder not included I
I I Each pump or irrigation circle (2) $ 63.00 $ I
j I Each sign or.outline lighting (2) $ 63:00 $ I
I I Signal, circuit Or a li!TIited.energy panel, I S 63.00 I $ I
a1teratlOn, or extenslOn (2)
1I,."~~::~~~:~:,~.~~;~~~,~i~n:,~I)"y_",I_'.'..!'~~.$l"":~~~. ""I
~t1:fi~,;';;!fIt'&~~~,'l<(f,C'~.,jfJt!A~~(;a[C1(NjR:aUSE:r~~~,~iY.J~,.,g-~
I (A) Enter subtotal of above fees /j 1/1 G~
(Minimum Permit Fee $58.00) $ / ~" ___
I (B) Enter 12% surcharge (,12 x [A]) $ "1. q:>
I (C)Technology Fee (5% of[A]) $ / & ' ~ '2--'--
I TOTAL fees and surcharges (A tbrough C): $ .f (",4 1"7
1~=~::~~~V:;;~~~ERNM~~;eeRc:wg~~~~1
~~c;;'Ait!;G'OR:("fiQF,,'ll~<:)NSJ:RI:J,CillIQN~~~lf:!ti:'it~:1
!;~~~~~;lI~~~IN~~R~~~::~ND~k~c~~~;;;:41~~j
I Job site address: lIP 0 5/0:: I
I City: <;;I'-f.f) I State: 01<, I ZIP: 91-+7<9 I
I Reference: I Taxlo!.: I
"""'--""'~D. E'S..C' 'R'I""'I'O'N"'O,O="'W'O'R. .K""',::'N';C"",M'C;:,::," I
h~~~'E~~..lNh'y _ ~. '.m'. r.;iIL._ ~a_-"p':;1,--,-, .... 'c. <;;':.("',:\-> ',-'.:'~",:,~,;,',:", :.,
~M01)L~d 7?e4'Ac~ !)U7MTCD 'C!I:?cu/T
I flt< t.yt~ ,/'0112/,4X,
I:"'~.'_~'.wc~'~" 'O'"'ER""''"'' "'"""''''''''''''''''-''' ,,-,.
to;fi.'01Jti17i4e;;p~B&:~~~]~R'.r.; ,''::~lfiiiC)WNER~(~~'$'!il'2~1\~~}
I Name:/LJ.r.u'Y r:.d~U?M5
I Address:lbo 5/f/
I City: J?fJ:J
I Phone:91f -Yffo otJ3L I Fax:
I E-mail:LJjch ,'lofer"5(<J)('Ji'QJ.-J/I"e, 11-<'.1-
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, or rent. OAR
;;:::r~;O~~,.&~
l~mC:ONm~iTlO~INS.T:,6;I!~WI.ON~'11,\i;{f;;:lli
I Business name: '7
I ;\.ddress: --
I City' I State:," I ZIP;
I Phone: ' "I'Fax:
I E-mail: . "',.""
I CCB license no,: I BCD license no,: "",
I Signing,sup'e~isor's license no.:
p-ririf name of signing supervisor:
Signature of signing supervisor:
I State:
.:9 IC I ZIP; 7'94 r d" I
I
I
i4\
lDC; ,
\~~~
440-2584-} (~q ,
K~~~1}~:~Jfu~rkf~~~~~P,'if~~~,REE;.t~_SCHE:J!)W~Ei'~:;{\tn;;~,{:'~~N*FA;~,~~~1
t?B~T!f~r~~~~~!~~~~r~~t:H~~:~/~:0}~:~.rQ'~~.I:;::::~~~~>~irf'!~1~~~.r~::1
1 Residential, per unit, service,included:
'11,000sq,ft,orless(4) I
Each additional'SOD sq. ft. or portion
thereof .
$134,00
$ 25.00
Limited energy (2)
I Each manufactured home or mo4ular
dwelling service or feeder (2)
I $ 32,00
I
$ 63,00
Services or feeders: installation, alteration, relocation
200 amps or less (2)
I 20 I to 400 amps (2)
I 40 I to 600 amps (2)
I 601 to 1,000 amps (2)
lOver 1,000 amps or volts (2)
I ReCOIUlect only (2)
l
$ 81.00
$ 95.00
$158.00
$206,00
$469,00
$ 63,00
$ ?,
,'.' I.
$
$
$
$
$
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) I I $ 63,00 $
I 20 J to 400 amps (2) I $ 87,00 $
I 401 to 600 amps (2) I $126,00 $
lOver 600 amps or 1,000 volts. see services or feeders section above
I Branch circuits: new, alteration, extension per panel
$
-~
$
-~.
$
$
<.-"'-='