The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2009-10-23 , ElectriCal Permit Application li;'st!6~~~5Y~EN:f,'U~'E;ON[Y;, .;"'1 'I pf~/;:;;tz.oo" -Of 5' sg I I Date: (0- 23 -0 '7 225 Fifth Street. Springfield, OR 97477tPH(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 within 180 days of issuance or if work is!'suspended for 180 days. ' , ""'oeAl' GOVERNMENT" A'''''ROVA''~''''"'jj"I' M".' 1 """'i'-'''~'--1"'''7'''''''''''''''''EEl!S'CH' ED':"'E7-"~'''<'''7':1'''''_''''''W--.:;;I ';i~i,-;J' " : ' ,'~;~ '-.; _,' _ ' . ~;~~r:~:- _ . '. ~~~?~;L~',,,4~} ~~-~/ r~~'E!i:.~~'WiB,;,:t~tJ5ri;~,:0;~d 17, __-':jf", ____' _q.] __J:~~11'f~1~';f'.-;)I,Lji[:JY~t%'rl'1~..i}',~~T$1f1 I Zoning approval verified? 0 Ves 0 No I ;~Uni_~e?o!;ij,i~fai~:~~:p'~r:itl~:i-rf;;IQ!rl ':f:iJ~t":::;I)?'0t3)":1 IJi.:B~if~i:i;.HcATEGORYiiOI7J"<::ONSJI'RU()"[ION::,,~t;"~f;:>';?"'I ,.",.", ...."", "d....," ,'n;.",'. "t" ,-" ."""ea.,,,",, ',., ,c.ost,,, I Residential, per unit, service included: I ' i~~~~;~~~~,:r:E:~'N~~R~~~7;N~;ANjjli~~()~ii7;~~~~~~!i 11,000 sq ft, or less (4) $134,00 $ I I r ' I Each additional 500 sq. ft, or portion $ I Job site address: '70'?} n<t- J rU /,{, u/ thereof $ 25,00 I City: '9LJr;,)/'/FI~L D I State: 0 R. I ZIP: I Limited energy (2) $ 32,00 $ I I Refere~ce I~ 6:5 27l( Z I TaxlotOO30 I I I Each manufactured home or modular $ 63,00 $ I i'p,k"i(!'::,';:"",'DESCRIP'tION/OF'WORK'l!!';iii>'i;':':,"f<::~,;,,(,;n;1 dwelling service or feeder (2) )J . L::' ."~, i ('J ~ . . " ',,- , ."." -. ;1 'I I Services or feeders: installation, alteration, relocation I 'C. uJ oJ<'-r i/ / c.....,",- , I I 200 amps or less (2)_\: Oft i -n $ 81,00 $ Sf I I Name 5<1- ~ ;PRoeER~~d~R." '~;E~O~J~e J~~~;t~:w: :1:::::: I Address: . :fljD g.el- 3 3t/~O y", /1/ .e.10~~~;-ce It in ~"~,a~~s bY $205,00 $ I City: Cf-<. S W -t./ / ~ Slate: tp R I ~~~~:i~ ~- ~~JMl\~!v;. $469,00 $ I PhoneS'II-81,<;'- 9-e-ifl(" I Fax: _ _ 0090;,,;~~ne:eltgI:C~~~rR\\t.ty:~O\\~1 $ 63,00 $ I I E-mail: . Co.("";;,{ 'ot Ln~ .fPJ:~RP~tr feeders: 'installation, alteration, relocation l' ~"rfibe "II" \ , " .' v'" ., ,,00 amps or less (2) $ 6300 $ I This installation is being made, on residential or farm prop~rty _ " owned by me or a member of my immediate family, This 201 to 400 amps (2) $ 87,00 $ I property is not intended for sale, exchange, lease, or rent OAR 479.540(1) an'YJ9560~) _!; JI'!},7 1<_ J /. 401 to 600 amps (2) $126,00 $ I SIgnature: ~ 1(;!/lU-/1 Over 600 amps or 1,000 volts, see services or feeders section above I I Busin~;"n::~N1;:'~Rl~AtlAT'ON:' 'I : :r;::~o:i:::~~~ ~i::~~:(:~~::r:~:s:s~~::::,::e~r feeder fee I Address: Each branch circuit 13 I $ 6.00 I $ 17\ I City: ,I State: I ZIP: . I b, Fee for branch circuits without purchaseofa service or feeder fee; I I Phone: I Fax: I First branch circuit (2) $ 55,00 I $ I I E-mail: . \ I Each additional branch circuit... $ 6.00 I $ I I CCB license no.: 1 BCD license no.: 1 I Miscellaneous fees: se~ice or feeder- rLOt included I I Signing supervisor's license no,: n)1 J."ih PS,,::o:~t~et;;~'TH"i''''i'E:'''''''i'''O'I$$ 6633',0000 $$ II I Print name of signing supervisor: ,~ Ht ~n }lr""'Jr W ~ I Signature of signing supervisor: 111~~ Bb,c~~.;' 0 rfiRMlll,I' N\.J ~,$.63,00 $ I CAON ,~~\i~t~~.!~I~'I5:ctlOn:, (I'^CI)...., <' - ~."".. $~~~""'$ .' _., II %-,,!.:,",;.x"''''J;}~~it:.{ j,~"'.:oE~~AF?~1l ANT~lISE~"f'n1f,1\'E;'1" '1,~~1.I/fq,'f4'}J' "- (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) ,I (B) Enter 12% surcharge (,12 x [A]) I (C) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A through C): ~'~ ~~ ~ 440.2584-J (9/08/COM) "'$ '1 i $ 1/88 $ f./ 1ST $/} stjl Status Issued 225 Fifth Street, Springfield; OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 708 FAIRVIEW DR ASSESSOR'S PARCEL NO;: 1703274200301 CITY OF SPRINt.l'lJ<,LD Building/Combination Permit PERMIT NO: COM2009-01558 ISSUED: 10/23/2009 APPLIED: 1012312009 EXPIRES: 04/23/2010 VALUE: Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace panel and add 3 circnits Owner: ' RIDDLE SAMUEL W & SHANNON M Address: 81086 SEARS RD COTTAGE GROVE OR 97424 Contractor Type Electrical CO,ntractor OWNER # of Units: Primary Occnpancy Gronp:': R-3 Secondary Occnpancy Gronp: Primary Constrnction Type <, VB Secondary Constrnction Type: # of Bedrooms: ' Frontyard Sethack: Side 1 Setback: Side 2 Sethack: Rearyard Setback: Solar Setbacks: Street I~provements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction I CONTRACTOR INFORMATION I 14~S '1v~ '~i\'f \S". te~~t'li~'i~~Expiration Date Phone "at' .~e at e S'" ^"," , ,."a" ~ ",.n ~ _e. tt '''''''''l:'' ' 'j;])" &r~".,~;F ~ea'" p..4'1f.l1I( (~fl,Ult'.II'_I~~b-u).\e~ot'e . \0\\0'" a\iot'ce ~.ofl' r:.09\e'6 \e.ev'~(\ ~O\\\iC~'b~~i'tle .~(\ IN.o\e', ~e ~o~ Lot Size: \t' aj>.\'ofl )i&l1JIlb'f' ~ctl/r~ \)\\\~,. Sq Ft 1st Floor: ~gO'ET~ ~C)te~:'..dl:' Sq Ft 2nd Floor: c#- ~ ,~- Sq Ft Basement: (\~ n e: 'Sq Ft Garage/Carport Energy Path:'- Sq Ft Other: Sprinkle<! Building.........,," n/a Occupant Load: , / , DEVELOPMEN~ INFORMATION' REQUIRED PARKING Overlay Dist: '" .'" , ..",Total: . # Street Trees Rqd: ' "",',";it,~?!iif':'H~l~ped: ~:~~dL~:'~:v~~:~e~,:",,:';i~~;\;\~~~~~: ,,' , 1F-.."C\~~' ~;r! f;..~~ t7,"{v..~'O o..\t:~ ~ I PUBLIC IMPR~II11E1l'~1O \)~~ \'0 f>.~~~V , . . f>.\\ ~~'t.~C't.~ ~Xlk Type: C~'{ '\'O() \l~ Downspouts/Drains: I Valuation DescriDtion , $ Per SqFt or multiplier Square Footage or Bid Amount Value: Date Calculated Pa~e 1 of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01558 ISSUED: 10/23/2009 APPLIED: 10/23/2009 EXPIRES: 04/23/2010 VALUE: 225 Fifth Street, Springfield,' OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees P,aid I Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Ea "Add Perm Serv/Fdr 200 amps odess Amount Paid Date Paid Receipt Number $11.88 $4.95.. $18.00 $81.00 10/23/09 10/23/09 10/23/09 10/23/09 2200900000000001217 2200900000000001217 2200900000000001217 2200900000000001217 Total Amount Paid $115.83 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 sa:me working day, inspections requested after 7:00 a.m. will be made the following work day. ' I Rellllired Inspection~ I Rough Electric: Prior to Cover Electric Service: Ap~roval required prior to utility company energizing service. " Final Electric: When':all electrical work is complete. :l By signature, I state and agree, that I bave carefully examined the completed application and do hereby certify tbat all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of tbe 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 are in 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, tbat 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. ',I /~~ 1L/ ~ " . 1:1 .- L '3 ~o 7 Owner or Contractors SignaJure Date Page 2 of 2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal'Number COM2009-01558 COM2009-01558 COM2009-01558 COM2009-01558 Payments: Type of Payment Cash Change Job/Journal Number COM2009-0 1558 COM2009-01558 COM2009-01558 COM2009_01558 Payments: Type of Payment Cash Change cReceintl " RECEIPT #: "~R1N<!~J"'-'!_' ;L)A n ..".,. City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000001217 Date: 1 0/23/2009 Description Penn Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge Paid By SAM RIDDLE SAM RIDDLE Item Total: L:heck 'Number Authorization Received By Batch Number Number How Received djb In Person djb In Person Payment Total: Description " Penn Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% T~chnology Fee + 12% State Surcharge Paid By SAM RIDDLE SAM RIDDlcE Item Total: L:heck Number Authorization Received By Batch Number Number How Received djb djb In Person In Person Payment Total: , ' Page I of I 1:30:52PM Amount Due 81.00 18,00 4,95 11,88 $115.H3 Amount Paid $120,00 ($4,17) $115.H3 Amount Due 81.00 18,00 4,95 11.88 $115.H3 Amount Paid $120,00 ($4,17) $115.H3 10/23/2009