HomeMy WebLinkAboutPermit Electrical 2009-10-26
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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, .
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1""'t""''''a,O' '8' '''S'''I''E''I,'N'''O'R'M''A''",'I'ON''''A'N-HD-,,'.rO''G'A''''I'O'N'1i:oW"'''''~1 11,000 sq, ft. or less (4) $134,00 $
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I Job site address: I/' Lf15 ~ . 1 ~~~~6tditionaI500 sq ft. or portion
1 City: _ ~ 1 State: ;;;; I ZIP: 17,/1 t 1
. 1 Reference: '~~ I Taxlot.: I
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I .:V., C 'PRORERTY,OWNER'..' I
I Name ~ ~~ I
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~ I Sa,: 1 ZIP I
. . 1 Fax 1
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Over 600 amps or 1,000 volts, see services or feeders section above
'I I Branch circuits: new, alteration, extensio~ per panel
I I a, 'Pee for branch circuits with purchase of a service Of feeder fet:;
I I Each branch circuit I $ 6.00 1 $
I b. Fee for branch circuits without purchase of a service or feeder fee:
1 First branch circuit (2) $ 55.00 $ 1
I I Each additional branch circuit $ 6.00 $ I
/}o- t{$/ C. I I Miscellaneous fees: service or feeder ':lot included I
I I Each pump or irrigation circle (2) $ 63.00 $ I .
I 1 Each sign or outline lighting'(2) $ 63.00 $ I
I Signal circuit or a limited-energy panel; $ 63.00 $ I
alteration, or extension (2)
Each additional inspection: (I) 1 $58,00 $ 1
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Electrical Permit Application
22SFifth Street. Springfield, OR 97477. PH(541)726,3753+FAX(541)726,3689
Address:
City:
Phone:
E,mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for'sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
I '. .:tCONTRAGlOR:INSTAll::ATION;,t
I Business name: iC~1l ~
1 Address It? 1/.i Q 7~ ;t'_,";
I City: C:L~ nA-k I State: ~ . 1 ZIP: <f7f!t1f
I Phone: 1 72-1'-/6'ODI Fax:
I E-mail:
I CCB license no.: 6 ;(3'17 I BCD license no.:
I Signing supervisor's license no.: C(I(S' .,r;
I Print name of signing supervisor: /i.rt{...fJ I! /3 row/V'
I Signature of signing supervisor: ~ ~.
1
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440,2584,) (9108/COM)
$ 25.00
$
Limited energy (2) $ 32.00 $
I Each manufactured home or modular (' $' 63.00 $ /. <? I
dwelling service or feeder (2) . LV ~
I Services o{f~ede~if;:nstallqtipJ!J plte.!:S!Jion, relocation_< I
I 200 amps or kSs (2) t;;;--tItf./ -eI-$-~~ I
1 20 I to 400 amps (2) $ 95,00 $ I
I 40 I to 600 amps (2) $158.00 $ 1
I 60 I to 1,000 amps (2) $205.00 $
lOver 1,000 amps or volts (2) $469.00 $
1 Reconnect only (2) $ 63.00 I $
I Temporary services or feeders: installation, c;zlteration, relocation
I 200 amps Or less (2) $ 63.00 $
I 201 to 400 amps (2) $ 87,00 $
40 I to 600 amps (2) $126,00 $
(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])
1 TOTAL fees and surcbarges (A through C):
$&3
$ ';' '"
$ '3 i.:?- I
$ 73:L1
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line.
SITE ADDRESS: 4475 DAISY ST SPACE 99
ASSESSOR'S PARCEL NO,: 1702323406500
CITY OF ~rKll\i\.jl'lELD '
Buildi~g/Combination Permit
PERMIT NO: COM2009-01564
ISSUED: 10/26/2009
APPLIED: 10/26/2009
EXPIRES: 04/26/2010
VALUE:
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Add electrical feeder- see C9,1519
TYPE OF USE: Alteration
Residential
Owner: EASTMAN SHIRLEY D
Address: 4475 DAISY ST SPACE 099
SPRINGFIELD OR 97478
Contractor Type
Contractor
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Sethack:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
. Notes:
Description
Type of Construction
.:~..... "nIl to
__ ._,1""'\",\. nH~aon \.al/" l......;.,-~'.:.....nn Uli\\ty
A 1'€ONIRAGI.OR:INFORMATlm"/"Iort\1 ,
10\,:'," '. Genter, "'vo-" AR 95~,001-
NO\lllc;~~~'001'Oo1~thrOui~~eic.\l.OSelle5 bfi;xpiration Date
~~~~ YoU may obta\~~~f'l'lhe telep\1One_
, . p~l'JJ.L~MiJJ"""~Nri~\,ou,,"'~"-"
Ill! I ~' 1Io'''IJ''&d!Y;J\).
I U .. r.entel is '.IlV ....
# iJrStories:
Height of Structure
Type of Heat: .. '
Water Type:~ ~--- .
Range Type:
Energy Path:
Sprinkled Building:
n/a
Phone
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft.Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
"I ,DE\VElJOPMENT INFORMAil'J'iW.tNORI<.
~H\S 'PERM\1 ;,rl~l.~"~~\S ~ERM\1Ts NOT
AU1HomN\:l:1a~~i: .l\RANOONEO fOR
COMMPt.~[OtOO~ Rqd:
y 1 BR"i'lWlQliJlU\il~:
AN ~o of Lot Coverage: .
I PUB~IC IMPIWVEMENTS I
:.'
I ValuationDescription I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Paee 1 of 2
REQUIRED PARKING
Total:
Handicapped:
Compact:
~:I- .
Sidewalk Type:
DownspoutslDrains:
Value
Date Calculated
s"m,IIol"''i'''''LD'
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01564
ISSUED: '10/26/2009
APPLIED: 10/26/2009
EXPIRES: 04/26/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of projec(
F~~~ Pa,i~ I
Fee Description
+ 12% State Surcharge
-+; 5% Technology Fee
Mannfactured Home Feeder
Amount Paid
Date Paid
$7.56
$3,15
$63,00
10/26/09
10/26/09
10/26/09
Receipt Number
2200900000000001225
2200900000000001225
2200900000000001225
Total Amount Paid
$73.71
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.
I nC'cll,"ed In<oection<.
11,..i1 II. I"" IT" ,OL
MH Service: Approval required prior to utility company energizing se""ice,
Final Electric: When all electrical work is complete.
By signatnre, I state and 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 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 only contractors and employeeswho are in compliance with ORS 701.005 will be used on this project,
I fnrther 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
timesd1iZtion. ~~, {Jet 2& /09'.
Owner or C/ntractors Signature Date /
I.
Pae:e 2 of2
225 Fifth Street
Springfi!;ld, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009,O 1564
COM2009,O 1564
COM2009-0 1564
Payments:
Type of Payment
Check
cReceintl
.,
RECEIPT #:
Date: 10/26/2009
2200900000000001225
Description . .
+ 5% Technology Fee
',+ 12% State Su~charge
Manufactured Home Feeder
Paid By
RALPH BROWN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc 2875 In Person
Payment Total:
Page I of I
2:40:29PM
Amount Due
3.15
7.56
63.00
$73,71
Amount Paid
$73.71
$73,71
] 0/26/2009