HomeMy WebLinkAboutPermit Electrical 2009-10-27
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I Zoning approval verified?" DYes, ,DNo 1 1'-N~ni;;e;~fi~i'~iti~'.;~f'.;rii~~'<')J)4'I'Qf:l<iSo~!\;f;;I ;"Total.:1
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1/:>.ifR 'd . I I 0' G ' I 0 'C ,'- I I Residential, per ~U1t, service Included: I '
LJ, eSI entIa ovemment ommerc;aJ
1~}~~OBiSlliE'lJNI1.0RM~j1HQJiI~JANDIJI10GA'ljION~1:r~ii'il [1,000 sq. ft, or less (4) I $134.00 $ I
I . 'I ? ( ? J - A ,J A . 1". ' , , ,I I Each additional 500 sq. ft. or portio, n $ 25.00 $ I
. Job sIte address: :> > L-7tl.l.... 1'-\ ULrt- thereof '
City: S:"?rb 1 State:OJL. 1 ZIP:"J7'1771 1 Limited energy (2) $ 32.00 $ I
I,~e~~~~~ce, !<~~S~iR~I~N?OF.WJJ~~~~;,~;;~,~~~,~ I ~~~l~:ns~~~~~r~~ ~e~~:r (~)odular $ 63.00 $
I -Ac1J. '~("CJA -, +. ~ ,;v-~' ,.~, iJ';~' '''[ I Services or feeders: installation, alteration, relocation
I ' I 200 amps or less (2) . $ 8l.00 $
I .. . ;RROP,ERT'hOWNER ,',,1 201 to 400 amps (2) $ 95.00 $
I Name: , T 0. \,.. ,0 17. WI N1-e i\... I 1401 to 600 amps (2) $158.60'- $
I Address - I~ f3 L I~ vO'\l1l1 0 " c" I'} Y(' '; .11601 to 1,000 amps(2) $205.00 $
1 City:S'f!, I State: =1 ZIP: cfq ~'l') 1 lOver 1,000 amps or volts (2) $469.00 $
I Phone: 4 ~ '\- _ <-\ :\'3t 1 Fax: I I Reconnect only (2) $ 63.00 1 $
I E-mail: - . ,I !emporary serv,ice_s ':iO[n~ers: installation, alte;ation, relocation
This installation is being made on residential or far~~vjlj:- r! '~e~~'!I\~LGbn Utility $ 63.00 $
owned b~ me or a member of my immedi~tefami ~ohmit -r~es a 0 :21'\lIilldINul1mJ;$ij) set forth '$ 87.00 $
property I~ not I ended for sale, elt;c n1" lease, <I'lgtiflcl'ltiml Ce 1t', tb ~, ~ 1lO;!'OO1-
f9.540(lt and .560(l~ InOAR952.()().loC04tO t ,:..~':1\R'eNll'lIby $126.00 $ .
Sig~atur~,. ,.,' " ,~ ,"~ _,'." II OO~~i' YOU me:' ~ ~~~~~f~tElWljJhOl\e, see services or feeders section above I
I ..- ('I';'CONTRACJ;OR'INSTAl:l:ATIOr:l'r.~E~e ::It.n~"~}\l~sm,n. extel1slOnperpanel I
I Businesslhame: t<.>IAI JoIFa ~r Ila1;l1l,j~~tits with purchase of a service or feeder fee: 1
I Address: - I I Each branch circuit I 1 $ 6.00 1 $ I
I CitY: ( State: ! ZIP: I b. Fee fof branch circuits without purchase ofa service Or feeder fee: I
I Phone: 1 Fax: I First'branch circuit (2), ( $ 55,00 $.rr'
I E-mail: I I Each additional branch circuit $ 6.00 $
I CCB license no.: I BCD license no.; J I MisceJla~eoils fees: service or feeder not included
I Signing supervisor's license no.: I I Each pump or irrigation circle (2) $ 63.00
I Print name of signing supervisor: I I Each sign or outline lighting (2) $ 63.00
I Signature ofsigningsuperviso'r: -1'1 Signal,'c, irc,u,ito,r,a,]i~ited:ene~gypanel,. $ 63.00 $
f1~rlGr; alteratJO~'Hre"t'.n,:!~n(2).
ATHIS PERMrr SHAlr:iH:~:"~'W ,^.,~!~'~".,:_,
;~~riN~~ ?!:!:"~_~.""~;:'
~~ '. (B) Enter 12% surcharge (.12 x [AD $ h 9i
\\):L:O~ (C) Technology Fee (5% o[[AD $ Z
~lb'(' TOTAL fees and surcharges <A through C): $ ~7 8
~
Electrical Permit Application
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I C:OW\z,oo't-OrS7L{ I'
Permit no.:
I Date: (0 - 2-7 -0 c:; I
225 Fifth Streel+Spdngfield, OR 97477+PH(541)726-3753+ FAX(54 1)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.
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440-2584-J (9/081COM)
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$
$
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 In,spection,:Line'
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01574
ISSUED: 10/27/2009
APPLIED: 10/27/2009 '
EXPIRES: 04/27/2010
VALUE:
,
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SITE ADDRESS:. .c; 1313 LA WNRIDGE AVE
ASSESSOR'S PARCEL' NO;::. J703252204100
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Add ~ircuit for out building
TYPE OF USE: New
Residential
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Owner: JOHN WINTER c l}:iij)~ .:
Address: 1313 LA WNRIDGE'AVE ','
SPRINGFIELD OR 97477
Contractor ~e,ose
OWNER" \_.., fe(\U\teS^" \}\\\i\'t.
- :,'~tc - ,j..,Bf,JU.DJN}i~~~~o;'.
,~\i~~ \~s~L.J, "'(~~OU,.AI. &'0'1
\ ~ fU__"'-'~ .....ougl. '''efU,e
\Oll? \\o\'luo:er I\U"" .S&o\\" no\'le
R~O\\M~ 952'~~W1 ~"'~~p~s \s\~ca\\on
\1\ 0(>1 '(ou ~.e:.'tIi#~9\U\\\\\'I ~o I
. vroo~\\l\g ~:I~~0R1ll9~?-~)'
!\'lUst \au \Sw&9
I\~ . gy Path: '
, Sprinkled Building:
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Contractor Type
Electrical
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# of Units:
Primary Occupancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:;' .".
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:; .,
Special Instruction:
Notes:
;, .. " I::
.. '.'
Description ,; Type of Construction
I CONTRAC'WR INFORMATION'
,u/a
I DE~ELOPMENT INFO~TION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
. Phone Number: 541-465-4530
Expiration Date Phone
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
- .~...-"
REQUIRED PARKING
Total:
Handicapped:
Compact:
'tt. U-\Q~'"
I PUBLIC IMPROVE!YlENTS I . tf..?,?t ''r ~~\~ ~\J\
. .' ~ Q \ \V~' }JI,i \S~f>.\.\il{~~lf~~~ f\)?
. \"I\S ?'t.?\ U~\)'t.T\ 'Qtl..~\)6~~ " .
1 \)i\"l\)?'\7.'t.\) \)?\ ,'9liWHspoutslDrilins:
~ \.JI\'J\'t.~c't.\) ?'t.?\\\)\)'
c~'/ '\ ~() \)/1.'/
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I V~luation Desc~iption I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
.,
Pa~e I of2
Value
Date Calculated
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01574
ISSUED: 10/27/2009
APPLIED: 10/27/2009
EXPIRES: 04/27/2010
VALUE:
. ,(',
Status
Issued
i.~ ..-
225 Fifth Street, Springfield, OR ,'.
541-726-3753 Phone .
541-726-3676 Fax. "'.<'. .
541-726-3769 In,speCtion Line
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-y.
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Total Value of Project
F~.es P3id ~
Fee Description;:
+ 12 % State Surcharge
+ 5% Technology Fee .
Add, Alter,.Extend Circ
Miuimum/Adjustment Electrical ,
, 'Amonnt Paid
Date Paid
Receipt Number
$6.96
$2.90
$55,00
$3.00
10/27/09
10/27/09
10/27/09
10/27/09
1200900000000001191
1200900000000001191
1200900000000001191
1200900000000001191
Total Amount Paid
$67.86
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':7 . ~,;;t- ~~
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.
,.
, .
Reouired, I~~necti?n~ I
Rough Electric: Prior to Cover
. Final Electric: When all electrical work is complete.
By signature, I 5tate and agree, that I have carefully examined the completed application and do hereby certify Ihat all
informatiou hereon is true and correct, and I further certify that any and all work perfo~med shall be done in accordauce with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work deseribed herein, and
that NO OCCUPANCY' will he made of any structure without permission of the Community Services Division, Building Safety.
1 further certify that only contractors aud 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 readahle from the
street, that the permit card is loc ted at the front ofthe property, and the approved set of plans will remain on the site at all
l:cg~tr7on.l . .
~ner or Contractors Signature.; .:: Date
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Pa2e 2 of2
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225 Fifth Stre~t
Springfield, Oregon 97477
541-726-3759 Phone
RECEIPT #:
':.;
City of Springfield Official Receipt
, Development Services Department
Public Works Department
1200900000000001191
Date: 10/27/2009
Job/Journal N-u~be~;~~;::~'.ries~~iptio~ ";:::', -:
COM2009-01574 Add, Aiter, Extend Circ ,
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COM2009-01574 Minimum/Adjustment Electrical
COM2009-01574 + 5% Technology Fee
COM2009-01574 ., +12% s:ate?~\~~arge
Payments:
Type of Payment
CreditCard
. .
. Paid By ,
:CJOHN '\ylNTER,
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. cReceintl .
Received' By
djb
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Page I of I
Item Tolal:
Check Number Authorization
Batch Number Number How Received
0403 I I In Person
Payment Total:
1l:23:17AM
Amount Due
55.00
3.00
2.90
6.96
$67.86
Amount Paid
$67.86
$67.86
10/27/2009