HomeMy WebLinkAboutPermit Electrical 2009-11-5
,
Electrical Permit Application
225 Fifth Street+Springlield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689,
I pe~~eoo ';-olb~1
I Date: 11- 5' - 0 '(
This permit is issued under OAR 918-309-0000. Permits are n~ntransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for t 80 days.
1'Ii'j1l1'1i'1:8ffi:lIViUlfOC'AIK:!GOVERNMEN:'::Jf.......RO V'A':~:t'::jt"$,"">!!lll
~el,,*'''''0''~' . ", ..",,' ^............. ....... 'I<.~r;r;;. . ,., 1.,.;."',~il2"\c"~,,""'~.:W
I Zoning approval verified? DYes D No "I
l~xfil!?18fu:''''0??![,tilcATEG.ORYi~O~MCONSJRUql()Nl.!JrtlJ(;;:;lll!is;r:J;llU
I.~esidential .10 Government] 0 Commercial.1 r Residential, per unit, service included:
1:;llli!i~i::JOB]!SITE!!INEORMA"'IONfAND,!l!OCA"'ION-;~'Ji!ll! 1,000 sq ft. or less (4) $134,00 $
I l' I Each additional 500 sq. Il.orporlion
Job site address: 7_:;ri:. AIMvr A-II-e. thereof ' $ 25,00 $
'1~~;~it~~~lJ~~~a:E:~~~~:!~~ I ~~~;:;:~~;~~~~~ ~e~~:r (;jodular : ::::: :
"Dfr;v~~ .€ud.' ~ b",.s ,~ , ,~ . ~i! 18 ~\M,~~ or feeders: Installal/on, alteratIOn relocal/on
Itf~~. P.:.i-~#:.b~ lltedbytneera~;~~U'!ffiJiorleSs(2) III $ 81,00 $'tt~
1;j;"~::'f'!1~4!.!.:@f'!X~\eROB'1~, __ter"'U'f~iJ~~~~'" a~~OO:"mpS(2) $ 95,00 $
I Name:,Dc....4U In....~52..()01-oUll' ~noieSOl h,'...'U\tlt amps (2) I I $158,00 $
I T.....,O"': obtar e\ l'i/O'\""- I
Address:"2S-~ A-tle'",~~OUmllY 9r. (Note:,t~e ~ct\l\l""Ijj'\i\l00amps(2) $205,00 $
I City c,fJr) "".(lIe-a ; ~h nil th fl~% 4'1i Over 1.000 amps or volts (2) I $469,00 $
I Phonr5QI-7ttl '207"if" Faxoenter!B ~~gll'1u', I I Reconnectonl) (2) I $ 63,00 $
I E I J / I . .A rJ f. _ .~- ,.4 -l- I I Temporary sen'ices or feeders: instalfalion, alteration, relocation
-mai :<1d"'~46,M'.-,. """'- 'S'(Y'C'_<"4~'.1V"'"
This installation is being made on residential or farm property I 200-amps or less (2) I $ 63.00 $
owned by me or a member of y immediate mily. This I 201 to 400 amps (2) . $
property is not' ended'D e, exchan en!. OAR $ 87,00
479,540(]) d49,560 140] to 600 amps (2) I $126,00 $
Signature: L lOver 600 amps or LOOO volts, see services or feeders section above
-NSTALrltAJI(jN~lL.'ltkl"{~~!ii1M1 I Branch circuits: new, alteration, extension per panel
B!Jsiness naITle: ',c-) ,..../ A/".;v, I a. Fee for branch circuits with purchase of a service or feeder fee: J
I Address: "I ! Each branch circuit ", I $ 6.00 I $ ]
I City: State: I ZIP: I I b. Fce lor br~~,~]~,sJr~,~.i.t,~ without purchase ofa service or feeder fee:
I Phone: I Fax: I I 2);, I I $ 55 00 I $
I E-mail: I c1i:,~jrcuit $ 6,00 I $
/' CCB license no.: I BCD license up'.: ~ s:-~~.DU9~.-,or feede~;!1ot included
I Signing supervisor's license no,~ ,,(\\\\j:':~~\1 ~W~,~o.. , ~ I igat;cfktrr~le (2) $ 63,00 $
I Print name of signing supervisor: ~\-\\S Y'C.~~~t\l \)~~C; f>I SIgn o.ro(,tlm~ IIghtmg (2) $ 63,00 $
I Signature of signing sup~ivisor: [l-IJ\\'\U' '~\Ct.tl V..,,\t~\lf Signal ClrclIit or a IImited-energ) panel. $ 63,00 $
1'-,,1\~\~ _. n~n\'+' alteratton. or extension (2)
c,lJ\~\I' an \l~\ ,
[l-~'l '\ u" I Each additional inspection: (I) $58,00 $
W '"" I (A) Enter subtotal of above. fees
~ .V - ,(Minimum Permit Fee $58.00)
.\0 ~ (B) Enter 12%sureharge(.12x [A])
'\ \.: ,t.5r I (C)Tecllllology Fec (5% oflA])
~' I TOTAL fees and surcharges (A through C):
'>>-
,~
$ I{ (
$ pz.
$ I{o'i'
$ 9"Y
440~2584~J (9108/COM)
Status,
Issued.
225 Fifth Street, Springfield; OR
541-726'3753 Pbone
541-726"3676 Fax
541-726-3769 Inspection Line
CITY OF ~rKll'lhI'lELD.
Building/Combination Permit
PERMIT NO: COM2009-0I62I
ISSUED: 11/05/2009
APPLIED: 11/05/2009
EXPIRES: 05/05/2010
VALUE:
Springfield TYPE OF WORK: Electrical Work Only
SITE ADDRESS: 256 ALLEN AVE
ASSESSOR'S PARCEL,NO:: 1703233303800
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION:': Relocate service entrance
O'1'ner: MARTIN DONALD L.& C A
Address: 256 ALLEN AVE
SPRINGFIELD OR 97477
Contractor Type
Ele.ctrical
Co'ntractor
, OWNER
# of Units:
Primary Occupancy Group:
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:
"
Description
Type of Construction
R-3
VB
.,-
. on law requ/l"~ '--,','
~.TT;::\'r,\O~1'. 018~ d b the Oregon UtilIty
foilow rules adorJ~e ThoYse rules are set forth
Notiticati~Q ~~~t~~1 (l thrOugh OAR 952~~
10 Uf"\n ~..J_ ':~".'\')tflJ.n cOples Ul_"'~~ .J.--
Ql(!(l)N'fRA'C'1.l1R;INlWtRM){\}llart~
C.H..J 6r~g6HtJl/.r'l AI
number for the, 1-ao~~~
Center is
Expiration Date
Phone
BUILDING INFORMATION'
# of Siories, ,.i .. '. "'.'.-:' ,
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building: nla
Lot Size:
Sq Ftlst Floor:
!:
Sq Ft hd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION '" ",:, , r;JA~
, \l~\~~
O'(C'fty Dist:~~\?'i:.. ?<\'J\tt~
l\Qi\~~~fte~\\f\ '9- \\-\\~ ~~tt\ ~
\\1iiv~~ ' \'21 t>-'Of>,~
~~~~~~~~\OD,
I PUBLIC IMPROVEMENTS I
REQUIRED PARKING
, Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDrains:
I Valuation Descriotion ,
, $ PerSqFt
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa~e 1 of 2
Status
, Issued
.lr
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12 %' State Surcharge,
+ 5% Technology Fee
Perm ServlFdr 200 amps o~ less
Total Amonnt ),'aid
Amount Paid
,.;c. $9,72
$4,05
$81,00
$94,77
Total Value of Project,
~ees Paj~ J
Date Paid
11/5/09
11/5/09
11/5/09
I Plan Reviews I
CITY OF SPRINLil'lELD
Building/Combination Permit
PERMIT NO: COM2009-0162I
ISSUED: 11/05/2009
APPLIED: II/05/2009
EXPIRES: 05/05/2010
VALUE:
Receipt Number
2200900000000001261
2200900000000001261
2200900000000001261
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. win: be made the following
work day.'. .
I Renllirerl T nS'1ections I
Electric Service: Approval required prior to utility company energizing service,
By signature, T state and agree, that 1 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,
T 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, that the permit card is located at the front of the property, and the approved set of plans wii'1 remain on the site at all
times during construction. '
gA/lIJ/ iJJh~
< ~
O,,:ner or Contractors Sign~ture
Paee 2 of2
'..'
II-oy 07
Date
225 Fifth'StJ;eet
Springfield, Oregon 97477
541"726"3759 Phone-
Q-'..""..'i'.'.!P..Riri. ..'. ..
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City of Springfield Official Receipt
Development Services Department
. Public Works Department
;"
RECEIPT #:
2200900000000001261
. Date: 11/05/2009
11 :59:05AM
Job/Journal :Number}~',
COM2009-0 1621
COMio09-01621
COM2009-0 1621
. Qescripti~n ". : ~.'
. Perm ServiFdr 200 amps or less
+ 5% Technolo~y Fee
+ 12% State Surcharge
Payments:
Type of Payment
Check
':paid,By <:
. 'CHARLOTTE MARTIN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 4556 In Person
Payment Total:
Amount Due
81.00 '
4,05
9,72
$94,77
Amount Paid
$94,77
$94,77
f:. ".'. '. .
H ~.
~:
cReceioll
Page I of I
1115/2009
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TA'X LOT-
/7031.33303200
rlla.r'f; n
'15(; Allen Ave,
SPrinSfieUJD R
CJ7477 .
51{ VlL! 1-2078
5 L/ {. 5D1-lo 5 0
Elect riCo.. I Feed
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