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Home My WebLink AboutPermit Electrical 2009-11-20 Electrical Permit Application "DEPARTMENTusE ONLY '.>r.;\:\ _ . ' I . /..0.' _ ?J/f/62 Perrmt no.:' ('7 U I 225 Firth Streett Springfield, OR 97477. PH(541)726~3753. FAX(541)726-3689 I '/ / I . Date /1;:)0/0 7 This"permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 dayslof issuance or if work iss'uspended for 180 days. 1 ',,"\~1i0CAL~,GOVERI'lMENT~{:f.I1F>'RO.vAlfY;:'i":~~f:11ir\;~il I Zoning approval verified? D.Yes D No I I Wi!Wi,!j,',".r;;i'cCATEGO R'(1[OFi'C()NS1:RUC1:ION~,;":~:2}i ",,<,,",\ I <,,,;,_'U,,~,I"""L~~\ .',' , . ,~, _ _h~.,' .. . _, _ ,_, '. .' ".'" ~'...,,".>' ,_ ,0._ I D Residential I D Government I D Commercial liM~j!j~~()BASI1:EjiINI;0RMA;r:IONttANjj[ilE(),CMI()I'l~~o/iif;i I Job site address S-t!.?j J7:i::1., 5J. . I City: S,rpf!Ji~ State: OR I ZIP: 97Y),/ I Referen&': \ n (A. J Taxlott*a'~ I'" . , .' D SCRIPTION, 'OF',WORK' <Ii,~,,:.)"": '"~,:~.:: ",'. r1r1,rfat"(:) )1",--!e:r- .-:J2.~/ I ~- ~r-::,\ I I I I OR I ZIP: 97c;77 I 1 I I "., :PRO~ERT:Y';OWNER.;' I Name )l1i]-p OJr),'\" I Address ,c;-i51i 17 51-. I City:, _c:;dlJJ. , 1 State: I Phone: ?:tr5- JiIJff I Fax: I E-mail: This'installation is being made on residential or farm property own,d by me or a member of my immediate family. This prop'erty is not intended for sale, exchange, lease, or rent. OAR 479.540(1) an~79~J) j 'I Signature: t?' a6/t ~ I, " ..j;CONTRP,CT;OR; INSTAI!.L{:f.1:ION I Busi'ness name: I Address: I City: '---- I Phone: - __________ I Fax: ~ IE-mail: ~ I CCJ;llicense no.: ABC~nse no.: I Signing supervisor's~e nJ',: ~ I Prin't name o~ng supervisor: , Sigriatu~ signing supervisor: I State: / I ZIP~ -...... \-\) \~ < \ I~~~\)l\ \\ s~y ~~ 440-2584-J (9/08/COM) 1~~{flit~~'MA~.~~~f:m~;~n~r'1J:H=ESf,SV~H.EQU. ~E[,@1I<'i\1.!~.zrit~~.~.~1'~~~f}J.Jj I':N ti m :be,}!8ii~-~~'~~i'W[{~:~~'~ ,i"[~m~:(:r;j[~,:: IQt~';;I''- '~,f9~t,':;r~, 1 ""f$otaf' '" ',;_"'-';',",;~i::~-J>j ;.f:i~b-,~~,," "}i~,;:<'''''/',;,- :r;,,:h' .~";V-'" \:#;",. ~!., :".. 7,l:J',;;e~; (,\ .-;. ",:'.~.O_~tf : ,'" I Residential, per unit, service included: I . I 1,000 sq. ft. or less ,<4) $134.00 $ I I Each additional 500 sq. ft. or portion .- $ . '1 thereof $ 25.00 I Limited energy (2) $ 32.00 $ I I Each manufactured home or modular I dwelling service or feeder (2) $ 63.00 $ I Services or feeders: installation, alteration, relocation I I 200 amps or less (2) I $ 81.00 $ I I 201 to 400 amps (2) $ 95.00 $ I I 401 to 600 amps (2) $158,00 $ I 1601 to 1.000 amps (2) $205.00 $' I lOver 1,000 amps orvolts (2) $469.00 $ . . 1 I Reconnect only (2) I $ 63.00 $ (y ~ I I I I 1 I I I I I I I I I I I Signal circuit or a limited-energy P8:nel, $ 63.00 $ I . alteration, or extension (2) 1;!t;;~~;~~~~ill;:A~0~~~KNt~USE1~iM~:\\~~~~ljiii;~'1!cij;{ji $ G2. (iJV Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) $ 63.00 $ I 201 to 400 amps (2) $ 87.00 $ I 40 I to 600 amps (2) $126.00 $ lOver 600 amps or 1,000 volts, see services or feeders section above . -I I Branch circuits: new, alteration, extension per panel I I a. Fee for branch circuits with purchase of a service Of feeder fee: [ I Each b:-anch circuit I $ 6.00 I $ I \ b. Fee for branch circuits without purchase of a service or feeder fee; I 1 First branch circuit (2) $ 55.00 $ I I Each additional branch circuit $ 6.00 $ I J Miscellaneous fees: service or feeder t}ot inclucjed I . I Each pump or irrigation circle (2) $ 63.00 I I Each sign or outline lighting (2) $ 63.00 I $ $ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) ,I (B) Enter 12% surcharge (.12 x [AD I (C) Technology Fee (5% of [AD I TOTAL fees and surcharges (A through C): $ '3./.::.> I $ 7-6?f' $'"27 .7Y, Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2009-01682 ISSUED: 11/20/2009 APPLIED: 11/2012009 EXPIRES: 0512012009 VALUE: 225 'Fifth Street, Springfield, OR , ' 541,726-3753 Phone 541,726-3676 Fax 541,726-3769 Inspection Line SITE ADDRESS: 568 17:fH ST ASSESSOR'S pARCEL NO.: 1703362406100 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Service reconnect Owner: GElDER-MICHAEL H & DIANE M Address: 568 N 17TH ST SPRINGFIELD OR 97478 I CONTRACTO~ INFORMATION I Contractor Type Eleclrical Contractor OWNER License Expiration Date Phone BUILDING INFORMAT,ION I # of,Units: Primary Occupancy Group: Secondary Occupancy Group: Priinary,.C~nstruction Type Secondary Cou'struction Type: # of, Bedrooms: # of Stories: Height of Structnre Type of Heat: Water Type: Range TYpe: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicap'ped: Compact: S t f'~,~1 mqi{>g'E~me~ ts: 'Tfjuc P/"I"> . Stor')' ~~,,,')r'M)iJl~Jrnll E . , spe~iNlit$tr,!!A,liBII(JNDER T~PIRE IF THE WORK COMMENCED OR IS ABA'NSOPERMIT IS NOT Not.~~:( 180 DAY PERIOD. ONED FOR , S "ou \U I PUBLIC IMPROVEMENTS. on laW leo,u,re ,', "'Ii\y 1)reg ,Qre9o\\ V\\ ~TT\:NU\ ;~~' ~dopiESld,,'W\lJt\l#i.:e set 101t\1 tallow I, tel. I\1OSer 'a~52'001' NotilicaMn C;~_oo-Rt\~fI'P.(!litQDh'l{1~es by In O/>..fI 952~a obtain caples ~ ~e\ep\1One . 0090\ii~~~he ~ntel. t~~t~~i~fty NotilicatlOn :mbef tOI \~e,0~e.ioO_332-2344). ae" 1'1 I Valu3tion De'scriotion I Description Tvpe of Construction $ Per Sq Ft . or multiplier Square Footage or Bid Amount Valne Date Calcnlated Paee 1 01'2 CITY OF SrKll~L.J.<l]<'LD . Status Issued 225lFifth Street. Springfield, OR 541'726-3753 Phone 541;726-3676 Fax 541,726,3769 Inspection Line . auilding/Combination Permit PERMIT NO: cOM2009-01682 ISSUED: 11/20/2009 APPLIED: 11/20/2009 EXPIRES: OS/20/2009 VALUE: Total Value of Project I Fees Paid. _III r . Fee:'Description + 1'2% State Surcharge + 5% Technology Fee Se~ice Reco~nect Amount Paid Date Paid' Receipt Number $7.56 $3.15 $63.00 11/20/09 11/20109 11/20/09 2200900000000001317 2200900000000001317 2200900000000001317 Total Amount Paid $73.71 I Plan Reviews , To'Request an inspectioh caIl the 24 hour recording at 726-3769. AIl inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. wiIl be made the following wotk day. I Reouired }11sllections . IIIIII T , EleCtric Service: Approval required prior to utility company eriergizing service. By Signature, I state and agr~e, that I have carefully. ~xamin~d 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 Springfi~ld 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 cectify that only contractors aud employees who are in compliance with ORS 701,005 will be used on this project. I fu'hher 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 tim~s during construction. Owner or Contractors Signature Date : Paee 2 of 2 225 Fifth Street Springfield, pregon 97477 541-726-3759 Phone Job/Jo~rnal Number COM2009-0 1682 COM2009-0 1682 COM2009-0 1682 RECEIPT #: Descriptio," Service Reconnect + 5% Technology Fee + 12% State Surcharge Payments: Type o[Payment. Paid By CreditCard cReceiritl MICHAEL GElDER ~~~!;jjl Wi: City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000001317 Date: 11/20/2009 Item 1Total: Check Number Authorization Received By Batch Number Number How Received njm 032473 In Person Payment Total: Page 1 of 1 1: 11: 17PM Amount Due 63.00 3.15 7.56 $73.71 Amount Paid $73.71 $73.71 11/20/2009