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Home My WebLink AboutPermit Electrical 2009-12-11 225 Fifth Street. Spcingfield, OR 97477. PH(541 )726-3753 tFAX(541)726-3689 1~;:>~Ef{~~tMEN'fU~'EO~C'( : "1 I peimitnoCC,... f) I1~CI- , I Date: \ J -l \- O'~I I Ele€trlcal Permit Application 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, 1;";""'~'L!0CAL':G0VERNMEN:r;fAP'F1:ROYAlQ'i'\!t1Jif!'J~;1r~Y,1 1~f;!Yf?9~'~Sll'?t&'t)'j~j~1"(I7:EE~SCHEI)81!!E!!ii1&~i_~'!;~~~~ I Zoning approval verified?' DYes' D No I 1.'-~~,njber"ofj:~ii~~ii@~'p,~'r..t;J~~{r:::.;IQW:1 :~psr0:1.:,:;rotii',: ~,.,. ~'f'" ~~"CATEGOR~ "OF 'CONS~RUeTION-""~' '.r..... '''..,T I' """"',:;':'~'H':{-' .."'" .<},~e."",;l...-"",\, ";\.- (;'cS~t; ',.,'" ' ,.), .,~!l..~"" "-- CPSt.:f;. 1~~;l~~~~JmE~'N~~:~;~;N~A~D~~~c~;;ir~~:~,i I ~~:~::ti~I,:,el:;'~i:; smice included: $134.00 $ i . I Job site address: 19S1oJCa..me(Ua -5 T . I I ~~~~:ritional 500 sq ft or portion $ 25.00 $ I I City: S~ ' I State: [)fL I ZlP: q)~ ''7BI I Limited energy (2) $ 32.00 $ I 1-.~~:~:~nc;:":"\'DESCRIRTI0N;;'0F.,,^,J;~~~;\.i'it'i"';8f;;,;,\~,:~i I ~~~~I~:nS~~~~~~~ ;e~~:r(;)odular $ 63,00 $ I I p~ c..nCYY'\9Q ~ I 'I Services or feeders: installation, alteration. relocation I V. I I 200 amps or less (2) I I $ 81.00 $" 1 ' :PROPERTYOVVNER ,I I 201 to 400 amps (2) $ 95.00 $ I Name: \I\'vvt..e... I~c (' ~rc ~ 0 I I 401 to 600 amps (2) $158,00 $ I Address: 45\ 0 CAhllt".i 1~5( I 601 to 1,000 amps (2) $205.00 $ I City: "1;r,LV f;',../ I State: U:J I ZIP: q,({75{1 Over 1,000 amps or volts (2) $469.00 $ I Phone: I_U- I Fax: I I Reconnect only (2) $ 63,00 $ I E-mai1~ I I Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or farm property I 200 amps or less (2) $ 63,00 $ owned by me or a member of my immediate family, This I 201 to 400 amps (2) $ 87,00 $ property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479,560(1). I 401 to 600 amps (2) $126.00 $ Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I. ]C0NTRACJ.0R:"INSTAL:kATI0N,',..' 'I I Branch circuits: new, alreratian, eXlensian per panel I Busi~ess name: ffill fJec:t-Y\\'L 1\t\. 70 1 Nt ' I I a, Fee for branch circuits with purchase of a se'rvice or feeder fee: I Address: 3 d-.~ 16 Rl\ EO,\! If\ Me I I Each branch circuit I I $ 6,00 I $ I City: Coik~(~{),Ctrn~ I State: OQ. I ZIP: q7~d'-ll I b. Fee for branch circuits without purchase ofa service or feeder fee: I Phone:S~~ Z'll~ i 401..\ I Fax: - _ . I I First branch circuit (2) $ 55.00 I $ I E-mail: rn \) tle.m\C \'1\ N I N-C.. ~P1fl\6.i\ ,(DJ'ljI I Each additional branch circuit $ 6,00 I $ I CCB license n'o.: '67SDb I BCD license no.: (;:.0 -3i3lLl I Miscellaneous fees: service or feeder nal included I Signing supervisor's license no.: \' .~ y '~O S -:L'Each pump or irrigation circle (2) I $ 63,00 I Print name of signing supervisor.: :Ed~~i<\CJ-~' -Qi['fr r Each sign o. r outline lighti,ng (2) $ 63.00 I Signature ofslgnmo supervlsor:,}: /) -0 i'\ . I Slgnal,clfcult or a h~TlI~ed energy panel, $ 63.00 $ ~ C..t1~ f\-J ...... alteratIon, or extensIOn (2) ".,J.,O~ 11.~,:~;~;~,~::~.';:I.i:.:;~tiO~:,~)..., ,_ $5B~O~c' $ . . II ~~ YO'~ '~ ;~~~:;:'~t::~~;:~:;:.~~NT)~USE~l~:fl~)~f~~%':li~1'<~?~B;; ^' g/.~- \\:11 .1 (B)EnterI2%surcharge(.12x[Al) $ ., L.j. p<;' (C) Technology Pee (5% offAl) $ q ,17'2- TOTAL fees and surcharges (A through C): $ q Lf .I 77 $ $ ~ .o~ ~~\\9 r '\ ~(;;( . ~ ~ ~. 440,2584-) (9!08/COM) Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01764 ISSUED: 06/11/2009 APPLIED: 12/11/2009 EXPIRES: 12111/2009 VALUE: SITE ADDRESS: 4510 CAMELLIA ST ASSESSOR'S PARCEL NO,: 1702324304100 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Panel Change Out Owner: BRANCACCIO VINCENT F Address: 32827 KESTREL LN EUGENE OR 97405 TYI'E OF USE: New Residential I CONTRACTOR INFORMATION' Contractor Type Electrical Contractor MY ELECTRICIAN INC License 87506 Expiration Date ] 1/2012011 Phone 541-729-1454 BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: #01' Stories: Height,of Structure Tyjle of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd 1'1001': Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I I PUBLIC IMPROVEMENTS' Sidewalk Type: I you to !II: 0 ~on law requ res , , ^TTENh\Q~p'odY' fI'!J1tthe Oregon Utility follow rules a se rules are set forth Notification Center, Tho hOAR 952-001- In OAR 952-001.0g~~~h;~~i~S of the rules by 0090. You may 0 ~ote' the telephone ......'1.:.-.; .""^ ,",onbr. on U~II1\Y ."\.IJ.:_:-:::- number for the, r1e~OO'332'2344). ' Center IS ..., Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: NOTICE: ;' ! ~: ::: ~::-:~.~:;; :: !l.~:" E;::-':~: I~ TI !~\.A.'r;~~. Description \UTHORIZED UNDER THIS 1)\I1~mt\~.tJmscription I "0fv1fv1ENCED OR IS ABANuv,,,':u ,u,' "! "(H) Q^V p~Rlnn $ Per Sq Ft Tvpe of ConstructIOn I' I' . or lUll tip leI" REQUIRED PARKING Total: Handicapped: Comllact: Sqnare Footage or Bid Amount Paee 1 01'2 Value, Dllte Calculated -r:;;'Q" '~~"'" ." a.~? 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fa, 541-726-3769 Inspection Line . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01764 ISS UED: 06/11/2009 APPLIED: 12/11/2009 EXPIRES: 12111/2009 VALUE: Status Issued Total Value of Project Fees Paid I Fcc Description + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Date Paid Receipt Number $9.72 $4.05 $81.00 12/11/09 12/11/09 12/11/09 2200900000000001372 2200900000000001372 2200900000000001372 Total Amount Paid $94.77 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 Reouired InsllectioMls I , 111,1111 Electric Service: Approval required prior to ~fility company energizing service. ~ '.1 . By signature, I state and agree, that I have carefully e,amined 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 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 re<tdablc 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 ';"";::;)'~"~ I:J 10/ M Owner or Contractors Signature Date ,\;! ., ~I Pace 2 01'2 225 Fif!h ,Street Springfield, Oregon 97477 541-726-3759 Phone GP .A.I~C?:.~_.BI... ~li"""" ',.......... "~ ' ';r' ,,; -,.:,~,..; City of Springfield Official Receipt Development Services Department Public Works Department Job/,Journal Number COM2009-0 1764 COM2009-0 1764 COM2009-0 1764 Payments: Type of Payment CreditCard cRcccintl RECEIPT #: Date: 12/11/2009 2200900000000001372 Description Pe~m Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge raid By MY ELECTRICIAN Item Total: Check Number Authorization Received By Batch Number Number How Received njm 0055049 0055049 In Person Payment Total.: .' t. Page 1 of 1 II :57:20AM Amount Due 81.00 4.05 9.72 $94.77 Amount Paid $94,77 $94.77 12/11/2009