HomeMy WebLinkAboutPermit Electrical 2009-12-11 (6)
I ~.i\'< :\'<, '~:'!'ti~bCAL:\GOVERNMENt~h~~~PR:OVAI.B'~~~~~i':~.i~~~r1'II~~':1Ftfq?!~~~~~1:J~~f!tF.EE:lsCHE"D.Ol!lEk~~1Y~W~~~\~~~1
1 Zoning approval verified? . 0 Ves, 0 No I LNu"!~er'?f!~spe~iio'ri~p'e~,if~"';;'().:,~".IQh.1 :~f6~!'\1 ,Total:'1
Ir":ldi"i\\,i,:\ir:~.CJ.l.TEGOR'/\~OFc;~CONSTRUCTION~;~'~"\~i;",<:,1 ,','". .,',' "'.de...,,, ,", ,.c."..., ,hea." , , cost."
1 .-..<" 'I I' I I Residential, per unit, service included:
1~~~~~~rrE~INF~R~Ar~;~~AN[j!jl~C~;~~~~~~~~~111 [1,000 sq ft, or less (4)
. I I Each additional 500 sq. ft. or portion $
Job site address: thereof $ 25,00
City: 1-{9C6 Uf\l:, \.j' 1 State: () c.., [ZIP: q tLf7?J 1 I Limited energy (2) $ 32.00 $
lr,~e~:;~~ce: 1.~o.D~?c:~~~N>0F'W~;~:~~:~;~;1ty~;:.;:11 ~~~~I~:nS~~~~~r~~ re~~~r (~)odular $ 63,00 $
10 ~0. ' 17('; (K.. . . /,1 _ ~ ~" ',,"' '. b, :;., - "'1 I Services or feeders: installation, alteration, relocation
....f"rcf'{r:: L)\[y.AtioL.. u'f q "'-6 rN... +,c/W" 1M eEl"" 1
I I 200 amps or less (2) Z $ 81.00 $
I . . ' :PROP.ERTV.oWNER ',,' I I 201 to 400 amps (2) $ 95,00 $
1 Name: C' Ni"U'10 Wt,D/;f'S I 401 to 600 amps (2) $158,00 $
I Address: LI80 <::, Df\lS- c:; <;,T ArrEfllTrON~ . 601 to 1,000 amps (2) $205,00 $
1 City: ~1j)iF(f;UJi' State: Of., 1 ztib~~~d~~~!llll!lll9lRi';>MO!J~f{ $469,00 $
Phone:~<{I-It1i. Iq ~7 I Fax: . In OM 952-Dn. ~tlrRIRJAA,'lf~r.g~QJJon Util;~y $ 63,00 $
. ~- - -v jUo.1h_ '-~ "I.fl.. ..
rn 6 7 ~{MdC" ~ A. y", I' .' CC v'\ U., YOU may ot ~~)""."",gWi'~J:\'/:f~~..euth<: installation, alteration, relocation
.. ''-1' >-<,0, eEl/lIng t~ :'21l~~l€llt -V"VlJ).
This installation is being made on residential or faJlIIl/!!$~" ce lte r, '=' '1 ~1~ru1es-"r $ 63.00 $
owned by me 0: a member of my immediate family. ThIs r the O~l\OiJoo;i!fi&il~phone - $ 87,00 $
property IS not mtended for sale, exchange, lease, or rent. BRftter II ,"'LJP" ' j' !;;;.L~l;a!lO
479.540(1) and 479.S~\(I). .0 !..a~_~tL} n $126,00 $
Signature: Ck~_ ~ lOver 600 amps or 1;000 volts, see services or feeders section above
I . :',,:, '::tCONTRACi\;0R'INSTA~lATION: :.: .1 1 Branch circuits: new, alleration, eXlension per panel
I Business name: ~ [.,;' AI t::rIl. I I a. Fee for branch circuits with purchase ofa service or feeder fee:
Address: / I 1 Each branch circuit 1 I $ 6,00 1 $
City: I State: ~ ZIP: I b. Fee for branch circuits without purchase of a service or feeder fee:
1 Phone: I ~ - 1 First branch circuil (2) I $ 55,00 $
I E.mail: /' I 1 Each additional branch circuit $ 6,00 $
I CCB license no.: /' I BCD license no,: I I Miscellaneous fees: service or feeder :'0/ included
I Signing supervisor's~nse no.: 1 I Each pump or irrigation circle (2) $ 63.00
j Print name of signi~g supervisor: I I Each sign or outline lighting (2) $ 63.00
I Signature of signing supervisor: NOTICE: 1"l's'igrial:'cirCuit or a limited,energy panel, $ 63,00 $
THIS PERMIT ::iHALL t!\t'ltit I "fff~W1'Rr.ten,S1on (2)
AUTHORIZED UNDER THIS PEb,trt,;~t~~~:t:;~~ction~:~).. . .,L.~~8~~,~,"_, ~ ,~". II
COMMENCED OR IS ABANDOIIE!:"'~0Q,",~,.:M<=,'~~AF!eI1lCANTJ:!USE'ii.~;,,':;>l;,~~:j\;:.:ri1;i,",:-;."
ANY 180 DAY n:IflGY (A) Enter suototal ofabovefees 1~2.
~'V,..(1 (Minimum Permit Fee $58.00) $
\t\ .\\9 'l/\ 1 (B) Enter 12% surcharge (.12 x [A]) $ I'l'...f
1C'(A)~ 1 (C) Technology Fee (5% of[AJ) $ &,"'0
~ 'D\ 1 TOTAL fees and surcharges (A through C): $ I p" ~<f
IJ;.\
Electrical Permit Application
-
}, oil. "
225 Fifth Street. Springfield, OR 97477tPH(S41)726.37S3tFAX(S41)726.3689
l~f:\D~f~~T~ENfG~'E ofol,i:y:..:,,cl
I P~~:::;ZCO ., - 017 &i I
I Date: /2.-(/-0; I
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.
$134.00
440.2584.} (9/08/COM)
$
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Status
Issued
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
541-726-3676 Fax
54],726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01768
ISSUED: 12/11/2009
APPLIED: 12/11/2009
EXPIRES: 06/1 1/2010
VALUE:
SITE ADDRESS: 4205 DAISY ST
ASSESSOR'S PARCEL NO.: 1702323305300
Springfield TYPE OF WORK: Electrical Work Only
ATTENTr
fol/ow rut ON: Oreb~~nRACTOR INFORMATION'
NotifiCatio:~ adOPt~a by th - ,.OJ "S you to
XA~~o~~::' Those r~,~egon Utility License
-~~V.tIU mall ^".!~ throuflh nAa:,e~~et forth
nu~;;: ~noe center.-'_"lNm4>~_1ATlON I
r the Or ! Iblb' .
. Center Is egon~t' ~I .1?hone
f -a<lO :stg~ation
R-3 -e, 11f Strnctnre
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
PROJECT DESCRIPTION: Replace service and feeder
Owner: . HODGES CAROL YN A
Address: PO BOX 390
SPRINGFIELD OR 97477
Contractor Type
Electrical
# of Units:
Primary Occupancy Gronp:
Secondary Occupancy Gronp:
Primary Construction Type
Secondary Constrnction Type:
# of Bedrooms:
VB
TYPE OF USE: Repair
Residential
Phone Nnmber: 54]-606-1977
Expiration Date Phone
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive I{qd:
% of Lot Coverage:
NOT/CE- I PUBLIC IMPROVEMENTS I
Street ImprovementsrHIS PER'
.f1/1TH MIT SHALL ',' .'
Storm Sewer Available, ORIZED EXPIR ''''':''',
Speciallnstruelion:COMMENCE UNDER THIS E IF THE WOR
ANy 18 D OR IS PERMIT I K
Notes:. 0 DAY PERIOD:BANDONED FO~ NOT ,
Description
I Valuation Descri9tion I
$ Per Sq Ft Square Footage
or multiplier.... ." or Bid Amount
Type of Construction
Paee] of2
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01768
ISSUED: 12/11/2009
APPLIED: 12/11/2009
EXPIRES: 06/11/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% Slate Surcharge
+ 50/0 Technology Fce
Perm ServlFdr 200 amps or less
Ainount Paid
Date Paid
Receipt Number
$19.44
$8.10
$162.00
12/11/09
12/11/09
12/11/09
2200900000000001374
2200900000000001374
2200900000000001374
Total Amount Paid
$189,54
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 R~nui"ed Insnections I
Electric Service: Approval required prior to utility company energizing service.
By signatnre, [ state and agree, that I have carefnlly examined the completed application and do hereby certify that all
information hereon is true and correct, and I further c,ertify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the La,,, of the State of Oregon pertaining to.the work described herein, and
that NO OCCUPANCY will be made ofany structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who arc in compliance with ORS 701.005 will be used on this project.
I further agree to ensure thnt 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 01" plans will remain on the site at all
times during construction.
I, ^ \\ "-
( .0vf.\ /'- ~ '\- ~
I r ~ 1\-
Owner or €ontractors Signature \j
/J.-- (/-09
Date
Pa2e 2 012
. ','
225 Fifth Street
Springfi.cld, Oregon 97477
541-726-3759 Phone
Job/Journ:ll Number
COM2009-0 1768
COM2009-0 1768
COM2009-0 1768
I'ayments:
Type of Pllymcnt
Check
cRcceint 1
.. :~I~.'!~..B+!)~~' , ~..'. ,~: '.:"..'....
IlAlr ",'
ta:"Iij- -,:
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
22009000000000013 74
Date: 12/11/2009
Description
Perm Scrv/fdr 200 amps or less
+ 5% Technology fee
+ 12% State Surcharge
Paid By
CA HODGES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
1164
In Person
Payment Total:
Page I of I
] :28:25PM
Amount Due
162.00
8,10
19.44
$189.54
Amount Paid
$189.54
$189.54
12/11/2009