HomeMy WebLinkAboutPermit Electrical 2009-12-17
225 Hfth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
W' .'DEE~~;-MENTUS'EONLY
I LOAAe~O 9-0 I :S.~d
PermIt no.:
I Date: (Z - (7 - 0 <7
Electrical Permit Application
e t
This permit is issued under OAR 918-309-0000. Permits are uontransferable. Permits expire if work is uot started within 180
days of issuance or if work is suspended for 180 days.
I:' ;. . ....' 'l::OC~V:GOVERNMENT . Ap,PROVAL'i,:.ti':i:'i:':;-:'i !;<:;}i'?;).:\~!i\i7j!'!ifWBf'.EE:I'SGHED.~~Ef:\;l:g).:"1;~\\\'i!:m-~~",if,1;l1~1
I Zoning approval verified? D Ves D No l)'ium~~r,'?f.inJP~cii01X~~r.~t~~:() ",IQ~.I;~~~tl ,~~t~ll
::~e~id:nt~~~TEGr~~~~e~:~n;TR~lt~O;::~er:;al"'i I Residentia!, per unit, service included: I
i~:~[t;~:;:s~T:E~~iM~Tk:i-JNr;~5ATrION~~"Fi;1 i ~~;~O;d:i:~::tl~;O(:~ ft or portion :1:::::: I
I City: <; f,;''') I State: vJL I ZIP:~7C(711 I Limited energy (2) $ 32.00 $ I
I~eference: ~ 7~~~P~I~~FWJ;~~~~;~ 0 s 0 r .11 ~~~~I~:"S~~~~~r~~ ;e~~:r (~)odular $ 63.00 $ I
I ~. 2- C\("'~'^';- ~ -\-c::> I I Services or feeders: installation. alteration, relocation I
I . t;)c. '> +:::.. JJ tr+ . _ :: +-- I I 200 amps or less (2) $ 81.00 $ I
IPROI'ERTY OWNER ! I 201 to 400 amps (2) $ 95.00 $ I
I Name: <*"'" ~'d..!.(e I I 401 to 600 amps (2) $158.00 $ I
I Address: - 330lS0 J-l.C>Vt:: W I 1 601 to J,OOO amps (2) $205.00 $ 1
I City: & e"!iw I:!"t ( I State: oiL I ZIP: 97 t(z4. Over t ,000 amps or volts (2) $469.00 $ I
I Phone: N(- ~').8t)l:lI~ax: _ _ ' . I Reconnect only (2) $ 63.00 $ I
I E-mail: I I Temporary services or feeders: installation, alteration, relocation J
This installation IS being made on residentIal or fann property 11 200 amP.:2i,1~:to $ 63.00 $ I
owned bX me or a member of my immediate family. This II' aJtr!~~~:!-}Xl~~~n $ 87.00 $ I
property IS not Intended for sale, exchange, lease, r r ~!(Jlleg d 1 ",~\". ,....,,;P. ;'J. . I
479.540(J)~n 79.560(1..- '8"0,,\1 ,~'l.'/JlI3'~,g'&"i;~XlQ~- $126.00 $
,;1./ .. ~e$ u.. 't,C ~f:
Signature: ' (.,A/ f\I II cell\et. 0 \\l~~~<\l\lI~Ill;olts, see services or feeders section above I
. tl \ '\lO I ~"OI~' ....OIlV'.e
I CONTRACTOR INST ALl-ATI" 9P'l.~ 'Jt .11~ 1I.:r~16~.,fial\fh~\~ratlOn, extenSIOn per panel I
Business name: Ol.'" N ~ ~O. '(O~ 1I'''~'''.lt. "Ii~fiiu{II'\\l3~~~:CircUlts WIth purchase of. service or feeder fee I
"'-:"\\\1I1t ~ ....8 1.~~~... .
Address: - \Of '" 1--~' oranch circuit I I $ 6.00 I $ 1
City: I State: 1 m: (;en I b. Fee for branch circuits without purchase of a service or feeder fee:
I Phone: I Fax: I I First branch circuit (2) I I $ 55.00 I $
E-mail: ....J..J ,Each additional branch circuit zJ $ 6.00 $ II-
ces license no.: I BCD license no.: _ ~ I I Miscellaneous fees: service or feeder ~ot included 1
I Signing supervisor's license no.: 1 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
I Signature of signing supervisor:. I Signal circuit or a limited-energy panel, $ 63.00 $ I
alteration, or extension (2)
Each additional in.pection: (t) $58.00 $ I
I .~ 'x{j~'Y,w1~~'!'iri&1tff1b'~~~~eLitAN'fiiDSE\i\:;::::!'i;;:;:~N(t::{i{::;,!
~\ ~ r (A) Entersubtotarcifilbovo,J~OV-'" I
b-- 'J~ (Minimum ~fiI!"'f~~Y...'b\Q()1 $ I Z
~1~Gt~,,^\11 ~M>le~~~l?r~JWJA]) $ 1.'11{ I
.A..1"~'11-1~ 1'~?-\lEd~WCrnR~~~'t,f[A]) $ -bO
\:/l~ 1\\)11-1 ,,^E~c~Qr'Q!~kes and surcharges (A through C): $ 14 O~_
CO,,^ " \)1\'/ rc.0 .
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440-2584-J (9/08/COM)
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Status' Issued
CITY OF SPRINGFIELD'
Building/C;ombination Permit
PERMIT NO: COM2009-01558
ISSUED: 10/23/2009
APPLIED: 10/23/2009
EXPIRES: 04/23/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 708 FAIRVIEW DR
ASSESSO'R'S PARCEL NO.: 1703274200301
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace panel and add 3 circuits
Owner: RIDDLE SAMUEL W & SHANNON M
Address: 81086 SEARS RD
COTTAGE GROVE OR 97424
Phone Number: 541-895-8884
Contractor Type
Electrical
License
Expiration Date Phone
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupaut Load:
n/a
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side] Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total: I
Handicapped:
Compact: :
I.,:. :1
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPR?VEMENTS I
. . '
.Sidewarif.fY'~' e'
'dO _ \,-1(..
~." ~~,~~~Y.~{~ ns:
~~~\~E~~'i t~'t~ i\\IS ~~~~O rQ~ :.,::;
,.'JQoIIEO 0 Ie ^ 'OfI.~ . ," .....
fI.\l \ ':', ~~^\r.E~~'" .
I Valu~~~~'~~~c~~Dtion {
Notes:
Description
Tvpe of Construction
. $ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e] of2
Status
Issued
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
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Total Amount Paid
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01558
ISSUED: 10/23/2009
APPLIED: 10/23/2009
EXPIRES: 04/23/2010
VALUE:
Total Value of Project
Fee. Paid I
Amount Paid
Date.Paid
Receipt Number
$11.88
$4.95
$18.00
$81.00
$1.44
$0.60
$12.00
$129.87 .;:
10123/09
10/23/09
10/23/09
10/23/09
12117/09
12/17/09
12/17/09
2200900000000001217
2200900000000001217
2200900000000001217
2200900000000001217
1200900000000001342
1200900000000001342
1200900000000001342
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 Insnecti""s I
Rough Electl"ic: Prior to Cover
Electric Scrvice: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
By signature, I 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 withont permission of the Commnnity 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 ensnre 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
times during construction.
~J ~ Il~ 1"2- - /7-t11
Owner or Contractors Signature
Date
Paee 2 of 2
225 Fifth Street
Springlietd, Oregon 97477
541-726-3759 Phone
~~NG~~.
. .. '
':-.fi
Job/Journal Number
COM2009-0 1558
COM2009-0 1558
COM2009-0 1558
Payments:
Type of Payment
Check
cRcceintl
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
RECEIPT #:
1200900000000001342
Description
Add, Alter. Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SAMUEL RIDDLE
djb
Page I of I
5181
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 12/17/2009
II :35:02AM
Amount Due
12.00
0.60
1.44
$14.04
Amount Paid
In Person
Payment Total:
$14.04
$14.04
12117/2009