HomeMy WebLinkAboutPermit Electrical 2010-1-5
.
Electrical Permit Application
225 Fifth Street+Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689
8PRINQPlIlLD I "/?EPARTMENTUSE ONi.. y '"
1IiiL:~ I Permitno,:C 10 - roC) I L I
I Date: 1- 'S - 2 c> f 0 I
CITY OF SPRINGFIELD, OREGON
This permit is issued uuder OAR 918'309-0000. Permits are noutransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
I' ,LOCAL GOVERNMENT APPROVAL
f Zoning approval verified? 0 Yes 0 No
CA TEGORY OF CONSTRUCTION
I IDesidential I 0 Government I D Commercial
I. ,JOB SITE INFORMATION AND LOCATION
I Job site address: S 2 D'S 4 z....A T1 B.
I City: 9Pj) , I StateO(L.:. 1 ZIP: 971.( 7 8
I Subdivision: l/oz.3Z- ~.3 I Lotno.:O')'/C>c.
I ' DESCRIPTION OF WORK
I MJ..I ,4..tfC;t.. ~ t:,A.rc....,...\,,; +" Services or feeders: installation, alteration, relocation
1 I 200 amps or less (2) $ 81.00 $
I ' PROPERTY OWNER 201 to 400 amps (2) $ 95,00 $
I Name: WlrtHe T~ ~a# I 401 to 600 amps (2) $158,00 $
1 Address: 18'70 c/Mie-vL ~ At! 1.1601 to 1,000 amps (2) , $205,00 1 $
City: IM/LtI'lT,t<; 1 State:cA I ZIP: 'soJ( 1 Over 1,000 amps or volts (2) 1 $469,001 $
Phone: I Fax: 1 Reconnect only (2) 1 $ 63,00 I $
/ E-mail: I_Temporary services orJeeders: in~ta/lation, alteration, relocation
This installation is being made on residential or farm property t9?'i'l"1r.~Jess (2) '><;\,,:;,{, :;.$:,63,00 I, $
owned by me or a member of my immediatefamily, This ill~i1S 'lllIlPmnrt2ohH611 ':Y.D. Ill.!: I,: TU :~^~ftO,1 "$
property is not intended for sale, exchange, lease, or rent. OAR C - . ::......+-R -~O,J:R=Pc
479540(1) and 479,560(1), ;ilUT<lftJCR4@~V:~JNnffi.II:IIS Pf: ~MIl. 1$l:fQM" I. '$
Signature: 1 (j6MIlQ&<J~EtlI(l]\Ill fSl\8tB~~tp{tJRs se,c},i~fabove
CONTRACTORINSTALLA TION I JU,l}!cil &Q:/iltlVnflEItIIQlihon, ex'ensio.~{!er po!!e!'):"':",
Business name: r \6 H 'fY1 E \~ k, t <":D. I a. Fee for branch circuits with pwchase of a ,service or feeder fee:
, -
Address: t1J ~O"l( 'd-. '5 a'-\ 1 Each,branch circuit I 1 $ 6,00 1 $
City: r:W ~ I State:O(Z I ZIP: Y rp-l O~ 1 b, Fee forbranchcircuitswithoutP~chaseofaserviceorfeederfee:
Phone&lI{Q~-OqDS I Fax:gH-~B{g-0050 I 1 First branch circuit (2) I $ 55,00 $
I E-mail:'E\\mt:I-e.@\-r~ ~('O QA-ot...QO""rn. 1 1 Each additional branch circuit Z $ 6.00 $
1 CCB license no,: 191..\ OOC) I BCD license no,: t.43 Y1 1 1 Miscellaneous rees: service or feeder not included
Signing supervisor's license no.: 1 C) It e '3 I I Each pump or irrigation circle (2) $ 63.00
Print pame of signing superviso;: 'Phl.L :5", KOl!. e... 1 1 Each sign or outline lighting (2) $ 63,00
Signatu, re of signing superv, is~r: /. _ j ./: -;~ ~ ~.""~ 0, I I Signal circuit or a limited.energy panel, I $ 63.00 $
. ~ ,-/,0 A v:. /-r-:-~ _ alteration, or extension a)
1 Each additional inspection: (I) I 1 $58.00 I $
ATTENTION: Oregon law requlr811 you to I APPLICANT USE
follow rules adopted by the Oregon UtIlity I (A) E t bt t I f bo fi
"... Notification Center. Those rules are set forth n crsu 0 a 0 a ve ccs
\ \."Y. (\ In OAR 952-00'-0010 through OAR 952-GOI. (Minimum Permit Fee $58.00)
~'\) ~ 0090. You may ob1aIn copies of the rules by I (B) Enter 12% surcharge (.12 x [AD
~ ~ ~ calling the center. (Note: the telephone I (C) Technotogy Fee (5% of [AD
'{ LfiV IlUIllber c':t:e Ia~~~~~~~uon I TOTAL r and surcharges (A through C):
_m.~'~> ~yl'~\\)'
I FEE SCHEDULE '
I Number of inspections per item ( ) I Qty.1
f Residential,- per unit, service.included:
11,000 sq, ft, or less (4)
I Each additional 500 sq. ft. or portion
thereof .
I Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
Cost
ea.
Total
cost
$134.00
$
$ 25,00
$
$ 32.00
$ 63.00 I $
$
$
$
__.,.I"",Gl1llilI,.Q,
\
Status
Issued
CITY OF SPRIl'HJI' H.LD
, Building/Combination Permit
!PERMIT NO: COM2010-00012
:ISSUED: 01107/2010
,APPLIED: 01105/2010
IEXPIRES: 07/07/2010
VALUE:
I
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 520 S 42ND ST APT B
ASSESSOR'S PARCEL NO.: 1702323305900
Springfield TYPE OF WORK: Electrical Work Only
,
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Add/alter 3 circuits
Owner: THOMPSON WAYNE D
Address: 1890 CRATER LAKE AVE
MILPITAS CA 95035
Contractor Type
Electrical
Contractor
BHM ELECTRIC COMPANY
I ~ONTRACTOR INFORMA 'BON .1
I
License
184005
Expiration Date
09/19120 I 0
Phone
541-686-0905
BUILDING INFO~MATlON:1
# of Units:
Primary Occupancy Gronp:
Secondary Occupancy Group:
Primary Conshnction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
ATTENTlON: Oregon law reqH'fbil!~uilding:
NIIIlW runllll t1uUJJ'''u ~
NotlflcationCenter. Th FORMATION ,.
In OAR 952.(IQ1-G010through OAR 952-00 . :
Fruntyard Setback:0090. You may obtain COP~8 otJM.~~m- i
Side I Setback: calling the cent8/'. (NOle".i ~s Rqd: !
Side 2 Setback: numIler for the Oregon Utility ~nve Rqd:
Rearyard Setback: Cent8/' 111-800-332- 0 r Lot Coverage:
Solar Setbacks:
R2
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft'Other:
Occupant Load:
VB
n/a
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Description
Type of Construction
.-",~ :,: ~.~;~{;.{~~.j;~:'::,~:"", .
. NOTICE: ", ....HE. WORK ;
_ . .._ ^"^' I CVDIR~ IF T
: ~:: _O',.'V'" .Jr, ..- - . Mil I~ NUl ~:'
I Valuation Descr.iiitib'{j)~IZED UNDER THA'NS ;~~ED FOR5~!{~'
CUIVIIVlb~CED OR IS AB . ...., ;'~,:",\
$ Per Sq Ft ~q.",a'l"B'0O~!\liepERIOD. Value'" ,'; "" ~at~ 'Calculated
or multiplier or Bid Amount
Notes:
" ~..,~,
f ,:' or
Paee I of 2
. ",J.
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00012
ISSUED: 01/07/2010
APPLIED: 01/05/2010
EXPIRES: 07/07/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54 ]-726-3769 Inspection Line
Total Valne of Project
,I Fees Paid I
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Add, Alter, Extend Orc
Add, Alter, Extend Orc Ea Add
Amonnt Paid
Date Paid
,Receipt Nnmber
$8.04 v,
$3.35
$55.00
$12.00
117110
117110
117110
117110
2201000000000000006
2201000000000000006
2201000000000000006
2201000000000000006
Total Amonnt Paid
$78.39
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. Re,~lUired Tnsj}ection\J
Rough Electric: Prior to Cover
Final Electric: Wben all electrical work is complete.
By signatnre, I state and agree, that I have carefnlly ejramined the completed application and do hereby certifv that all
information hereon is true and correct, and I further.'~ertify that any and all work performed shall be done in'accordance with
the Ordinances of the City of Springlield 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 Commnnity Services Division, Bnilding Safety.
I fnrther certify that only contractors and employees who are in compliance witb 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 ~ddress 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,
Owner or Contractors Signature
Date
Page 2 oft
225 Fifth Street
Springfield, Oregon 97477
54i-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Puhlic Works Department
Job/Journal Number
COM20 I 0-000 12
COM2010-00012
COM2010-00012
COM20 I 0-000 12
Payments:
Type of Payment
CreditCard
~Receinll
RECEIPT #:
22010000000~0000006
Date: 01107/2010
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
BHM ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
d'b
, J,
319475 In Person
Payment Total:
,
.i.!:;
Page I of I
7:53:48AM
Amount Due
55,00
12,00
8,04
3.35
$78,39
Amount Paid
$78,39
$78.39
11712010