HomeMy WebLinkAboutPermit Electrical 2010-1-5
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Electrical Permit Application
CITY OF SPRINGFIELD,QREGON
225 Fifth Streett Springfield, OR 97477+PH(541)726.3753tFAX(541)726-3689
,.. "OEPARTMENT USE ONLy
aPAINOPl.... ~
~... ' ..1 CI,?-OOOI3
. _ ". Permit no.:
loate:/-5-C:0 /0
This permit is issued uuder OAR 918-309-0000. Permits are nODtransferable. Permits expire if work is not started within 180
days of issuance or if work is sllspended for 180 days.
I lOCAL GOVERNMENT ApPROVAL
I Zoning approval verified? 0 Yes 0 No
I CATEGORY OF CONSTRUCTION
I ~sidential I 0 Government 'J 0 Commercial
l JOB SITE INFORMATION AND lO~ATlON
I Job site address: 520 S '-( Z....L. 917)
I City: Sf ~ I State: tXL I ZIP: 9747 E'
I Subdivision: 17" L 5. Z 3> ]. I Lot no.: oS 10 0
I . I DESCRIPTION OF WORK
I AdJ.-I Mfa z... c.trc...A-;-~
I f -
I
I Name: W~VN'(E" TffotA;\ f'~o,v .
I Address: /8"0 c,M-fl:tL. ~ #' I
I City:vI1/Lft""/ts I State: C)\ I ZIP: 9~'"03r-1
I Phone: I Fax: I
I E.mail: I
This installation is being made on residential' or fann property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479,540(1) and 479,560(1),
PROPERTY OWNER..
Signature:
I ' CONTRACTOR INSTALLATION
I Business name: "B\.\YY\'21uJ-v-id'0 .
I Address~O t>01- &5:),1.\
City: ~ ~J rl~.lJJ.. I State{)Q I ZIP:C('1t(- 0 ~
Phone6fn-(Q&D-D~oS I Fa)(BH-~<OIo-80S6
I E-mail:b\-lYh€kJ-rie.Co (tlQ.O'l.LO"r'\--"\
I CCB license no.:\€>400S I BCD license no.:t,4?'~
I Signing supervisor's license no.: ~ S 1..Sl BS -
I Print name of signing supervisor:.\) h i l S . Ko s €.. I
I Signature of signing supervisor: ~_ /7.,.,......, I
~/ ~/~.,-:// ~~
- - - - -"-
~~:"'~>"'~I'-~(V
THIS PERMIT SHALL EXPIRE IF TH K ~:
AUTHORIZED UNDER THIS PERMIT I T
. COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD. .
440.2584.J (9/08/COM)
I FEE SCHEDULE I
I Number ofinspecti~ns per ih~m () I City; I ~~t ~~~tl ,\
I Residential, per unit, service jncluded: J
11,000 sq, ft. or less (4) $134.00 $ I
I ~~~~;fditional 500 sq, ft. or portion $ 25.00 $ I
I Limited energy (2) $ 32,00 $ I
I Each.manuf'actu~d home or modular I
dwelling service or feeder (~) $ 63.00 $
I SCn'ices or feeders: installation, alteration, relocation .1
I 200 amps oi"less (2) $ 81.00 $ I
I 201 to 400 anips (2) $ 95,00 $ I
I 4.0 I to 600 amps (2) "0 ) \lPS8,00 $ I
I 601 to 1,000 amps (2) " \a"" t~,.. On \)t ~O $ I
I <?l'fl:~QII}is~:I1~~~';,ies~tes ~80 $ I
_~~'1P~\et''..''\tlIOu~~ 0 ._n" ulB~~ ' $ I
~~~~~t\<tcVl\~~' ~~l\'1\relocation I
~~10\5~~~I. \~\~\iilit 1'10 "$E63,00 I $ I
2 ~"Wihll OI\e~C\Q.~2' r $ 87,00 I $ I
I . """",;'f. \11 - I I
' 40 I tlIlMJ\ram~eW-el I $126,00 $ I
lOver 600 amps or 1,000 veils, see services or feeders section above I
_'I I Br!lnch circuits: new, alteration, extension per panel I
I 8. Fee for branch circuits with purchase of a service or feeder fee; I
I Each branch circuit I I $ 6.00 I $ I'
I b. Fee for branch circuits without purchase of a service or feeder fee: I
I First branch circuit (2) II I $ 55.00 $ S~ I
I Each additional branch circuit '$ 6.00 $ b I
f Miscelianeous fees: service or feeder not included f
I Each pump or irrigation circle (2) $ 63.00 $ I
I Each sign or outline lighting (2) $ 63.00 $ I
I Signal circuit or a limited-energy panel, $ 63.00 $ I
alteration, or extension (2)
I Each additional inspection: (1) $58.00 $ I
I APPLICANT USE '. I
I (A) Enter subtotal of above fees $ I( I
(Minimum Permit Fee $58.00) to
I (B) Enter 12% surcharge (.12x[Aj) $ 7~1
I (C) Tecbnology Fee (5% offAl) $ 30r
I TOTAL rees and sureharges (A through C): $ 7117
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2010-000I3
ISSUED: 01107/2010
APPLIED: 01/05/2010
EXPIRES: 07/0712010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769Inspeetion Line
SITE ADDRESS: 520 S 42ND ST APT D
ASSESSOR'S PARCEL NO.: 1702323305900
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
'PROJECT DESCRIPTION: Addlalter 2 circuits
Owner: THOMPSON WAYNE D
Address: 1890 CRATER LAKE AVE
MILPITAS CA 95035
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor ,..,.
BHM ELECTRIC COMPANY
License
184005
Expiration Date
09/19/2010
Phone
541-686-0905
BUILDING INFORMATION'
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Units: # of Stories:
Primary Occupan9' Group: R2 Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VB . Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: fDlWtsSllJI1l1:\~
on laW I ",~-O \;Wli\lln ' nla
;rC:N"fIO\>l~~~:?_A hV ~ .~~: .;;!lo~_g,
rolloW f~'~5cen\ell D'(YE:~'t1fl!i:U~MA T10N I
\>l0\iflca\~2.001.o0" V, \ Ipi9S orror. 11 o~
10 OAR "... ol>\alO CO.eI9Pno
0090. '{au ma~ 0\91. ~\>l0\~ 'N~ca\ion
calliog \lle ~e OlegoO _ ees Rqd:
tllIlI\b81 tor \el IS 1-&011 e Drive Rqd:
ceo % of Lot Coverage:
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
.1 PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction: .
'.".
Sidewalk Type:
;,
Downspouts/Drains:
.' ,<~''';H,,~,~'':'r'
Description
Type of Construction
NOTICE: - P1RE If THE WORK
THIS PER~l~ ~~~~~ ;.xHIS PERM\T_~S NOT
,\" \ Hunll-I-U _t, ABANDUNtU ,(,;1
I Valuation Descriution(lMMENCED ORD\I~D
' ANY 180 DAY PEn .
$ Per Sq Ft Square F'ootage V I
or multiplier or Bid Amount a ue
Date Calculated
Notes:
Paee 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00013
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
541-726-3769 Inspection Line
Total Value of Project
Fees Pair! I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Receipt Number
$7.32
$3.05
$55,00
$6.00
117/10
117/10
117110
117fl0
22010000000Q0000007
2201000000000000007
2201000000000000007
2201000000000000007
Total Amount Paid
$71.37
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. "~.~OI:,irer! Inspections I
Rough Electric: Prior to Cover
Final Electric: Wheu all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, a~d IJurther certify that any an~ 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 stru'cture without permission of the Community Services Division, Building Safety.
I further 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 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.
Owner or C~mtractors Signature
Date
.T."
Paee 2 of 2
225 Fjfth, Stofeet
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journlll Number
COM20 1 0-000 13
COM20 I 0-000 13
COM20 I 0-000 13
COM20 1 0-000 13
Payments:
Type of Payment
CrcditCard
cRcceintl
RECEIPT #:
8,,~~AI.!!.a~,~': II,,' ".:,
~.~ ...'
IlL.'
City of Springfield Official Receipt
Development Services Department
Public Works Department
2201000000000000007
Date: 0'1/07/2010
DescrilJtion
Add, Alter, Extend Circ
Add, Aller, 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
djb
'319475 In Person
Payment Total:
"
Page'l of 1
7:54:42AM
Amount Due
55,00
6,00
7.32
3,05
$71.37
Amount Paid
$7L37
$71.37
11712010