HomeMy WebLinkAboutPermit Electrical 2010-1-20
225 Fiftb Street+Springlield. OR 97477+PII(541)726-J75J+FAX(541)726-J689
SPAINQ..RLD, I D~PARTMENT USE ONLY
w.::ii. I CO':""Z-ClIO - DOC '8Lf
-.. Permit no.:
I D~te: I - 20 - I D
Ele~t.rical Permit. Applicat.ion
.
~ITY OF SPRINGFfELD, OREGON
. -~. -~~
This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for ]80 days.
I LOCAL GOVERNMENT APPROVAL I FEE SCHEDULE
1 Zoning approval verified? DYes D No 1 I Number of inspections per i,tem"(), IQty.1 ~~~t
I CATEGORY OF CONSTRUCTION I 1
I I 1 1 Residential, per unit, service included:
..I2rResidential 0 Government 0 Commercial 1
JOB SITE INFORMATION AND LO,CATION I 1,000 sq, ft, or less (4) $134,00 $
, 1-' 7 ? I I '" + I I Eacb additional 500 sq, ft, or portion $ 25,00 $
Job sIte address: ,.):> t'T .:> thcreof
City: s.~Pb 1 State:~ I ZIP: T7l.{77 I I Limited energy (2) 1 $ 32,00 $ 1
Reference: 17 D ~ ~ b z. ( 1 Taxlot.: r::, i lf~ I Each manufactured home or modular I $ $ I
DESCRIPTION OF WORK I dwelling service or feeder (2) 63,00
7", ~ ~ \ l ~ """"" fr IL-....l I Services or feeders: imtal/ation, alteration, relocation. I
1 1 200 amps or less (2) 1./ $ 81.00 I $ l? I 1
PROPERTY OWNER I 1 201 to 400 amps (2) 1 $ 95,00 1 $ 1
Name: Kobe-v \<:..,.; I ~ lNe Y\I I I 401 to 600 amps (2) I $158,00 I $ 1
Address: 1'7 '-< '< JJ<<+_ I I 601 to 1,000 amps (2) I $205.00 I $ I
City:" Yt';::\I2.::J:'/LeJoI State:DK.. I ZIP: 9'/ r 7 I Over 1,000 amps or volts (2) I $469,001$
Phone: ~ V -7 6 B92,13<fFax: _ _ ' 7'/' 1 Reconnect only (2) I $ 63,00 I $
E-mail: 1 1 Temporary services or feeders: imtal/ation, alteration, relocation
This installation is being made on residential or farm property 1 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family, This 1 201 to 400 amps (2) _ $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479,560(1). 1401 t0600_ampsG~ftlQIl\tflS~ii-t 1 $126.00 $
Signature~~ ~~ ~~~-~ii.e~~="~~"
I co~~ II.",."..LATION 10N8l\l ~_""Ie,,~ 0 panel
1 Business name: " N tI1, ~.ol)QJ~!l\ rviee or feeder fee:
1 Address: ~ ~ 1.- 'f0dlmQll~UlNote~ ~~ $ 6.00 I $
I City: 1 State: I ZIP: c1\'ll~1 _<C~~~aseofaserviceorfeederfee:
1 Phone: 1 Fax: 1 "I'~el ~ctit (2) $ 55.00 $
1 E-mail: 1 1 Each additional branch cireuit..--- -:-, $ 6.00 $
I CCB license no.: I BCD license no.: 1 I Miscellaneous fe_es: ~en:iee~or feede'f.~-;;t included
I. Signing supervisor's license no.: 1 I Each pump' or irrigation circle (2) $ 63.00
1 Print name of signing supervisor: 'I 1 Each sign or outline lighting (2) I $ 63,00
IS. f.' . I I Signal circuit or a limited-energy panel,
Ignature 0 slgnmg supervisor: alteration, or extension (2) $ 63.00 $
."",,;.;0i"4iW~''Eu~{additionUI inspection: (I) I $58.00 I $
"sY~ ~/\\).0.s2~t~ t ~~?-~\~~J \$~Y\?tr subtotal Of~::'~~~ANT USE
(f.-J (~~ 1'\01\ t.\\UI\i S\'\f>-\?- 1\'\\S ~\t.t) f~~!~i~~m Permit Fee $58.00) $ g I
\ :'b\ \\'\\~JQ\\\lt.t) U~~ \S t>.~t>.~t)~ ..,..'~ I (B) Enter 12%surcharge(12 x [A]) $ '772.1
~~& '- [>.\l \>J\Wlt.~Ct.G Q t.\\\Qt). I (C) Technology Fee (5% offAl) $ V<J f 1
W .... C~'l '\ ~() GI'>'l ~ 1 TOTAL fees and surcharges (A through C): $ 94 77 I
Total
cost
$
$
440-2584.) (9/08/COM)
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Status
Issued
.: ~
CITY OF SPRINut'Il!..LD'
Building/Combination Permit
PERMIT NO: COM2010-00084
ISSUED: 01120/2010
APPLIED: 0112012010
EXPIRES: 07/20/2010
VALVE:
225 Fifth Street, Spriugfield, OR
541-726-3753 Phone
54 ]-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: ]733 H ST
ASSESSOR'S PARCEL NO.: 1703362109400
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Install meter main
Owner: , KALKHOVEN RODGER N
Address: 1733 H ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
Froutyard Setback:
Side] Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Uuits: , # of Stories:
Primary Occupancy Group: R-3 Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VB wale'i;o4D
Secondary Construction Type: On 1a't4'~ iOi'\~
# of Bedrooms: -ctmOtl:Oleged \:1'1 \tleJQf Ii f6lWtt!\
"" ,.. leS adopt -noOSe ~i ~rng:
.^lIn'H ru ."'^ntB!' ''', ~hO ,J/iI"'t14
tlO~~952.oo\~~~WfI!f)fqi~,!",ORMA T10N I
In '{ou may o:;-l"'lt.J~. N~\I'.
0090.. tt\ll cen\et.~ ~~\. '
calling ,or \he Ol 'Oist:
III1~et cent" \8 \ # Streei Trees Rqd:
Paved QriY",-Rqd:
.-. %.ofI,ot Coven.ge:
.. ,,,,.~...
-----. ,-"\,,,,-,~..
Lot Size:
Sq Ft ] st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
REQUIRED PARKING
Total:
Haudicapped:
Compact:
,",.,.
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS',
., '''''",>;'f;,..;;::o1';:Sidewalk Type:
NOTICE: .',' -; ,
THIS PERMIT~HAlVXPIRE IF THE WOa.\<nSeoutslDralUs:
AUTHORIZED UNDER THIS PERMIT IS NO~..f
COMMENCED OR IS ABANDONED FOR ;;~::Ji:"
ANY 1 RO DAY PERIOD. ","':;if; ''''.;..''
Notes:
I V aIuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier,
Square Footage
or Bid Amount
Value
Date Calculated
Paee] of2
.__~~SI'.~~EI~"9,~ ~11!!~,,~III,
1111, ',' ,'...'" '.
~J
CITY OF SPRINGFIELD'
Building/Combination Permit
JIIi:"'.,~,'
- .~.
- .., '..".., ,~/
Status
Issued
PERMIT NO: COM2010-00084
ISSUED: 0112012010
APPLIED: 01/20/2010
EXPIRES: 07/20/2010
VALVE:
225 Fifth Street, Springfield, OR
54]-726-3753 Phoue
541-726-3676 Fax
54]-726-3769 Inspection Line
,;
'Total Value of Project
Fees Paid I
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
$9.72
$4.05
$81.00
1/2011 0
1/20/10
1120110
Receipt Number
2201000000000000051
220]000000000000051
2201000000000000051
Total Amount Paid
$94.77
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 Reoll:red Insoections I
Electric Service: Approval required prior to' utility company energizing service.
By signature, I state and agree, that I have carefully examined the completed application arid 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 Spriugfield 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 permissiou 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 readable from the
street, that the permit card is located at the front of the property, and the approved set of plaus will remain on the site at all
times during construction.
1-.;20 ---;0
~-
~ ~ i\-'
Owner or~ Signature
Date
il,:j
~\:I.
'!
Paee 2 of 2
225 Fifth Strcet
Springfield, Oregon 97477
541-126-3759 Phone
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Job/Journal Number
COM20 I 0-00084
COM20 I 0-00084
COM20 1 0-00084
Payments:
Type of Payment
Check
cReceintl
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
RECEI PT #: . 2201000000000000051
Description
Penn Serv/Fdr 200 amps or less
+ 12% State Surchargc
+ 5% Technology Fee
Pllid By
JANET KALKHOVEN
djb
"I,t
Page] of 1
2066
City of Springfield Official Receipt
Development Services Department
Public Works Department
Datc: 01/20/2010
2:22: 13PM
Amount Due
81.00
9,72
4,05
$94,77
Amount Paid
In Person
Payment Total:
$94,77
$94,77
1/20/20 I 0