HomeMy WebLinkAboutPermit Electrical 2010-1-28
Ele~trical Permit Application
225 Fifth Street. Springfield, OR 97477. PH(:;41 )726-3753. FAX(541 )726-3689
I ('DIM 1:.0 '0-00 I z..z.
Penmt no.:
I Date: 1-2 lJ- / D
This permit i~ issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days ofissuance or if work is snspended for 180 days.
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Services or feeders: installation, alteration, .relocation I
I 200 amps or less (2) / $ 81.00 $ X ( I
I 201 to 400 amps (2) $ 95.00 $ I
I Name: /~;"h, ~&A.t/c.!--:<'!'" I 401 to 600 amps (2) $158.00 $ I
I Address: Z ')C( J. / - S T ve.d- 601 to 1,000 amps (2) $205.00 $ I
I City: ~,i~-..,-fr'el J! . I State:dC>- I ZIJ': Cj7L( 77 - Over 1,000 amps or volts (2) $469.00 $ I
I Phone:{"LII '6cG s--:JJS I I Fax: _ I Reconnect only (2) $ 63.00 $ I
1 E-mail: I Temporary services or feeders: installation, alteration, relocation I
This installation is being made on residential or farm property I 200 amps or less (2) $ 63.00 $ I
owned by me or amembecofmy immediate family. This 1201 to 400 amps (2) $ 87.00 $ I
property is not intended for sale, exchange, 'lease, or rent. OAR I
479.540(1)and~//1' 401 to 600 amps (2) ...,",;;ii:;:f;'" "'i', $126.00 $ I
~~ign:ture: y ~~ - _ __ -;wr 1 lOver 600 amps:6r\i~.6"O(~~~i1~~s or feeders section above I
1!ll'-;h~'i8J,~ilIJCONTRACTORf)INST-Al!!I!A:rIONliI:r.,r:,i'7~'4!!':::~ I Branch ci:tiP.~M' a!t~,\,&,~)",\\on per panel I
I Business name: ,\J\1\C't::I~J:r~~~t~cl?~1I~~h(lSe ~~a service or feeder fee: I
I Address: _ ~ ~\-\\S ?\:.:)\1' n 'l)"'j,1w.~\J\~b)tlh~,. I I $ 6.00 I $ I
I City: I State: /"1 ZIP: JI,\Y'i\\\J,~~\ ~\'j.{I'I'.ch CIrCUIts WithOut purchase ofaservlce or feeder fee' I
I Phone: _I J'aX:' CCl~:\~;;1' DJl,'flgff'~ch CIrcuit (2) I I $ 55.00 I $ I
[ E-mail: /' ~N ': Each additional branch circuit $ 6.00 $ ,
I CCB license no.: / I BCD licef.l~4~..no.: I Miscellaneous fees: service or feeder not included I
I Signing supervisor'plicense no.: I Each pump or irrigation circle (2) $ 63.00 $ I
I Print name of sigiling supervisor: I I Each sign or outline lighting (2) $ 63.00 $ I
I Signature of signing supervisor: J. ~- ignal. circuit or a li!llited-energy panel, $ 63.00 $ I
_ _ .tlon, or extenSIOn (2) .
N' Oregon laW rt;jq~" -
AITENTIO ' 0 ted by the Oregar ~ditional inspeetion: (I) $58.00, $ I
~~:~~;~~~'c~~t~r. Those:~~:, f.2"gol_~.A~RmcANTg!uSE~~.I':~1
in OAR 952-001-001 ~ th~ i~B of thelrUl8sI1P1'r subtotal of abovefees $
0090. You may obtBm(N fe' the tele~mnm Permit Fee $58.00) % (
II' the center. o. ~
ca mg f the Oregon Utility Not er 12% surcharge (.12 x [A]) $ '17 Z. I
number or QM .....1) 23441
Center is h,VU-' (C) Technology Fce(5%0f[A]) $ I.(or
I TOTAL fees and surcharges (A throngh C): I $ 9 C( 77
1iil:~!il!~f'!''f;'''-ili!l!0CAIJ!I!G0VERIIIMEIII1i'1?AF!I;>ROVAl!!f'''~~~:'0f~1
~",_~^",_^,~_"^.,,,-?fi\,. _._ .....,.. ... ~"" .. _, .' _ .. .... r.., _ '" __'. .,........... .,..-0ili1;;:.r;j;:~,i~
Zoning approval verified? 0 Yes 0 No '
f~=:;~i~~TEG~Rb~~~::~~TRUr~0~o=:~~~1!~
f7;~~:~:~:~TE~~!1M;TIOIII~ND~CAfION\~~~~
I City: Sbf-/&.. I Statede:> I ZIP:'17Li77 I
I Referen~e: 703>3> b { ( Taxlot: 13 3 ~o
ct-.V,/ co
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440-2584-) (9/08/COM)
I Residential, per unit, service included:
11,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
$134.00
$
$ 25.00
$
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$ 32.00
$
$ 63.00
$
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00122
ISSUED: 01/28/2010
APPLIED: 01/28/2010
EXPIRES: 07/28/2010
VALUE:
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 2595 F ST
ASSESSOR'S PARCEL NO.: 1703361113300'
Springlield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Change panel
Owner: EDWARDS KEITH N & CARLA A
Address: 2595 F ST
SPRINGFIELD OR 97477
Phone Number: 541-606-5281
I CONTRACTOR INFORMATION'
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: R-3 laW l\\qatlll9~lfre
Secondary Occupancy Gi~I'f\\ON: Oregon by \I\liJlDregtlU!e~~
Primary Coustruetion T fow rules wppte~hOse ~a~ ,()O1-
Secondary Constructio RfCation Center. O\llroJi\l'iCill\6\~rE
# of Bedrooms: In OAR 952-001-0~~\n cop\tl!c4~ .ell
090 'tou may ob (Notjpjlolif!llll : nla
O..J.i:::; ...." -;enter. , "H ,-",:,n'l' 'iq
number tor the.\PW'.,I~JK~I~ INFORMATION'
Center It "r ,
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dlst:
# StreetTreesRqd:
Paved Drive'Rqd:'
% of Lot <;'overage:
.'
REQUIRED PARKlNG
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS,'",,,
NOTICE: .' E I'F THE WOR~idewalk Type:
THIS PERMIT SHALL EXPIR' .
AUTHORIZED UNDER THIS PERMIT IS NO~n,~ownspoutS/Dra,"s:
COMMENCED OR IS ABANDONED FOR/l:','
ANY 180 DAY PERIOD.'
Notes:
I Valuation Descriptio~ ,
Desc.ription
Type of Construction
$ Per Sq Ft
or mnltiplier
S'luare Footage'
or Bid Amount
Value
Date Calculated
Page I of2
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CITY OF Srtur~\.JFIELD
Building/Combination Permit
PERMIT NO: COM2010-00122
ISSUED: 01/28/2010
APPLIED: 01/28/2010
EXPIRES: 07/28/2010
VALUE:
Status
Issued
225 Fifth Street, Springtield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$9.72
$4.05
$81.00
1/28/10
1/28/10
1/28/10
2201000000000000082
2201000000000000082
2201000000000000082
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. ~i11 be made the same working day, inspections requested after 7:00 a.m. will' be made the following
work day.
I Reo "ired I nsnections .
Electric Service: Approval reqnired prior to utility company energizing service.
By signature, I state and agree, that I have carefully examined:the completed application and do hereby certify that all
information hereon is trne and correet, and I further certify that any and all work performed shall be done in accordance with
the Ordinances ofthe 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 structnre without 'permission of the Community Services Division, Bnilding 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 ate at the front of the propel'ty, and the approved set of plans will remain on the site at all
times during construction. ~".
,.~ /-2f?'ro~
Date
/ Co/. ,
Owner or Contractors Signature
'Paee 2 of 2
225 Fifth Street
Springfield; Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Departmeot
Public Works Department
RECEIPT #:
2201000000000000082
Date: 01/28/2010
I :29:50PM
Job/Journal Number'
COM2010-00122
COM2010-00122
COM20 I 0-00 122,
Paid By
W LEE EDWARDS
Item Total:
, Check Number Authorization
Received By' Batch Number Number How Received
Amount Due
81.00
9.72
4.05
$94.77
Description
Penn Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Amount Paid
djb
317600 In Person
Payment Total:
$94,77
$94.77
ji, :
cRcceintl
Page 1 of I
1/28/2010