HomeMy WebLinkAboutPermit Electrical 2010-1-29
225 Fiftb Street. Springfield. OR 97477. PH(541)726-3753. FAX(541)726-3689
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I Permit no.: ~\t)..'oro:io I
I Date: \-1.Q-\D r I
Electrical Perm1t Application
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This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
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Zoning approval verified? 0 Yes 0 No I
=~~~ffi~G,'~~~~~~:;J]R~j~T~~~~;~111 ~~~;::ti~l,:,el::n(:; service :c1uded: $134.00 $ II'
~~~~~~~~~ i:;:::~~::""h~';OO :::: -=1
~;~~~.~~,wJ-~~~~~ I ~~~I~:ns~~~~r~~Fe~~:r(~)odular $ 63.00 $ I
~ I Services or feeders: instal/ation. alteration,relocation I
-r'\ I 200 amps or less (2) \ I $ 81.00 $ f!J...Pf(
1B~"(~"~a[QI.',J;Rlft(ilQ)NN,!;8.'!&~.!!Ifif~Jl)~'~l:\\'ll~ 1 201 to 400 amps (2) 1 $ 95.00 $ 1
1 Name:\g~~ . Sm ssro~ I 1 401 to 600 amps (2) 1 $158.00 $ 1
I Address33l'11) "' ~ W 1 1 60 I to 1.000 amps (2) 1 $205.00 $ 1
.1 City: ~r)\(ia.....- 1 ~ateOrz.. 1 ZIP:lt1~1 Over 1.000 amps or volts (2) I $469.00 $ I
1 Phone: 1 Fax: 1 Reconnect only (2) 1 $ 63.00 $ 1
"I E-mail: ,I I Temporary services or feeders: installation, alteration, relocation .1
This instaliation is being made on residential or farm property 1 200 amps or less (2) $ 63.00 $ I
owned by me or a member Mmy immediate family. This I 201 to 400 amps (2) $ 67.00 $ I
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1). I 401 to 600 amps (2) I $126.00 $ I
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I
"'m"'illt"''!!IrG'(;j'N"'''''I.b''''~E!..''10R1i!I~jSJjjj'h:'~i!1'''''l1'0'~'iI'''''''''''E.'''-''''t~"'k,';"..1 1 Brancb circuits.. ne"', alterat,'on. extens'.on per panel 1
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Business name: LII.AJAi'S elf(.....1- O';'L- I a Fee for branch circuits with purc?ase of a service or feeder fee: I
,Address: J30Y- ~ I 1 Each branch circuit I I $ 6.00 1 $ I
I City: NIl (lZ~s k.. 1 State: bIZ. 1 ZIP: 91Yl'8' lib. Feefor branch circuits without purchaseofa service or feeder fee: 1
1 Phone: s-=<lI-1'Zt.-'7{?95"J Fax:5"W~7<1t:.-Jz~-z....1 1 First branch circuit (2) I" I $ 55.001 $ 1
I E-mail: b~f..k1/Uf.5 2r.. (2 /l(SA/ . t""dWl .1 I Each additional branch circuit $ 6.00 I $ I
1 CCB license no.:S /,.Z ?'/~ '1 BCD license no.: Zo-nl-c:...1 1 Miscellaneous fees: service or feeder not included 1
1 Signing supervisor's license'no.: :J sS 1- s 1 1 Each pump or irrigation circle (2) $ 63.00 $ 1
1 Print name of signing supervisor: . L,~ lViV fJ., ~ 1 1 Each sign or outline lighting (2) $ 63.00 $ I
[ Signature of signing supervi'sor: I I Signal. circuit or a li~ited-ene:rgy panel, I $ 63.00. $ I
. alteratIon, or extenSIon (2)
1 Each additioual inspection: (1) . 1 $58.00 $ I
~;. "1!t~i;\~i~~t!irr....ag~~~&~~
(A) Enter subtotal of above fees
(Miuimum Permit Fee $58.00)
1 (B) Enter 12% surcharge (.12 x [A])
(e) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
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$fA rv
$ a'?M-
$4.
a.A.,
440-2584-J (9/08/COM)
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1
I
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2010-00036
ISSUED: 01/11/2010
APPLIED: 01/11/2010
EXPIRES: 07/28/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 1 nspection Line
SITE ADDRESS: 1010 DONDEA ST
ASSESSOR'S PARCEL NO.: 1802061307600
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Electrical Service Replacemen!
Owner:
Address:
STRASSBURG LEETHA J
38120 HWY 30
ASTORIA OR 97103
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
L YNNS ELECTRIC
License
102316
BUILDING INFORM;\TlON.
Expiration Date
10/14/2011
Phone
541-726-7895
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Strncture
Type of Heat:
Water Type:
'Range Type:
Energy Path:
Sprinkled Building:.
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq FtBasement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION.
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Notes:.
:'WTIGE:
i11$ PERMIT SHALL EXPIRE I~ I Ht"'L';-:~,
'TI-!!):-:IZED UNDER THIS PERMIT 1R.~1iation Descrintion I
.,:\ICED OR IS ABANDONED FOR
D ,. , T 'f'~ ' $ Per Sq Ft
escnptlOD 'yp~,o\'!'onstructlOn I ' I'
. ", ~ . 'or mu tip leI"
.' ,- .f.",...tn
I PUBLIC IMPROVEMENTS L-ENTION: Oregonb\a~~:'Or~gon Utility
11 1 , ~<:\9.Pted y re set lorth
10\\oW !;\li~~el'1tlJYpq!1ose ru\e~~p. 952.001-
Notification ,ng'ln through \ 5 by
in OAp.QJf)2riS~lliIt6ITW~pies 01 the ru e
090 'Iou may 0 tal ote' the telepho~e
o caliing the center. (~n Uiility Notilicatlon
number lor the. O~~~00,332,2344).
Center \s
. Street Improvements:
Storm Sewer Available:
Special Instruction:
Sq uare Footage
or Bid Amount"
Value
Date Calculated
Page 1 of 2
"
_$l"'''lI,"~!llll\l.D:
,I
,
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
Perm Serv/Fdr 200 amps'or less
+ 12% State Surcharge
+ 5% Technology Fee
Perm ServlFdr 200 amps or less
Total Amount Paid
Amount Paid
$9.72
$4.05
$81.00
$9.72
$4.05
$81.00
$189.54
:,
Total Value of Project
Fees Paid'
Date Paid
1l1ll10
ll11l10
III III 0
ll29110
1129110
1129110
I Plan Reviews I
CITY OF SPRINGFIELD I
Building/Combination Permit
PERMIT NO: COM2010-00036
ISSUED: 01/11/2010
APPLIED: 01/11/2010
EXPIRES: 07/28/2010
VALUE:
Receipt Number
2201000000000000019
2201000000000000019
2201000000000000019
1201000000000900087
1201000000000000087
1201000000000000087
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.
~ef_uired Ins\l~ctions ,
Electric Service: Approval required prior to utility company energizing service. .
By signature, 1 state and agree, that I have carefully examined the COm.pleted applicatioo 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 without permission of the Community Services Division, Building Safety.
1 further certify that only~ontractors 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 plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Page 2 of2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM20 I 0-00036
COM20 I 0-00036
COM20 I 0-00036
Payments:
Type of Payment
CreditCard
cRcceintl
RECEIPT #:
1201000000000000087
Date: 01129/2010
Description
PennServ/Fdr 200 amps or less
+ 12% State Surcharge
+ 5%Technology Fee
Paid By
LYNN'S ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Nu-mber How Received
njm
65782P
65782 P Phone
Payment Total:
Page 1 of 1,
10:34:09AM
Amount Due
81.00
9.72
4.05
$94.77
Amount Paid-
$94.77
$94.77
1/29/20 I 0