HomeMy WebLinkAboutPermit Electrical 2010-2-1
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Electrical Permit Application
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-225 Fifth Strect+Springficld, OR 97477. PH(541)726-3753+ .'AX(541)726-3689
Permit no,C18 - 1.- 3 ~
Date: 2.. ~.1- - J...8
This permit is issued under OAR 918-30.9-0.066. Permits are nontransferable. Permits expire if work is not started within 180.
days of issuance or if work is suspendedJor ]86 days.
1'~:\'i:;l'ti.!ii~\,~:jL:OCJ\[,',GOVERNMENT'!i'J\RPROVAl.!)'ijic;~:;ili:~lU$;
1 Zoning approval verified? DYes D No
I """'"",H:;""c''''CA'T'EGORy:tO'': 'CO, NSTRU' C" TION""'I.-:;",.'1t/i"""
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I 0 Residential I ~ Government I D Commercial
1,000 sq, ft, or less (4)
1"C\'ii,!r:l:'~OB::SITE'INFORMATIONj,AND"[OCATION::'::::::,:1
I r.J :-+- Each additional 500 sq. ft, or portion
lob site address: \3D:t -rio~-PIUu'-1G'Sl ' thereof $ 25,00 $
1 cily:6priV\~ I State:012 I ZIP:"il<!i-:t- 1 Limited energy (2) $ 32,00 $
I Reference: --.J ."~Ql.t..-) I Taxlot.: I Each'manufacturcdhOle~modular $ 63.00 $
[~;~~:r:':~~:St:ISff;~~~~~;:j)~;i~fui'~1 : ~~~~:;s:::;~::,e~;~:S;~II::ion alteration, relo:at~:~oo $lJ (
1 201 to 400 amps (2) $ 95.00 $
1 1 401 to 600 amps (2) $158,00 $
I I 601 to 1,000 amps (2) $205,00 $
1 lOver 1,000 amps or volls (2) $469,00 $.
I 1 Reconnect only (2) $ 63.00 $
, 1 Temporary sen.'ices or feeders: in~tallation, alteration, relocation
I 200 amps or less (2) $ 63,00 $
1 20 I to 400 amps (2) $ 87,00 $
1 401 to 600 amps (2) I $126,00 1 $
lOver 600 amps or 1,000 volts, see services or feeders section above
.1 Branch circuits: new, alteration, extension per panel
'I a. Fee for branch circuits with purchase of a service or feeder fee:
Signature:
li".iiiii,i!,iibi,CONTRACTClRi!INSTAIrI!:'J\TION!'0'!ifuli\lfiii"?iii!i;~
I Business name: l.o...v\T:zFi-lctn' c... I
I Address: 04<:)-<,1 ttw~ Slf ' I
1 Cily:El.I.l\.e.'VH~,.. 1 State:OR l ZIP:'1~{)C, 1
I Phone,9W:rUDCoSi 1 Fax:5</I -=t4l:Y,/Ll7 1 ,I First branch cir,uit(2) I I $ )5001 $
1 E-mail:-tc..VIcJmO\(.@COl'l1&il-st.}Jet 'I Each additional branch circuit $ '6,00 $
! CCB license no.: 15 '1://1 ~ I BCD license no.:~ 2D3Z:J:. 1 Miscellaneous fees: service or feeder not included
I Signing supervisor's licen; no.: 3l{.q2_~-l-- ~ 1 Each pump or irrigation circle (2) I I $ 63.00
I Print name of signing superviso?'\... ~ \~l L ..!.-.-- Each sign or outline lighting (2) $ 63.00
I Signature of signing supervisor:--j""""1 (Y)-' LIJ.:~ -" Signal circuit or a limited-energy panel, I $ 63.00
" J ~VI~ alteration, OTcXtension (2)
I Each additional inspection: (1)
r j~ nt ~ry-i V\",hpJJ
I Address: .] ,
I City: I
1 Phone:
I E-mail:
This installation is being made on_residentiili or farm 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),
State:
1 Fax:
1 ZIP:
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, f\~'
440.2584.) (9/08/COM)
1 Residential, per unit, service incl~ded:
$134.00
$
11$6,001$0,
, b. Fee for branch circuits without purchase of a service or feeder fee:
Each branch circuit
$
$
$
$58,00' $
(A) Entcrsublotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (,12 x [All
1 (C) Teclmology Fee (5% of[All
1 TOTAL fees and surcharges (A through C):
$~~I
$ /Olfi.f I
$ I
<~/I
225 Fifth Street, Springfield. OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.,',.
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00133
ISSUED: 02/01/2010 '
APPLIED: 02/01/2010
EXPIRES: 08/01/2010
VALUE:
Status
Iss u ed
. j"~'.
SITE ADDRESS: 1807 PIONEER P ARKW A Y EAST Springfield TYPE OF WORK: Right of Way Permit
ASSESSOR'S PARCEL NO,: 1703262302402
TYPE OF USE:
Public
PROJECT DESCRIPTION: Replacing Traffic Signal
Owner:
Address:
CITY OF SPRINGFIELD-' ,
225 FIFTH STREET, -
SPRINGFIELD OR 97477
Phone Number:
541-726-3753
Contractor Type
Electrical
ATTENTioN: Ofegon law requires you to .
f~"~'" ,.","" ";.j,~'orl h\l thA Dreaon Utility
\ N~'i''1::;',O'I,' i';~ f,;;.nipj ThnSfl mies are set forth
',Ic.CON'tRAIci_TQR.m"~9, ~I-001-
IH , ,., ,II , 1,:,r~i'i'-IIiI1IIIIIiIIII)'I' ~'ri( by !
~age: Yoli may obtain copies OT ne ru 8S .
Contractor, ' 'eel\ingihe center. (Note:,~on.Expi ation Date
LANTZ ELECTRI~\l\l\~erior the Oregon UtI!~~~tilicatlOft 07/1412010
I ~U1L1Wm!1t~~\1ATiON~'>>'
Phone
541-726-0659
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
U
# of Stories:
Height of Structure
Type of Heat:
Wa,ter, Type:
Rii,nge Type:
" Energy'Pa'th:
Sprinkled Building:
Lot Size:
Sq Fl I st Floor:
Sq Fl 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other: ,
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyanl Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
. :# Street Trees Rqd:
Paved Drive Rqd:
NOTICE: % of Lot coveraTRE \f THE WORK
-rUle; pl'~~~\! SH~l~ ~~rr~~ftlT l~ NOT
. AU, fllIIlN!llffiMV~9-'v~o fOR .';
'coiVll~,tl;LU ~fI.i,. ,
M!Y 180 DAY PERIOD. Sidewalk Type:
Downspouts/Drains:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
':.":.
Notes:
)
I V~Iua~ionDescrintion ..1
Description
'Tvpe of Construction
, $ Per Sq Ft
'or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
I
Pa2e 1 01'2
..,'" ..
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: GOM2010,-00133
ISSUED: 02/01/2010
APPLIED: 02/01/2010
EXPIRES: 08/01/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
,I "
$10.44
$4.35
$6.00
$81.00
2/1/10
2/1/10
2/1/10
2/1/10
Receipt Number
1201000000000000089,
1201000000000000089
1201000000000000089
1201000000000000089
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid ,,"
Date Paid
Total Amount Paid
$101.79
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.
R,~oui,red J~spections .
Rough Electric: Prior to Cover :' '.':,' ,,'
Final Electric: When all electrical wo'rk is cOli'iplete; i
By signature, I state and agree, that I have carefully examined the eompleted application 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 berein, and
that NO OCCUPANCY will be made of auy structure without permission 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 plans will remaiu 011 the site at all
times during construction. I'
Owner or ,Contractors Signature
Date
,
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',Paee 2 of2
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225 Fifth Street
Sp,rinWield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM20 I 0-00 133
COM20 I 0-00 133
COM2010-00133
COM20 1 0-00 133
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
.~RfNOJ:lEU)~
~,
City of Springfield Official Receipt
Development Services Department
Public Works Department
1201000000000000089
Date: 02/0112010
1l:18:48AM
Description
Penn Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ i 2% State Surcharge
+ 5% Technology Fee
Paid By
TIFFANY A
LANTZ-HALBROOK
Amount Due
81.00
6,00
10.44
4,35
$IU1.79
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
KLK KLK 01571 C In Person
$101.79
Payment Total:
$101.79
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Page I of]
2/1/2010