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Home My WebLink AboutPermit Electrical 2010-3-16 Electrical Permit Application e , ~ ....::.. _, - '7 -;. -' ':. . ,CITY OF SPRINGFIELD;:OREGON,.:,", .' " _' .; ;:" J ;;, ';1 -. '1-_~N- \ ,s:: ~, " ~ - ~. . 225 Fifth Street + Springfield, OR 97477. PH(541 )726-3753. FAX(54 I )726-3689 SPR'NGFOELD ""'0 ~'~ t1.~.~.' . ~ "~-:;~ ,..,'i....~," . DEPARTMENT USE ONLY 1 . Penn it no.. IJ - 3 2-5> Date: 3 - 1- This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. "~I :120CJl.L;GOVERNMENT:'A~F'ROvAIE~',\<:'f:;f\' Zoning approval verified? 0 Yes 0 No " ,;:. I,:'CATEGORY.}OF::CONSTRUCTIONf;;", "\ o Residential 0 Government Commercial ~a~~~OB\iSITiE:iINFORIIJIATION/:AN[j~120CAl!ION~1;,~i~~X( ~!E-<;I State: oe ZIP: 7 L/7 7. ~ I Q33Gl9 TaxIot: . 'DESCRIPTION: OF.WORKi'.ki~';_;<,: ';'J'~\"1Y;::: .' " Name: Address: City: Phone: E-mail: This installation is being made on residential 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). 7l{? . Signature: CONTRACTOR INSTALLATION. L iC- LkC- Signing supervisor's license no.: Print name of sign iog supervisor: Signature of signing supervisor: -,~~ W\: " ~~~ ~~~ ~~ 440-2584-J (9/08/COM) ~;~,'~\"f~~:,};~~:;~T~~fwi)t~if'; ~EE~.SC A ED_uc1E~7N~rtA~~;~~~"J;?:i~~ .~ .~ Cost Total .N~~~er.~\in~p~~t~~,~i ~~!"}te~ P.::/, q~r' ; . 'ea.~. cost Residential, per unit, service included: 1,000 sq. fl. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: instal/ation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 40] to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over] ,000 amps or volts (2) $469_00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: instal/ation, alteration, relocation 200 amps or less (2) $ 63.00 $ 20 I to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126_00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration. extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) , $ 55.00 $.f:i'J.Qt Each additional branch circuit ..:) $ 6.00 $/:2 .,"Ii Miscellaneous fees: service orfeeder ,:ot included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (1) $58.00 $ ?'''''''''''~!'''f''~''l1C!;if4'''''i:\'AF!pi2ICANt''tJS' ",""';""""';'2"";'"""""" ,"" , \;~,'i!:,;:W,li.",&~~;';t"~i;:;:I:i;,,,; _ "- ~': . ,_,' ::',~~,' ,E,~'f!.i.;'.'f.<lJ;:.i"_~.'f~:!!!}-!+ft~"_~,,,'t. (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ (B) Enter 12% surcharge (.]2 x [AD $ 8,M (C) Technology Fee (5% of [AD $ 515:> TOTAL fees and surcharges (A through C): $7-P?,3G !~.t -; .,.... CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00325 ISSUED: 03/16/2010 APPLIED: 03/16/2010 EXPIRES: 09/16/2010 VALUE: .t...::L\ . ~. ..! Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 225 5TH ST ASSESSOR'S PARCEL NO.: 1703353103300 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Public PROJECT DESCRIPTION: 3 Circuits Owner: CITY OF SPRINGFIELD Address: 344 NORTH A ST CITY HALL SPRINGFIELD OR 97477 Contractor Type Contractor Expiration Date Phone BuiLlJING INFORMATION ~ # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary COllstruclion Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Rallge Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft BlIsemellt: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION ~ REQUIRED PARKING Total: HlIndicllpped: Compact: Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Sular Setbacks: AlTENnOW."Or~ililw,(8qU/res you 10 foUow rulesllltltllmSdfIYlIIb''Oregon UtII.... Notiflcatlon amtlll! rni~' "y In OAR 952..(JGfG(lI~-forth 0090. You may obtaIn COpies 01 the '::'10 Street Improvements: Storm Sewer Available: Speciallnstructinn: !.! " ;l,~', DownspoutslDrains: Notes: I Valuation Description ~ Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I of2 CITY OF SPRINGFIELD Building/Combination Permit 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ,'. "" . ,".1.0 ~~. l:'._ PERMIT NO: COM2010-00325 ISSUED: 03/16/2010 APPLIED: 03/16/2010 EXPIRES: 09/16/2010 VALUE: Status Issued ~ " . Total Value of Project I Fees Paid' Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $8.04 3/16/10 2201000000000000243 $3.35 3/16/10 2201000000000000243 $55.00 3/16/10 2201000000000000243 $12.00 3/16/10 2201000000000000243 Total Amount Paid $78.39 I Plan Reviews ~ 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, insp~cti9n~ requested after 7:00 a.m. will be made the following work day. . ..- ., ,. , . LRelluired InsDections ~ Rough Electric: Prior to Cover Final Electric: When 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, 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. ' 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 t~vyrmit card is located at the front of the property, and the approved set of plans will remain on the site at all '7#~ ~to . Owner ur Contractors Signature Date ~ {~:I\1 .' ,~:' ,.~~ Pa2e 2 of 2 225 Fifth Street Spr,ingfietd, Oregon 97477 541-726-3759 Phone ~~ii City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000243 Date: 03/16/2010 9:48:30AM Job/Journal Number COM20 I 0-00325 COM20 I 0-00325 COM20 I 0-00325 COM20 I 0-00325 Payments: 'f}'PC of Payment Check cReccintl . i~ Amount Due 55.00 12.00 8.04 3.35 $78.39 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add , " + 12% State Surcharge + 5% Technology Fee Paid By CONRICH ELECTRIC, LLC Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid KLK $78.39 $78.39 3382 KLK In Person Payment Total: Page] of I 3/1 6/20 I 0