HomeMy WebLinkAboutPermit Electrical 2010-3-4
Electrical Permit Application
225 Fifth Street+Springfield, OR 97477.PH(541)726~3753. FAX(541)726.3689
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DI7~~~RTMENT liSEONLY
Date:
This permit is issued uuder OAR 918-309-0000, Permits are uontransferable. 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
'N,.;:#>};[,!;>~i!.c:ATEGOR.Y!i6I;,;C0NSTR.LJCTI6N~~F';'". ;'
Residential D Government D Commercial
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City: State(:)
Taxlot.:
"DESCRIPTION.,OF,WORK'.;~Ji:;';"'{i'~;.."'"
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).
E-mail:
CCB license no./'iBf/2'
Signing supervisor's license no
Print name of signing supervisor:
Signature of signing supervisor.
440-2584-J (9/08/COM)
~~~~~~~~U~~~~~~FEE~SCHEPO~E~~~~~~~~~~~~~~
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1,N~~ber o.<LIn.~pect'ons<Py~r";'~~H"{')":{,;;.:, Q~y. :,'2ea.,"1:.: ",'.;"cost, ,
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Residential, per unit, service included:
1 ,000 sq, ft, 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 $ 53.00 $
dwelling service or feeder (2)
Services or feeders: instalhition. alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) I $ 95.00 $~5
40 I to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
40 I to 600 amps (2)
$ 63.00 $
-I"", $ 87-.00 $
$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:
FirsCbranch circuit (2)
Each additional branch circuit
$ 55,00 $
$ 6.00 $
Miscellaneous fees: service or feeder '!ot included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
$
$
$ 63.00
$ 63.00
$ 63.00 $
Each additional inspection: (I) $58.00 $
(~~;~~~~J~~~~~~~;;}~~Rei2IcANT!~tJS~EWE~tf~&i4fii~~(~~_lt.~~~, ;~!;~
(A) Enter subtotal ofahove fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of lAD
TOTAL fees and surcharges (A through C):
$c?6
$//-4'::; __
$ .-y: -;:5
--
$ ///./)
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-00278
ISSUED: 03/04/2010
APPLIED: 03/04/2010
EXPIRES: 09/04/2010
VALUE:
Status
Issued
SITE ADDRESS: 3840 OREGON AVE APT I
ASSESSOR'S PARCEL NO,: 1702314103702
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Service for Apt 1,2, & 3
Owner: ARNDELL FAMILY TRUST
Address: PO BOX 1943
EUGENE OR 97440
I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor License
COMPLETE ELECTRICAL INSTALLATION 184274
BUILDING INFORMATlON_
Expiration Date
10/14/2010
Phone
541-225-7827
# of Units:
Primary Occupancy Group:
Sccondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
H~ight of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATlO~
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:
NOTICE: XPIRE IF 1 '
fHIS PERMIT S\-IJI,LL E ERM lion Dese
UNDER THIS P
, ,WTHOHIZED ~PI\~IDONEDi?fi. S Ft
DescnPtlOnV1M~NT@ 6:lR::lStgrruction I,ql'
,U\ ~ v ~ ERIOD or mu tIp ler
NYi80DAYP ,
I PUBLIC IMPROVEMENTS ~
Sidewalk Tm'iis yoU to
N' Oteonn laW teq l't'I'ty
ATTENTIO, oDol)'n~p'QlUlliVV:t\iih!': II
talloW rules adopt~ll 'se rules are set forth
Notification cent~~; 6~~rough OAR 952-00~.
In OAR 952-00;- 'co ies oithe rules Y
I 0090.: You may obtain Nofe: the telepho~e
the Oregon \1 l
, ; BOO-332-2344).
ter IS -
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Square Footage
or Bid Amount
Value
Date Calculated
.~'" '
"'>r:f-'" .
Pa~e I of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00278
ISSUED: 03/04/2010
APPLIED: 03/0412010
EXPIRES: 09/0412010
VALUE:
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspectinn Line
TotalV~lne of Project
I . Fees Paid.
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Perm Serv/Fdr 201 to 400 amps
Amount Paid
Date Paid
$11.40
$4.75
$95.00
3/4/10
3/4/10
3/4/10
Receipt Number
1201000000000000204
1201000000000000204
1201000000000000204
Total Amount Paid
$111.15
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 Reau~red Insnecti,ons ~
..,".' I
Electric Service: Approval required prior 'to'ui.ility company energizing service.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 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, th:lt 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
Date
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Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000204
Date: 03/04/2010
2:01:3SPM
Paid By
COMPLETE ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
95.00
IIAO
4.75
$11 1.1 5
Job/Journal Number
COM20 I 0-00278
COM20 I 0-00278
COM20 1 0-00278
Description
Penn Serv/Fdr 201 to 400 amps
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Amount Paid
njm
004792 In Person
Payment Total:
$111.l5
$11 1.1 5
/
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