HomeMy WebLinkAboutPermit Electrical 2010-3-15
225 Fifth Street. Springfield, OR 97477< PH(541)726-375H FAX(541)726-3689
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Electdcal Permit Application
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Pennit no. (2/ D ,...-003
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Date:
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.
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Zoning approval verified? D Ves DNo - , . -', - . ': ,'<' .' . . - ..,'.-,',c' . /"~'_' ':' ',' ,'" .' CoSt Total
,Number of.inspecti~ri~'per itinic)' <.;.QIy. ..
._j::~e.a~"( .. C(lst
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Residential, per unit, service included:
o Residential I 0 Government T 0 Commercial
~t1:-l1~lttOBil1:SI;rE~INE.6R/VIARIOI\jt.'AIIION!~().CAT'10Nil,,~),.'i~'~11 \,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft, or portion
Job site address: 2.- .,;.-<;c-\ M....... 5\ thereof $ 25.00 $
City: S""-"'- c.'e.\; I State: 0" I ZIP: q 7'-17) Limited energy (2) $ 32.00 $
Reference:' \fl{)~ '1:0'3'2.. I Taxlot.:f....' Each manufacfured home or modular $ 63.00 $
, , ,'DESCRIPTION; .OF'WORKi'!:,i:>',' ';', dwelling service or feeder (2)
r Ck\J..<,,., Go-,^~ G-kh \2,OL~t-.. Services or feeders: installation, alteration, relocation
dc;-t)iC('
C"-"C"'-(- " 200 amps or less (2) I~ $ 81.00 $
'PROPERl"YOWNER. . . 201 to 400 amps (2) T $ 95.00 $
.
Name:::::" 1<~'M/3DL/o---.J 40 I to 600 amps (2) $158.00 $
Address: "2-><:5 '( rYI AN of2-- 601 to ] ,000 amps (2) $205.00 $
City: S-o I 0 IL_-- State: cfZV 1 ZIP:4 7 Lnrs Over 1,000 amps or volts (2) $469.00 $
Phone: ~ ~- I Fax: - - Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or fann property 200 amps or Jess (2) $ 63.00 $
owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR 40] to 600 amps (2)
479.540(I) and 479.560(1). $126,00 $
r- Sign'atme: (' Over 600 amps or 1,000 volts, see services or feeders section above
. 'CONTRACtOR INSTAlL:.ATION Branch circuits: new, alteration, extension per panel
Business name: L-M"! c:ierL-' ('\ a. Fee for branch ci~cuits with purchase of a service or feeder fee:
Address: 1~C;1 G-ou.<..-"-t- ~~ Each branch circuit {..I $ 6.00 $
City: F'.i J<: C<A.C State: Or -1 ZIP: '17'-105 b. Fee for branch circuits .without purchase of a service or feeder fee:
Phone:.,<tI-l1rr CB,7l7 I Fax:<;,!I-{,5J 8 '3, L--3 First branch circuit (2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: /BS68(c I BCD license no.: Miscellaneous fees: service or feeder ,:ot included
Signing supervisor's license no.: !\LJ3<-J S Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: Rol.. c:.r+ $, L 0""<-<" Each si'gn or outline lighting (2) $ 63.00 $
Signature of signing supervisor: ./71 J. (7 ~ l Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
'IT G---- ---- Each additional inspection: (I) $58.00 $
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~\9~ (A) Enter subtotal of above fees d~
(Minimum Permit Fee $58.00) $ h
.
O""I~ (B) Enter ]2% surcharge (.12 x [All $lO."i' It
,. ~ (C) Technology Fee (5% of [A]) $4 ,'01 D
TOTAL fees and surcharges (A through C): $\ r: )\. \':--,\
~
440-2584-) (9/08/COM)
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00321
ISSUED: 03/15/2010
APPLIED: 03/15/2010
EXPIRES: 09/15/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2859 MANOR DR
ASSESSOR'S PARCEL NO.: 1703233201500
Springfield TYPE OF WORK: Bathroom
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace two fixtnres
Owner: MEDLIN SUSAN C
Address: 2859 MANOR DR
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor.
DOUGS PLUMBING INC
License
110163
Expiration Date
11I24/2011
Phone
541-688-3385
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Coustruction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
RangeType:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Fl Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
..
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
I PUBLIC IMPROVEMENTS I
ATTENTISid'e~aJj&l'y'p'e:w requires you to
follow rules adopteD oy the Oregon Utility
Notificatiol~~mlmUII(9JI!\'!J.es are set forth
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Uti lit Notification
en erls
'"
Storm Sewer AvtVll.ble:
Speciallnstructib'n':JTlCE:
THIS PERMIT SHALL EXPIRE IF THE WORK
Notes: AUTHORIZED UNDER THIS PERMIT IS NOT
.n~n~fl!:'"
ANY 180 DAY PERIOD.
Valulition Descri
Description
Type of Construction
$ Per Sq- Ft
or multiplier
, Square Footage
or Bid Amount
Value
Date Calculated
Page I of2
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
+ 12% State Surcharge
+ 5% Technology Fee
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Fixture
Minimum/Adjustment Plumbing
Perm Serv/Fdr 200 amps or less
Total Amount Paid
Total Value of Project
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"Fees Paid j
Amount Paid'
$6.96
$10.44
$2.90
$4.35
$6.00
$38.00
$20.00
$81.00
$169.65
I Plan Reviews I
Date Paid
3/15/10
3/15/10
3/15/1 0
3/15/10
3/15/10
3/15/10
3/]5/10
3/15/1 0
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-0032I
ISSUED: 03/15/2010
APPLIED: 03/15/2010
EXPIRES: 09/15/2010
VALUE:
Receipt Number
1201000000000000230
2201000000000000242
]201000000000000230
2201000000000000242
2201000000000000242
1201000000000000230
1201000000000000230
2201000000000000242
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'
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workday. 'V:. '
~ ,~'J,: . ' ,.{;
Reouired Insoections I
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
By signature, 1 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 Springlicld 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 rcadahle 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
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Paee 2 of 2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-375<1Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000242
Date: 03/15/2010
2:36:06PM
Job/Journal Number
COM20 10-00321
COM20 1 0-00321
COM20 I 0-00321
COM20 1 0-00321
Payments:
Type of Payment
CreditCard
cReceintl
Description
Perm Serv/Fdr 200 amps or Jess.,
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
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Paid By
ROBERT YOUNG
Check Number
Batch NUl1)ber
Received By
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Page I of I
Item Total:
Authorization
Number How Received
Amount Due
81.00
6.00
10.44
4.35
$101.79
Amount Paid
000266 In Person
Payment Total:
$101.79
$101.79
'.
311512010