HomeMy WebLinkAboutPermit Electrical 2010-3-31
Elecfrical Permit Application
225 Fifth Streett Springfield, OR 97477 tPH(541)726-3753+ FAX(541)726-3689
DEPARTMENT US.E ONLY
c~ZO(o. o~ 395
Penmt no.: .
This permit is issued under OAR 918-309-0000. Permits are nontrli",sferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
. L::OCAL(;OVERNMENT APPROVAL:.:
Zoning approval verified? D Ves D No
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Job site address:
City: -SOr
ZIP:
Reference:
Taxlot.:
DESCRIPTION OF WORK'; ,
:Si
", .'
,.;Num~er' of..inspectio:'ns per ,item.: ( ). .
. .'.' '-. " , ,-,-,-,.',.-..,
Total'
cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
ZIp:y7lf77 Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Name:
Address:
City:
Signature:
Business name:
E-mail:
CCB license no.:
Signing supervisor's license no..
Print name of signing supervisor:
Signature of signing supervisor: .
TempQrary serv'ces or feeders: installation, alteration, relocation
$ 63.00 $
$ 87.00
J alteration, extension per panel
a ee for 'ranch circuits with purchase of a service or feeder fee:
Each branch circuit
$
b. .~ee for branch circuits !ithout purchase of a service or feeder fee:
_ First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder ':lot included
$ 63.00 $
$ 63.00 $
$ 63.00 $
$58.00 $
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(B) Enter 12% surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
440-2584-J (9108/COM)
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$ b~
$ 75
$ "3r)
$ ,
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00393
ISSUED: 03/31/2010
APPLIED: 03/31/2010
EXPIRES: 09/30/2010
VALUE:
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2]5 MAIN ST
ASSESSOR'S PARCEL NO.: ]703353205700
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Sign lighting
TYPE OF USE: New
Commercial
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Owner: YI KENNETH & RUTH
Address: 2]5 MAIN ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor License
MY ELECTRICIAN INC 87506
BUILDING INFORMATION ~
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
. Height of Structure
Type of Heat: \0
Water ~p\eSo~O~\i\i\'i
. Oteg~~\\?,~\3g a\ \ot\h
:\1"\'1'110\'-\' c\o\lI(,~lIe~gy t~l!!,:a.te~s 2-00\-
f'... ,,' {\.l\eS a. leI S\iti1ft1e ~iIOi '.\eS '0'1 n/a
I \\0" . ~ el1' Oil ..
\,-\ol\\\C"'g:: - "". N
. Of'..B. ~.. ", '"
\~090;\~~~\\e eel1\8et;egol1 ~~~_'2.Z.44).
ell. '-e,el jot Itle, 'I~~0m:' "
I1IlIl1 cel1\8t 'ff Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
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Notes:
"ff
f:,;
Description'
$ Per Sq Ft
or multiplier
r>:
Square Footage
or Bid Amount
. Tvpe of Construction
Paee ] of 2
i,
Expiration Date
] 1/20/2011
Phone
541-729-1454
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Value
Date Calculated
, ,
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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,,' Total Value of Project
I Fees Paid__
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Sign - Outline Lighting Each
Amount Paid
$7.56
$3.15
$63.00
Total Amount Paid
$73.71
I Plan Reviews ~
Date Paid
. 3/31/10
3/31/10
3/31/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20tO-00393
ISSUED: 03/31/2010
APPLIED: 03/31/2010
EXPIRES: 09/30/20 I 0
VALUE:
Receipt Number
2201000000000000297
2201000000000000297
2201000000000000297
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. ,.""" '. ". .'
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L Reauired InsDections ~
Sign Eleetrical: After connection is made but prior to energizing
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is trne 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 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 01' Contractors Signature
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Page 2 of 2
Date
22? Fiftl1 Street
Spri'ngfield, Oregon 97477
541-726-3759 Phone
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...... II
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000297
Datc: 03/31/2010
2:53:29PM
Job/Journal Number
COM2010-00393
COM2010-00393
COM20 I 0-00393
Description
Sign - Outline Lighting Each
+ 12% State Sur,charge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Paid By
MY ELECTRICIAN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
63.00
7.56
3.15
$73,71
Amount Paid
djb
013445 In Person
Payment Total:
$73.71
$73.71
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3/31/2010