HomeMy WebLinkAboutPermit Electrical 2010-4-5
Electrical Permit Application
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:CITYOF SPRINGEIEI.;D-',.OREGON.t.
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225 Fifth Street. Springfield, OR 9747HPH(541)726-3753+FAX(541)726-3689
DEPARTMENT USE ONLY
Permit no.: (! /0 ~ ~I J'
Date:
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.
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.
. . lOCAL: GO\lERNMENT APPROVAL>':"
Zoning approval verified? DYes D No
..,.'.CA TEGORY;OFCQNSTRUC1}ON:,'
~ Name:
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),
Signature:
E-mail:
CCB license no.:
Signing supervisor's license no.:
Print name of signi.ng supervisor:
,
Signature of signing supervisor:
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440.2584.J (9/08/COM)
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_ c , Cost Total
Number" of..inspectio:ns per item: ( ) Qty.
. .',' -.', .'. .... --";.-,'i--,, ~~." cost
Residential, per unit, service included:
1,000 sq. ft. ar less (4) $134,00 $
Each additional 500 sq, ft. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ $
dwelling service ar feeder (2) 63.00
Services or feeders: installation, alteration, relocation
200 amps ar less (2) ) $ 81.00 $,;'/00
20 I ta 400 amps (2) $ 95.00 $
40 I ta 600 amps (2) $158.00 $
601 ta 1,000 amps (2) $205.00 $
Over 1,000 amps ar valts (2) $469.00 $
Recannect anly (2) $ 63.00 $
Temporary services or feeders: instal/ation, alteration, relocation
200 amps or less (2)
$ 63.00 $
201 ta 400 amps (2) $ 87,00 $
40 I ta 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 ofa 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)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder !lot included
Each pump or irrigation circle (2)
Each sign ar autline lighting (2)
Signal circuit or a limited-energy panel,
alter,!tion, I?r extension (2)
$ 63.00 $
$ 63.00 $
$ 63.00 $
Each additional inspection: (1)
!>f,;;;;;(i1~5~~i-.ili'~;'~'Ap"etJlb-ANm'i'tJsEt~::.
(A) Enter subtatal af abave fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A])
(C) Technalagy Fee (5% af[A])
TOTAL fees and surcharges (A through C):
$58.00 $
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$ 5"/60
$Y:4:
$ ~.o.,-
$ 9'7: 77
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00415
ISSUED: 04/05/2010
APPLIED: 04/05/2010
EXPIRES: 10/05/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 404 C ST I
ASSESSOR'S PARCEL NO.: 1703352410600
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Service change
Owner: COLEMAN-FRASER SUSAN
Address: 404C ST
SPRINGFIELD OR 97477
I CON'fRAGT0RINFORMATlON ,
Contractor Type
Electrical
Contractor . License
COMPLETE ELECTRICAL INSTALLATION 184274
BUILDING INFORMATION'
Expiration Date
10/14/20 I 0
Phone
541-225-7827
# of Units:
Primary Occupancy Group:
Secondary Occupllncy Group:
Primary Construction Type
Secondllry Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Rllnge Type: .
Energy Pllt": .
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GllrllgelCarport
Sq Ft Other:
Occupant Load:
nlll
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Afn:'iiJ'ff'
'""~; .~.f9I/ow rUI~sN~~;egon law requires you.~o
PUBLIC'IMP. ' ter. Those rules are setforth
001 0 throuQ~ OAR 952-001
0090.. You may obtailiiOO~JfJtfla: rules b .
callmg the center. mWI1;.lbllt~e y
number for the. Oregon Olmly Notification
Center IS 1-800-332-2344).
Frontyard Setbllck:
Side I Setback:
Side 2 Setback:
Rearyard Setbllck:
Solar Setbllcks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
NOTICE: I Valuation Description I
THIS PERMIT ~~lsnfIRE IFTijj;,WPmbt
Type of C~i1~Jf~fWZED YflJlri~RiJi~\S PERMl,t ~J@;o:~;
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD:
Value
Date Calculated
Paee I of 2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-004I5
ISSUED: 04/05/2010
APPLIED: 04/05/2010
EXPIRES: 10/05/2010
. VALUE:
. .."..\.. ...~:.. ~::"'-'"
Status
Issued
;'\.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Yalue of Project
LFees Paid , .
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$9.72
$4.05
$81.00
4/5110
415110
415110
2201000000000000318
2201000000000000318
2201000000000000318
Total Amount Paid
$94.77
I Plan Reviews i
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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 Reouired InsDections ,
Electric Service: Approval required prior to utility company energizing service.
By signature, 1 state and agree, that I bave can'fuIly.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 structnre without permission of the Community Services Division, Building Safety.
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
1 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.
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Owner or Contractors Signature
Date
Pa2e2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000318
Date: 04/05/2010
10:00:26AM
Item Total:
Amount Due
81.00
9.72
4.05
$94.77
Job/Journal Number
COM2010-00415
COM20 I 0-00415
COM20 I 0-00415
Description
Perm Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
. '-'"
Payments:
Type of Payment
CreditCard
Paid By
COMPLETE ELECTRICAL
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
njm
080905 In Person
Payment Total:
$94.77
$94.77
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