HomeMy WebLinkAboutPermit Electrical 2010-4-20
DEPARTMENT USE ONLY
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Permit no.:
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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.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
I\Z!. Residential D Government D Commercial
JOS'SITE INFORMATION AND LOCATION
Job site address:
City:
Refere
PROPERTY OWNER
ZIP:q'1.y-7?
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This installation s being made on residential or fann 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 79.560(1 .
Signature:
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
ZIP:
BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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440-2584-J (9/08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
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 $ 63.00 $
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 $
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) $ 63.00 $
20 I to 400 amps (2) $ 87.00 $
40 I to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: ne"W, alteration, extension per panel
a. Fee [or branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 I $~
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $ 6'f'~ "-
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not 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 $
APPLICANT USE
(A) Enter subtotal of above fees $ 6-'/3' .e
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AJ) $ ~r1 .0\1 17
(C) Technology Fee (5% of [AD $1 .l\C
TOTAL rees and surcharges (A thrnugh C): $ ^4 .9,1 "
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00484
ISSUED: 04/20/2010
APPLIED: 04/20/2010
EXPIRES: 10/20/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 431 EST
ASSESSOR'S PARCEL NO.: 1703352405700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Extend one circnit
Owner: THARP JOINT TRUST
Address: 431 E ST .
SPRINGFIELD OR 97477
I CON"FRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
. Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height 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 INFORMATION I
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:
I PUB[;[C:IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Description I
Description
Type of Constrnction
$ Per Sq Ft
or multi'plier
. , . S'qnare Footage
or Bid Amount
Value
Date Calculated
Paee I of2
Status
Issued
,.
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20]0-00484
ISSUED: 04/20/2010
APPLIED: 04/20/2010
EXPIRES: ]0/20/20]0
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
~ '.... ,
Total Value of Project
LFees Paid . ,
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Orc
Amount Paid, '
$6.96 '
$2.90
$58.00
Date Paid
Receipt Number
4/20/10
4/20/1 0
4/20/10
2201000000000000377
2201000000000000377
2201000000000000377
Total Amount Paid
$67.86
Plan Reviews ~
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To Request an inspection call the 24 hour r~cording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested afte,' 7:00 a.m. will be made the following
work day.
LReauired Insoections ~
Rough Electric: Prior to Cover
Final Electric: When all electrical work is con\plete.
'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 workperformed 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 pl'Ojecl.
I further agree to ensure that all required inspections are requested at the prope;' 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
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Date
Pa2e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000377
Date: 04/20/2010
12:35: 11 PM
Job/Journal Number
COM20 I 0-00484
COM20 1 0-00484
COM20 1 0-00484
Payments:
Type of Payment
CreditCard
cReccintl
Description
Add, Alter, Extend Circ
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
ORVILLE THARP
,Check Number
Received By Batch Number
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Page 1 of 1
Item Total:
Authorization
Number How Received
Amount Due
58.00
6.96
2.90
$67.86
Amount Paid
4 I 0243 In Person
Payment Total:
$67.86
$67.86
4/20/20 I 0