HomeMy WebLinkAboutPermit Electrical 2010-4-26
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Electrical Permit Application
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225 Fiftb Street+Springfield, OR 97477+PII(541)726-3753+ FAX(54 1)726-3689
DEPARTMENT USE ONLY
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Penn it no.: & {) - A:$
Date:
10
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? DYes D No
CATEGORY OF CONSTRUCTION
o Residential 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
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ZIP:
Taxlot.05"'\Q:)
DESCRIPTION OF WORK
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PROPERTY OWNER
Name; LErv,u!::::il+ Y
Address:
City:
Phone:
E-mail:
ZIP:
Fax:
This installation is 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 479.560(1).
Signature:
11OC'
ZIP:
E-mail:
CCB 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 t to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over t,OOO amps or volts (2) $469.00 $
Reconnect onty (2) $ 63.00 $
Temporary services Of feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 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) $ 55.00 $
Each additional branch circuit ::, $ 6.00 $JU
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: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ ;'0
(Minimum Permit Fee $58.00)
(B) Enler 12% surcharge (.12 x [A]) $ 3' ",9-
(C) Technology Fee (5% of[A]) $ i "'..9-
TOTAL fees and surcharges (A through C): $ ,,'" t.S-
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO:' COM20IO-00393
ISSUED: 03/31/2010
APPLIED: 03/31/2010
EXPIRES: 09/30/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 F:ax
541-726-3769 Inspection Line
SITE ADDRESS: 215 MAIN ST
ASSESSOR'S PARCEL NO.: 1703353205700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Sigo lighting
Owner:
Address:
YI KENNETH &.RUTH
215 MAIN ST .
SPRINGFIELD OR 97477
. \ requires you to
ATTENTION: Oregon a~he Oregon Utility
foilow rules adopted h~~e rules are set forth
Notification Center, T .h"" 'gh OAR 952-001-
mUAM::I",,-0618819 gthe ruleS DY
o~;o;=_lji , gtne
1I110gon Uti ity 0 lion
number for the re n.m....\.. ..
Contractor Center is 1-BoO-33~e ExpiratIOn Date
MY ELECTRICIAN INC 87506 11/20/2011
BUILDING INFORMATION I
Phone
541-729-1454
Contractor Type
Electrical
# of Units:
Primary Occupancy Group:
Secoodary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
. # of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type:, .,.,.",', ,',' .C' ..",,'" Sq Ft Basement:
NOT1~!.~ge Type: ' IF THE WO~ Ft Garage/Carport
S ~mft"S~Alt EXPIRE N~ Ft Other:
riTH1 H~itt~1'tJ~I!fl''fHIS PERN\ij~~R vdccupaot Load:
~t1~_~1~~~~~
'I'll'!\"- REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
o;',"of Lot Coverage:
~.~.:_..,~_ ......4." .._ . '.
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special I nstruction:
Sidewalk Type:
.Downspouts/Drains:
Notes:
I Valuation Description ~
Description
. Type of Construction'
$ Pe~Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I 01'2
"
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541- 726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L Fees Paid-l
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Sign - Outline Lighting Each
+ 12% State Surcharge
+ 5% Technology Fee
Add, Aller, Extend Circ Ea Add
"'';''':..f-' .>'~'''-~~,;."
Amount Pa~1.~'~, f. -'. .
~~'~~'l$;,
$7.56" . .
f:-
$3.15''''
$63.00
$3.60
$1.50
$30.00
Total Amouot Paid
$108.81
[ Plan Reviews' ~
Date Paid
3/31/10
3/31/10
3/31/10
4/26/10
4/26/10
4/26/10
CITY OF SPRINGFIELD
Building/Combination Permit.
PERMIT NO: COM2010-00393
ISSUED: 03/3112010
APPLIED: 03/3112010
EXPIRES: 09/30/2010
VALUE:
Receipt Numher
2201000000000000297
2201000000000000297
2201000000000000297
2201000000000000407
2201000000000000407
2201000000000000407
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.
L Reauired Insoections ~
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 work performed shall he 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 compiiance 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
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Sign Electrical: After connection is made but!?;'ior'toenergizing
Rough Electric: Prior to Cover ;".tf~!" ';;"~.
f.
Final Electric: When all electrical work is complete.
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W-l2b 110
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Date
,
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
iiC~:-
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000407
Date: 04/26/2010
II :29:50AM
Item Total:
Amount Due
30.00
3.60
1.50
$35.10
Job/Journal Number
COM20 I 0-00393
COM20 I 0-00393
COM20 1 0-00393
Description
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Paid By
EDW ARD GUIDRY
Check Number Authorization
Re~eived By Batch Number Number How Received
Amount Paid
cjc
011867 In Person
Payment Total:
$35.10
$35.10
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4/26/2010