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Home My WebLink AboutPermit Electrical 2010-4-26 ;;; . Electrical Permit Application . . 225 Fifth Streett Springfield, OR 97477tPH(541)726-3753tFAX(541)726-J689 DEPARTMENT USE ONLY ~ ~ permitno.:{]/(}-P2 L-' Date: 10 Tbis permit is issued uuder OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes D No CATEGORY OF CONSTRUCTION D Residential D Government D Commercial JOB SITE INFORMATION AND LOCATION <.. I q'"" City: .s State: 0 f( ZIP: Reference: \ 2> \ Taxlot.\\ecD DESCRIPTION OF WORK PROPERTY OWNER Name: ~f/j)U I L t:-:) Address: '-r 2"0, rl:c City: )/'FL...D Phone: E-mail: 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: I0C.:- . ~ ZIP: 9) lJ E-mail: CCB license no.: 0) :'-(9 G Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: .~ ~~~D'\\ V \\.W \S>~.\o ~\'~~ ~\}' 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 $ 401 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) I $ 63.00 $r,,'~ Temporary services or feeders: instal/ation, alteration, relocati~ . 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. Fcc for branch circuits with purchase of a 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 $ 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 $ (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [A]) $')~ (C) Technology Fee (5% of [A]) $ J!?- TOT AL fees and surcharges (A tbrough C): $ '7~ '&- ;.. ,.-'. . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00512 ISSUED: 04/26/2010 APPLIED: 04/26/2010 EXPIRES: 10/26/2010 VALUE: Status Issued "i" .,', .,., 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line '-.~<:. , ',' ':" SITE ADDRESS: 425 19TH ST ASSESSOR'S PARCEL NO,: 1703361311800 Springlield TYPE OF WORK: Electrical Work Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Reconnect electric service ' t: ATTENTION: Oregon law requiresyov 0 rvllvn I ~L:'5 aa~r:ts8 B~' tAG QrOSgA 11ti'~ Owner: ALV ARENGMc1l~~'EThose rules are set forth Address: 425 19TH ST in 'OAR 952-001-0010 through OAR 952..Q01. SPRINGFIELDOlllR YadTIlay obtain copies of the rules by calling the center. (Note: the telephone Owner: GILES ARMOWlM?oer for the Oregon Utility Notification Address: 425 19TH ST Ce9ter is 1-800-332-2344). SPRINGFIELD OR 9747 I CONTRACTOR INFORMATION ~ ".' t' Contractor Type Electrical Expiration Date 1l!20/2011 Phone 541-729-1454 Contractor ' License MY ELECTRICIAN INC' 'j.: . 87506 NOTICE: I BUILDING INFORMATlON~ # of Units: THIS PERMIT SHALL EXPlijlifl~tJH,I;:WORK Primary Occupancy GrbllpHORIZED UNDER THI!Hi!fj!ftMliT~.hIIdTe Secondary Occupancy gm!1RiENCED OR IS ABANQ(i)WIifihQR Primary Constructio~ ll,W'I' 180 DAY PERIOD. Water Type: Secondary Construchon''type: Range Type: # of Bedrooms: Energy Path: Sprinkled Bnilding: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION ~ Front yard 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: I PUBLIC;IMPROVEMENTS ~ Street Improvements:, Storm Sewer Available: Special Instruction: .. .ii, Sidewalk Type: Downspouls/Drains: . i:: l':....r Notes: Page,lof2 ,. j '!"., Status Issued 225 Fifth Street, Springtield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 tnspection Line .tf;^~<..,,1' ;!.. ;..iJ.'. Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project LFees Paid . Fee Description + 12% State Surcharge + 5% Technology Fee Service Reconnect Amount Paid $7;56. $3.15 $63.00 Total Amount Paid $73.71 Plan Reviews I "I,...".... 'Ii ....: " ..,~,t\'; :< "_, '.. -....'..., Date Paid 4/26/10 4/26/10 4/26/10 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00512 ISSUED: 04/26/2010 APPLIED: 04/26/20 10 EXPIRES: 10/26/2010 VALUE: Value Date Calculated Receipt Number- 2201000000000000408 2201000000000000408 2201000000000000408 To Request an inspection call the 24 hour .r~~9rdirig at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, in'spections requested after 7:00 a.m. will be made the following work day. I ReQuired InsDections . Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I furtiit+ certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springlield 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 Commnnity Services Division, Bnilding Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be nsed on this project. I fnrther agree to ensure that all required inspectious 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 constructioJl. , . ." . ,\.;. . . ~.' . ...t~"~;'1 -j.,.... ,I . "';.'/ '1:~. ~. . !.':~ i ,) Pa2e 2 01'2 4-- !;2?,)IO Date " iEtC City of Springfield Official Receipt Development Services Department Public Works Department 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone RECEIPT #: 2201000000000000408 Date: 04/26/2010 ]] :32:49AM Job/Journal Number Description Amount Due COM20 1 0-00512 Service Reconnect 63.00 COM2010-00512 + 12% State Surcharge 7.56 COM20 I 0-00512 + 5% Technology Fee 3.15 .....'f,.. .,., Item Total: $73.7] Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Amount Paid CreditCard EDWARD GUIDRY cjc 008053 In Person $73.71 Payment Total: $73.71 \ .,. . 'I ,'~ :i .. , ,,"'..."'.' -...,>-., , . ',," ..:..rJ___." cReceintl Page I of I 4/26/2010