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Home My WebLink AboutPermit Electrical 2010-4-30 Electrical Permit Application i . ' .' '"r -' ~ , l' ....." 1 . ,"4 - ~ "". - . - CITY.OF SrRIN tiEIEiLD~r,QREe(lN~~":" , \ "~ .'- ~J. :"L..21o; ".'- .~~ '01'" " ''''''''' ; 225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689 SPRINGFIELD iJ~'~ lS~i~"lilI,,_ 'IiQJI .. ,;(. DEPARTMENT USE ONLY ..'..,- CO.........-z.c.::.(O .O~ $"\8' Permit no.: Date: l..{- 30-(c:::, This permit is issued under OAR 918-309-0000, Permits are nontransferable,. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days, .. .c'G'OCJl.L;:GOVERNMENT'AF*I"RO.vA"r;::ii"f'~'j),;i'~Y Zoning approval verified? 0 Yes 0 No ;~S"'\,:'::::!CATEGORy:YbF :'.CONSTRUCTlON!},' ~Residential D Government D Commercial !li!!lit;'lt'Y;\;tOBf;SITE(IINFbRNlATIQN~Jl.N[j~lZOGA'I110N~tlW\ilj Job site address: S If 'I 5. f-f City: <;;;fl~ {', d State: 0 ( ZIP: Cf7P Reference: 707- sL{ l S Taxlot.QOl(ss . DESCRIPTION,OF' WORK'1'H:,.;,;,j,~lr,:',';;"""" A Dr ({, z: c,.rc......7"~ Name: Address: ZIpry7l17g- City: Phone: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature ofi . by, if In OAR 952-G01-GO;Othrough OARe9~2.torth OO:i, Yo~ may obtain copies of the rules t1y ng e center. (Note: the te/e h number for the Oregon Utility NOI~C:;:n Center Ie HICJ0.332-2344). ~-~_._._. ~/Q~ 440-2584.J (9108/COM) .....~~~ ~ ~;~?;;,('~~,tt~}l~~:,$~Q:~~~q\~'~k~ijFet:E~SCH ED.lli [jE.t?~;:r.~fi~rfJjF~r';>~~R~ ..'~" ", . V' . Cost Total .Number of -inspections per item 0 ". Qty. ..;:';ea~~, " 'cost. . ".'. ',~, ",~:-- .0' ,'....c,..~.i-< ~',:'.,,. ",!';',. '.:?~": ......', 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 t ,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 .) . --." ;::'t.~'W_ b$~.6:U)Q.(. .$ 201 lo'l'Pl1!\' C!U^, I :11 . 40t toAQPf'l't@fHl1m II nmi - ON )l . Over 600MM iit.JU.lm '@JQ;,ISeAfl'1imJ 0'r~!!l'f@!iltio~a,bove Branc~~lYcJiIWJ;)A'6IPEflJGfj).tension per panel. . " a. Fee 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 $ S) Each additional branch circuit ( $ 6.00 $ b 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 $ ~;It.tt~~#~~~r;~~~1i~,~~ARFi[iC'ANt{}jjs,E1]1.:~{~~i~~~}lf;~!~\~:~1'(~~~;:{{' ~~;; (A) Enter subtotal of above fees b ( (Minimum Permit Fee $58.00) $ (B) Enter 12% surcharge (.12 x [AD $ 712 (C) Technology Fee (5% of [AD $ ~O) TOTAL fees and surcharges (A through C): $ 7( n ., .l. ~J ;,; ".",... CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00548 ISSUED: 04/30/2010 APPLIED: 04/30/2010 EXPIRES: 10/30/2010 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 544 65TH ST ASSESSOR'S PARCEL NO.: 1702341300433 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Add 2 circuits Owner: DICKENSON KENNETH W & CAROL J Address: 544 65TH ST SPRINGFIELD OR 97478 I CON'fRAGTOR INFORMATION ~ ,.""." . . Contractor Type Electrical Contractor i'" . License MOUNTAIN VIEW VENTURES INC 185907 BUILDING INFORMATION ~ Expiration Date 03/16/2011 Phone 916-990-4459 # of Units: Primary Occnpancy Gronp: Secondary Occnpancy Gronp: Primary Constrnction Type Secondary Constrnction Type: # of Bedrooms: VB Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occnpant Load: # of Stories: Height of Structure Type of Heat: -.~ Water Type: . Range Type: Energy Path:' Sprinkled Building: n/a J.TT~tl-rlQN' 0""'9"'" lou.l r~<1ldr~ct l!"11 1ft follow rules adopted bYthEi~:~:~NT INFORMATIO~ Notification Cenler. Those ru, ID,OAR 952-001-0010 through OAR 952-001. Frontyard Se~l): You may obtain copies of the ~"" Dist: Side I SetbacJ{: calilng the center. (Note: the telepflllneet Trees Rqd: Side 2 Setback:number for the Oregon Utility NoIifieatillftDrive Rqd: Rearyard Setback: Center is 1-800-332-2344). % of Lot Coverage: Solar Setbacks: R-3 REQUIRED PARKlNG Total: Handicapped: Compact: ~'._~ . Jo ... ." on .~.. I PUBLicIMPR<JVEMENTS, Street Improvements: Storm Sewer Available: Speci.llnstructio": :7 Sidewalk Type: Downspouts/Drains: Description Tvpe of Construction . '.. ,...~-i;~::. ";,.'is' ;~'f f!~'.~i'';:'j,:~;~;'-''''- ~~~I~i~M1T SHAll EXP1R~ IF THE WORK Valuation Descr!' ti NeED OR IS ABANDONED FOR!.r,$:,~ $ Per Sq Ft . ~~trJ ~g09~1 PERIOD. V I '- . .,,; ",.F";'" . .. , ; 0'1' B',d Amount a ue Date Calculated or multIplIer .. .!: Notes: Pa2e I of 2 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line !c>f+ ," .' \~?~ ~.:~.,., CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00548 ISSUED: 04/30/2010 APPLIED: 04/30/2010 EXPIRES: 10/30/2010 . VALUE: Status Issued ,'"" ,.;':.0,.1 M 'f Total Value of Project Fees Paid . Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $7.32 $3:05' $55.00 $6.00 4/30/10 4/30/10 4/30/10 4/30/10 2201000000000000445 2201000000000000445 2201000000000000445 2201000000000000445 Total Amount Paid $71.37 I Plan Reviews ~ > ~,_~~;: ".' .'t.f-'" , ;...t(" :P r," ~\ ). 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, in.spections requested after 7:00 a.m. will be made the following work day. I Reouired InsDections ~ Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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 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 .11 times during construction. .j,j..."".~'. '. l' ~ ;,.".:'" ,~"-' H. Owner or Contractors Signature .Iod,"" '.,." Date !.;....: P.ee 2 of2 22~ Fifth'Street Springfield, Oregon 97477 541-726-3759 Phone " ; 8P!~QF;~ Wit.... . City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000445 Date: 04/30/2010 12:01:46PM Paid By MOUNTAIN VIEW VENTUR Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 55.00 6.00 7.32 3.05 $71.37 Job/Journal Number COM20 I 0-00548 COM2010-00548 COM20 I 0-00548 COM20 I 0-00548 Description Add, Alter, Extend Clrc Add, Alter, Extend Clrc Ea Add + 12% State Surcharge + 5% Technology Fee Payments: Type of Payment Cred itCard Amount Paid djb 012010 In Person Payment Total: $71.37 $71.37 :J;'t '-:.. .:; ~. tl~ cReceiotl page 1 of 1 4/30/20 I 0 ~'.'.~ "