HomeMy WebLinkAboutPermit Electrical 2010-4-26 (2)
"
"
Electrical Permit Application
I CC'l:fiJ'W @[ii' ~mo~lJO:\, ~
225 Fifth Street. Springfield, OR 97477. PI-I(541)726-3753+ FAX(541)726-3689.
LIO -0 os'-t 7
DEPARTMENT USE ONLY
I~
Penn it no.: (jjvt;)IJlo..{)()5.
~Ui 0
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
Residential 0 Government D Commercial
JOB SITE INFORMATION AND LOCATION
" ST.
Name:
Address:
--
City: j '"
Phone:
E-mail:
This installation is being made on residential or fann property
owned by me or a member afmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OA R
479.540( I) and 479.560( I).
Signature:
City:
Phone:
E-mail:
CCB license no.:
CIff
Print name of signing supervisor:
Signature of signing supervisor:
~'
NOTIC~ <-:J~;\;""'\-"\"~"i""
THIS PERMIT SHAll EXPIRE IF THE WORK .
AUTHORIZED UNDER THIS PERMIT IS N~T/
COMMENCED OR IS ABANDONED FOR Q(,;"
ANY 180 DAY PERIOD. . ..n,'~x~
440-2584-1 (9/0R/COM) . ~
-&-
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq_ tl. or less (4) $134_00 $
Each additional 500 sq. fl. or portion $ 25.00 $
thereof
l,imited 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) I $ 81_00 $ Xl....
20 I 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. alte!'gtifb~', '!Nation
200 amps or less (2) I (eO; ':y(~q:;1 d\'<;I
201 to 400 amps (2) _...o.O~ :: \'<;Ie .~~ Ilft~t-~~;"-l
401 to 600 amps (2k\O~' ::;'o9\1l~'(\C Se'v iI'~ ~\QQ.\ ~:$~e
.,r
Over 600 anpl"tbr.! ~~.~~~\",I':i~ \.'_o/cI~ller i>~-. Kt;'IJi\tt"
Brancheirc~<<~ $), :{:,~)~\~i~h~,~ "':-'~\.
a. Fee for br' c . ro~IlI'f'\ !e\>"~p~~(]j&v.i."f~eder fee
Each braoch ~~\~\~9 '\';~( \'<;Ie.:;. ~-\)\)T $ 6.00 I $ -..
b. Fee for branch c~~~t~('T)Rrchase 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: (l) $58_00 $
APPLICANT USE
(A) Enter subtotal or above fees $ 'g( ---
(Minimum Permit Fcc S58.00)
(B) Enter 12% surcharge (.12 x [All $(, /7--. i--
(C) Technology ree (5% of [All $ <J ),0,\
TOTAL fees and surcharges (A through C): sVlt.k 1" 7
......-'
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00547
ISSUED: 04/30/2010
APPLIED: 04/30/2010
EXPIRES: 10/30/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1210 F ST
ASSESSOR'S PARCEL NO.: 1703351105200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Emergency repair of service
Owner: T & B DEVELOPMENT LLC
Address: PO BOX 8129
COBURG OR 97408
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor License
WESTERN STATES ELECTRICAL CONSTR 155472
BUILDING INFORMATION I
Expiration Date
05/15/2011
Phone
(541 )265-8067
VB
# 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:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
nla
I DEVELOPMENT INFORMATlO~
"OU\O
, ul~eS' ~l\':i. n
Frontyard Setback: \alll ~e~ ego~ ;''ltlt'ist:
Side I Setback: ....na~: Otego~ '0'/ \n9 at ate$St 2:(f1Trees Rqd:
Side 2 Setback: ""~",, ~eQ ado~\nosa t\l\e~",~~~e Rqd:
Rearyard Setba,b\\Q'Il ~ (\ ce(\\a\otntOU~n 0\ ~~~~~ Coverage:
Solar Setbacks: ~0\l\\ce.~2.oo'\-~\al(\ CO~~~~n9 ta\e~\cat\OIl
Qo9O- ~ tne callt~;e<;\oll iMPROVEMENTS
~\lfl... \01 tna 8()()-
Street Improvemenl\iltl\'09tcal\tat Is \-
Storm Sewer Available:
Special Instruction:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Type of Construction
Sidewalk Type' ",.""""i. "'.~
. .. ':' ':,,'~r~i~~_~;':~~'< ~'& q.~~
Downspouts/Drains1":<"',"\'O~ ~C lJ\ ~~:,
,," \Y ~ ,e. ~,'."..
t'~' ....\.\. ~1S'\~~l~~'\ ~O~ ,,;~{<
i, vi ,D. ," O\\\.o~' ~ ~'OI" V. ,"\'0\'>1 Q~y"fJ '. ,.<\. '"..
u,;., ~,~t.~\1\ \J~fJt ~~fJ ,"
I V alu~t;on Description I\\l~~w.t.~c.t.~ '?t.~\lJfJ:
, , \, :-I '\ 'Q\) fJ
$ Per Sq Ft Square Foot'a'ge V I
or multiplier or Bid Amount a ue
."'''
Notes:
Description
Date Calculated
Paee I of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00547
ISSUED: 04/30/2010
APPLIED: 04/30/2010
EXPIRES: 10/30/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541- 726-3676 Fax
541-726-3769 Inspection Line
.'
~.'-". ....
...1-
Total Valne of Project
Fees Paid ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
Amonnt Paid
Date Paid
$9.72
$4.05
$81.00
.4/30/10 .
4/30/10
4/30/10
Receipt Number
1201000000000000397
1201000000000000397
120]000000000000397
Total Amount Paid
$94.77 '
I Plan Reviews ~
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. . .
!......".
Reauired Insnections ~
Electric Service: Approval required prior to utility company energizing service.
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 permissi?n 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 fr"ht ~f the property, and the approved set of plans will remain on lhe site at all
times during construction.
Owner or Contractors Signature
Date
.~pt'
. Ii, ~\~. i . ;
,I,
..".",
. .,
,tT, .
Paee 2 of2
22~ Fifth.Street
Springfield, Oregon 97477
541c726-3759 Phone
a
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
.r.'
1201000000000000397
Date: 04/30/2010
11:42:23AM
Paid By
WESTERN STATES
ELECTRICAL
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 10181 In Person
Amount Due
81.00
9.72
4.05
$94.77
Job/Journal Number
COM2010-00547
COM2010-00547
COM20 I 0-00547
Description
Penn Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
Check
Amount Paid
$94.77
..'
Payment Total:
$94.77
'}1,~,
, :.'
.. ;",'
~'H; }'
-, 'I
""
U.;r,''':'3. _'~
,x:,;, ;."-
......,.;.'..
,"h.l
"..-'
cReceintl
Page I of 1
4/30/20 I 0