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Home My WebLink AboutPermit Electrical 2010-5-1 Electrical Permit Application ~Ji1;". ., ~> ,-' . t>,": -<> to- "-" '" "if T~':" . '!. I :;m~.,,;;: .:';::!?::4' -~~':i~.... 'if- ~c'fX ~~~:;srl\t:Nn~o~~!1~,"g~~9J~~J:- 225 Fifth Streett Springfield, OR 97477 tPH(S41)726-3753+ FAX(54 1)726-3689 '. DEPAiuMENT USE ONLY ;"... ' ", Penn it no.: Dq- /Df]7 Date: -/ ~ /D This permit is issued under OAR 918-309-0000. Permits are uoutransferable. Permits expire if work is not started withiu 180 days of issuance or if work is suspended for 180 days. ", 'Il()CAVGOVERNMENT;iA~I"ROVAGr,\+:i;;}/Y;;!:F':, Zoning approval verified? DYes D No 3:!/,:(;';;.{';l[CATEGORyjOF. :lCQNSTRUCTIONL!) , , o Residential 0 Government 0 Commercial Iir~Jf,j~.().Elji.SITE\~IN~()RMATI()N~AN[j1iilEoCAT1I()N~5ifii:;''Yi1 Job site address: 7- $" () 66'" sI City: 1-1'" tlA!-1 State: D i2.. Reference: \1dL- ~ Taxlot.: . 'DESCRIPTION,:OF'WORK"'?i'.::c'" .::C fJ S ~ J c.. \ ....c.u., T.:5 . 0... S Name: Address: City: Phone: Fax: E-mail: NOlificallo This installation is being made on residential or far 52-0 owned by me or a member of my immediate family, '. YoU m property is not intended for sale, exchange, lease, or r61ltl/~fthe 479.540(1) and 479.560(1). number for I Signature: Cenl r ~CONTRACTOR INSTALLATION Business name: Ge..~ AVlL - r Address: 39.PI J-b- ciMJ g.... R- City: (- I d State: 6.e Phone: 1-71I2.-S1( Fax: E-ma!l: CCB license no.: K 71 'f S ;~ -,,~ D' ~~~ Signing supervisor's license no.: Print name of signing supervisor: G Cli Signature of signing supervisor: ~":~.:?4::,~~~~~ NOTICE: THIS PERMIT SHAll EXPIRE IF AUTHORIZED UNDER THIS PER COMMENCED OR IS ABANDON ANY 1 60 DAY PERIOD. c. ~~:;rji~i~j'YJ\-'f~iJ'~l~1.~~j},;);),~_~'lifEEfJ1S-CH.:[jtJIJE~l'~tf*:fI;~1<~~i,,\&~~~~~~ i'" -_....!>"..'~-.,~,'>',.j.,---i;i-.i'.-;,' I'Jl .' _.. - :?&:)..bl\,;;~4'),~;-.'~i""~ <',,~".~"">--(. , ,. ..- "-.. ...:.....' ':",..,:....,-,'.. . Cost ' Total Numb.rutinspeCtio'';; pe', item' ().,;, ,Qty. , .. ,- ';, l''t,,' "~-"'- , '.'; ,.<-.:"'.... ~. ",.., "',1" .- - ...:__:"'~' ..... _ ~ .,;"',;'ea'~1 ,; - c9st '. 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 $ 60 I to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ V: ~,connect only (2) $ 63,00 $ a (f1!l~tal!~lAA~Iij'<alI ~ffi installation, alteration, relocation e; .9'S~ ~on U!ility $ 63.00 $ Y .ilf~[1il~~R 95?';''::~1l $ 87.00 $ e lonl.'<M:dfg~i~~bV $126.00 $ ~ :-<J?P^~oUtiIityoNb v HI! see services or feeders section above Branch CI, \--~ . "frqr+', alteration, extension 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 $ Each additional branch circuit .z. $ 6.00 $ 12- 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 $ \S:: ~~1!~~~1l€b1ft~~WtAR~L'fC:ANfrgtJS,E1;r~;:':~9~1~;~G{~t~E:f~~r~, ::--~ ~ ~A)""Enter~ubtotal of above fees $ /2 ~~ Permit Fee $58.00) .~}:~ surcharge (.12 x [A]) /'f!!!..-r .J '-' I '. C.e~h~o.logy Fee (5% of[A]) .i>~ ,q .. 'TOT AL rees and surcharges (A through C): J.-I4::tr .f ;'..-::~ 440-2584-J (9/08/COM) Its f e.... . B~ (CiA) R. -.77 Il{.o'( Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01087 ISSUED: 07/28/2009 APPLIED: 07/28/2009 EXPIRES: 10/30/2010 VALUE: 225 Fifth Street, Springfield, OR 54] -726-3753 Phone 54]-726-3676 Fax 541-726-3769 Inspection Line S]TE ADDRESS: 750 66TH ST ASSESSOR'S PARCEL NO,: ]702341300203 Springlield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Pu blie PROJECT DESCRIPTION: Installation of new meter main on house Owner: LUNDBLAD ROY W Address: ]444 VERA DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION ~ Contractor Type Electrical Contractor G MILLER ENTERPRISES INC License 87]45 Expiration Date ] 1110/2010 Phone 54]-74]-2596 I BUILDING INFORMATION ~ I',TTENTION: Oregon law 1~4u""s yuu lU # of Units: follow rules adopted by the O~J.lI~~W Primary OccupancY"G~~l!Plion Center, Those rule~l 1llE\\/~~cture Secondary Occupa,jW:-<NO&~?--001-001 0 through Jl&i2fP..ltl, Primary ConstructiQQ?fx!!.~U may obtam copies IUU/%!!Y Second,,,] Constructit%'fXt:~he center. (Note:,t,h ~1$?Jt:" # of Bedruoms: num r (or the, Oregon Utility ~o'rgY't"RR: Center IS 1-800-332-2 . kl d7B' 'Id' n/a pile UI lUg:, Lot Size: Sq Ft ]st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Luad: I DEVELOPMENT INFORMATlO~ 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: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS ~ NOTICE: ',.. <" "":<(Ch)1i;5Ji"''';'j''c<, Sidewalk Type: THIS PERMIT SHAll EXPIRE IF THE WORK DownspoutslDrains: AUTHORIZED UNDER THIS PERMIT IS NOT ,S COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD...., ' I Valuation Description I ,.j>' '., Notes: Description Type of Construction $ Per'Si{Ft' " Square Footage or mult'iplier' or Bid Amount Value Date Calculated Paee I of 2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line " ',' .Total Valne of Project -F^ee~'P~id , . :~ Fee Description + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Ea Add Amount Paid. $9.72 $4.05 $81.00 $1.44 $0.60 $12.00 Total Amount Paid $108.81 I . Plan Reviews ~ Date Paid 7/28/09 7/28/09 7/28/09 5/4110 5/4/10 5/4/10 !" .': CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01087 ISSUED: 07/28/2009 APPLIED: 07/28/2009 EXPIRES: 10/30/2010 VALUE: Receipt Number 2200900000000000851 2200900000000000851 2200900000000000851 2201000000000000459 2201000000000000459 2201000000000000459 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. .: ".J.. .,.... ~.\' ... ~Re~'iii~ed~I;;~~ections ~ " Electric Service: Approval required prior to'ntility 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 Or'egon 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 ngree to ensure that all required inspections are requested,at the proper time, thut each address is rcud11blc 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. ,.., . ,,: Owner or Contractors Signature '.~""', . . ,:",. .,- '~"i,~';i: " ". /";'1 ~~'. ,. :,~C:H . ,_ ,'1. :~,f).:ll ' . Page 2 of 2 Date 225.Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000459 Date: 05/04/2010 3:28:05PM Job/Journal Number COM2009-0 1 087 COM2009-0 I 087 COM2009-0 I 087 Description Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Fee Payments: Type of Payment Check Paid By GERARD ELECTRIC Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 12.00 1.44 0.60 $14.04 Amount Paid djb ,:~.. ! '. .'\...~; 2449 In Person Payment Total: $14.04 $14.04 .. , ',. .,,-::.(,;. '.~ ';-J' :. _ ,i ",," cReceintl 'Page 1 of l' 5/4/20 I 0