HomeMy WebLinkAboutPermit Electrical 2010-5-11
EJectI,ical Permit Application
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225 Fifth Stree.tSpringfield, OR 97477tPH(541)726-375HFAX(541)726-3689
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, bEP'f~TNiENtUSE ONLY, .
Co"'" 2.0 (0 - c c::, ~ Jrtj
Permit no.:
Date: ) - 1/ - ( 0
This permit is issued under OAR 9] 8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for] 80 days.
"/C"; ";:120CAl:'GOVERNMENT'Ap,PROVAl",::,:':'fit;;j':~'f:
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Zoning approval verified? 0 Yes 0 No
;":'!",:,.>:,;,CATEGORy,,,bF;:CONSTRUCJlON~:!,::,;:" ",,'
~R:sidential "" 10 Government, "I 0 Commercial
r,w.!I\lj::~~j.oB>ilSITE~INFORM,6;il]Olllt;,6;NDWilO,CAT:lbN(~~(il5{l:;
Job site address: f3 /9 08-. ,c;7::~ee C '
city:\..5LlA::J:, State: O~ T ZIP: 9'7r/' >
Reference: 17C>J' 3 5"/ l..{ I Taxlot.: C> , 60 <:
,',," ',::> DESCRIPTION OF'WORK"~i';l{;;,;';,(yr:;>,"
-.,-- lr:-c~/ b # =-4/
--A~,,,,~,,....L c::;-,//i!c.:-;'cS 200 amps or less (2) $ 81.00 $
PROPERTY OWNER'.' 201 to 400 amps (2) $ 95.00 $
Name: '1 _ .. ~ G-A...-s U"'""Y 401 to 600 amps (2) $158.00 $
Address: I ~ ( ., l'\' OS+-- 601 to 1,000 C' to $205.00 $
City: 5 ~ rD I State:D T 1 Z~" 'ex., ~r ~e tlOO GjQpgan $469.00 $
Phone: _ _ I Fax: _ _ fO\l~:" . ion Ce te .llftIiiJBll IlBll{\1 .001- $ 63.00 $
E-mail: . OAR 952-0u' -0 '\Q 0 '_IUIM.s: installation. alteration, relocation
,100
This installation is being made on residential or f~~~Dernhe c n ~~'P'~fjWlllPt\ll8,tll!~pnUl'" $ 63.00 $
owned bJ: me or a member of my immediate family. -mMing::" t e J2ag10" $ 8700 $
property IS not mtended for sale, exchange, lease. or nut1llkm\.K"'r . _ -' .
479.540(1) and 479.560(1). cent r I 4 to 600 amps (2) $126.00 $
CCB license no.: I/'9 Y/.6 BCD license no.: c:: V.c;/ Miscellaneous fees: service or feeder /yO! included
Signing supervisor's license no.: YYYO .....s- Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor: /..h ' , ~. -:: Each sign or outlioe lighting (2) $ 63.00
S t f' .do ~ /" ~ .,-? Signal circuit or a limited-energy panel,
igna ur~ 0 sIgning supervisor~ ~ ~ alteration, Or extension (2) $ 63.00 $
d 7 E Each additionaJ'hi'sp~fi.tiri?:(-1".t~>"-" $5800 $
(/ 'NOTIC : "Q~l&"';";'lilf;;\'ij'f,,;j~;C",o;:'!:'";"";'
THIS PER~ 1I1l'\JS.Ea!li!".""~"t'.,.,.,~,,,<.
AUTHORIZ D"lJ~ElERtlfMt.s<FEflMIl.lS NOT, $ r
COMMEW .. NI!lOMI~MR.. ' 8.;:>
ANY 180'n~~)~f\IOOfsurcharge(12x[AJ) $ IOze
(C) Technology Fee (5% a[[AJ) $ ,-/2-(
TOTAL fees and surcharges (A through C): $ 99~-,
Signature:
;'CONTRACTOR INSTAllATION " .
Business name: hlf<;-c ,(),- /:.""'- E~ _Y-;c
Address: '68'=':T7 ~;--::;<;?i ,4~
City: -.:5,;'17>-{ I Statec:/'.I'l I ZIP:'9'.7ff''>;:;S
PhonOf<I-),;}-L' rO 9.6 / I Fax: - -
E-mail:
I'\~'Q~.\\
\Y \' !V
~~Q
~'f~~
''\}-'t7\ '
~
440-2584-J (9/08/COM)
",''''''''j.'''''; ')'f.il5Jr~';" F EE'[SCH' EDU "'E" ;.,#,''''I''';Vlt~'''''''.;?l!'''''''
~~",.",T'~_"":'"H:Y'.1,'(~j;~"'t<'I'.\oo> ,,,..,., . - _ . L,: _ ;,~'.;,;",\{~fiR~thlo-<t'~j.'1'f!t"_,i'1'};
,..",., "', ,
:.~~~t~~~ >?,~J~~~~fi~-?rf,~n,~tr.~,"~ -):~/~~~: g~r..:
Residential, per unit, service included:
, Cost j,
.~;,,'{~~;\
Total
\~ . ~_Qst,
1,000 sq. ft. Or less (4)
$134.00
$
Each additional 500 sq. ft. or portion
thereof
$ 25.00
$
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$ 32.00
$
$ 63.00
$
Seryices or feeders: installation, alteration, relocation
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per pane!
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit
$ 6.00
$
b. Fee for branch cir~uits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
f 1-J1
'>11;'
C>
80-
B"'T, >
$ 55,00
$ 6.00
$
$
"e'r:
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00584
ISSUED: 05/11/2010
APPLIED: 05/11/2010
EXPIRES: 11/11/2010
VALUE:
Status
Issued
,...... ..
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1319 D ST
ASSESSOR'S PARCEL NO.: 1703351409600
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Install 6 new branch circnits
Owner:
Address:
Contractor Type
Electrical
GREGORY RONALD"I & LYNN L
1319 D ST
SPRINGFIELD OR 97477
_e'o
r"fENTION: O[~~~.a% ~~A nON ~
, '.,CW rules ado . Those rules afe
Cll\ljr.ltctol1n Center. 0 thrOugh OAR 952.oo.1".License
FIBSTttEl:~ - ~oftherulesUY179416
Expiration Date
11127/2011
Phone
541-726-2961
# of Units:
Primary Occnpancy Gronp:
Secondary Occnpancy Gronp:
Primary Constrnction Type
Secondary Constrnction Type:
# of Bedrooms:
calling the cen .
number for the. ~-234
Center IS 1-8\1 of Stories:
R-3 Height of Stmctnre
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Bnilding:
VB
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occnpant Load:
n/a
I DEVELOPMENT INFORMATION .
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
,."". Overlay Dist: ~"r,~',,"'?i~X,./~i,:'~i..:.:~.~""
# Street Trees Rqd:"" _. i\'\E WO?'\{
"o~Drive ~'\.\ ~?\"'C \f Nt'" ,S ~Ol
1~\~?J~~~~~6~ ~~~;~~~ctl fOR
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Speciallnstrnction:
, ,(_~ 'i" ....~
Sidewalk Type:
Downsponts/Drains:
-;:'~\t:;~.': ..'.. ,
,,;hD. Ii'-
Of'.'I\:<,:'./< .'10,0;;
Notes:
I Valuation Description I
DescriPtion
Type of Constmction
$ Per Sq Ft
or mnltiplier
Sqnare Footage
or Bid Amonnt
Valne
Date Calcnlated
.' .1 .. ~ 0~1 j .
Pa2e 1 of2
.~._.Lt.. .'~. r y'
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00584
ISSUED: 05/11/2010
APPLIED: 05/11/2010
EXPIRES: 11/11/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,,("1'
:~Lt) \-':
, '-';-;"'~' "",
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
Dhte Paid
Receipt Number
$10.20
$4.25
$55.00
$30.00
.( I'
5/11/ 1 0
5/11/10
5/11/10
5111/10
2201000000000000479
2201000000000000479
2201000000000000479
2201000000000000479
Total Amount Paid
$99.45
Plan Reviews I
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~_., >t,:_,." ..-".-.
To Request an inspection call the 24 hour r~~:g"rding)at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspilctitins'requested after 7:00 a.m. will be made the following
work day. ..
L Reauired Inspections ~
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete. ,l
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 fur\~.er 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 descrihed 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 readahle 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.
~,o!,;';.J..
Owner or Contl'actors Signature
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,
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I':;,'
Date
Page 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000479
Date: 05/11/2010
10:43:34AM
Job/Journal Number
COM2010-00584
COM20 I 0-00584
CO M20 10-00584
COM2010-00584
Description
Add, Alter, Extend dic
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment . Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
55.00
30.00
10.20
4.25
$99.45
Amount Paid
CreditCard
WAYNE SYLLlAASEN
djb
r79582 In Person.
Payment Total:
$99.45
$99.45
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Page I of I
5/11/2010