HomeMy WebLinkAboutPermit Electrical 2010-5-19
Electrical Permit Application
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215 Fdlh Strftt .Sprin:fk'ld. OR 97477. PH(54t)7t&-3753. F A..X(5t1)726.3689
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,p~~ARTMENT USE ONLY
permit no,: C/o -
Date:
5-
-/0
This pennit is issued under OAR 9J8-309-0000. Pennib are nontransferable. Permit!l; expire if work is not started ft"ithin 180
days ofissuanec or if work is suspended for 180 days..
, ' ,LOCAL GOVERNMENT. APPROVAL" - .' . '. FEE ,SCHEDULE-
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Zoning appw\'al veritied? DYes DNo .' . . " Cost 'Total
_~u~~r or,ins~~ti<&'P':r-item.9;..' .-. Qt).. . Ca.' : '- cost
. ,CATEGORY OF CONSTRUCTION ,';, ,,'
Residmtial, per unit, st>r"ic:e included:
dcntial I 0 Govermnent I 0 Commercial
JOB SITE INFORMATION .AND 'LOCA nON., . }.ooo sq. fl. mless (4) $134.00 $
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Job site address: (t7. J) K ,~f)W D 0 "f Each additional 500 sq. fL or portion $ 25.00 $
thereof
City: ...hf.. l Ii 1 State: J Z!~ f't' I f Limited energy (2) $ 32.00 $
SulxlivisioJ: I Lot no.: Each manufactured home or modutw- $ 63.00 $
, ..' " . DESCRIPTION.OF WORK .::'. , dwelling service or feeder (2)
() j'flnn (II i' k' lJ' j 0 r-x ~ rg J'l.J'C 0:: Sen'ices or feedtrs: installation, alterah"o1J. relocation
\llJ::;"3~" A \CO""\D::> 200 amps or less (2) $ 81.00 $
./ 'l!ROPERn". OWNER '. :..... 201 to 400 amps (2) $ 95.00 $
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Name:" \0 INI LN I: 4011o@Oamps(2) $158.00 $
Address: (, '5)( (5) '::=:.'\ @lto 1.000 amps (2) $205.00 $
Ci~s;.,n J ;J ./ I State: r:s:fLJ ZIP: Or? '\'1'1. Ovcr 1.000 amps or volts (2) $469.00 $
Phone: t~ :tlD-':~? 10 , Fax: - I Reconnecl only (2) I $ 63.00 $ /-.-;:
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E-mail: I Temporary 5e-rvices or feeders: ins/allm/on. alterafion, relocation
This installation is being made on residential or farm property 200 amps or 1~'S (2) $ 63.00 $
owned by me or a member of my immediate family _ This 201 to 400 amps (2) $ 87.00 S
property is not intended for sale~ exchange, lease, or rent. OAR 401 to @Oamps(2)
479540(1) and 479560(1). $128.00 $
Signature: Over 600 amps or 1.000 volts, see services or feeders section above
, . CONTRACTOR 'INSTAlLATION ; , ,'. :-.' , Branch circuits: new, alteration, cxlensiml per panel
Business name: \1.(( l-J n ...\ i - a. Fee for branch circuit.'i with purcha.-re of a service or feeder tee:
'cL""'(
Address: Z-\"51 \)r:,(\ , )-t Each branch circuit $ 6.00 $
City: <"- rlO1r I State: 0 V ZIP: <i1411 b. Fee for branch circuits without purchase of a service or feeder fee:
Ph<>ne: <541 :1<.1~-%'l5t, I Fax:"5t.H -.%-3 ~ First branch circuil (2) I $ 55.00 I $
E-mail: r-;;>p,(d).jKc...ELH~.c..nYV\ Each additional branch circuit $ 6.00 $
CCI) licon':' no., % I z.ll I BCD license no,: 2.0-2..1'C- Miscd1wE'QUS fees: service or feeder not included
Signing supervisor's license no.: '4-'i11c;:.S Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor:, \Ilildll I ~ t.,.y Y. l~ Each sign Of" outl~e lighting (2) $ 63.00 S
Signature of signing supervisor: -' - ~.1 Signal.l,..;rcuit ur a limited-energy panel, $ 63.00 $
-/ alteration. or e),.1ension (2)
c..J EDCh additionalinspeetion: (I) $58.00 $
~ '..., .' " " . APPLlCANrUSE , ", .
~\o (A) Enter subtotal of above fees $ &.5
~ ~&.,\'q/ (Minimum Pennit F~ $58.(0)
(B) Enk-r 12% surcharge (.12 x (A]) $ Y.
D(. ~~~ (C) Technology fee (5(%, oJ lA D $ '3. J
TOT AI. fees and surcharges (A throagb C): $ '1..2 . [71
.t40-2584~J (9i08/COM)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00642
ISSUED: 05/19/2010
APPLIED: 05/19/2010
EXPIRES: 11/19/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541- 726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 658 B ST
ASSESSOR'S PARCEL NO.: 1703352415700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Reconnect
Owner: WYATT TERRI D
Address: 658 B ST
SPRINGFIELD OR 97477
Phone Numher: 541-870-8210
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I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor License
J K GUCKENBERGER ELECTRIC INC 45129
BUILDING INFORMATION I
Expiration Date
04/24/2012
Phone
541-746-4656
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# 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 Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
~D MENTINFORMATlON I
. n'aw req U y
. :rrENT\O~t orego(\ ~ \Ile oregon II' It
Frontyard S~~i'1J'lj::ru\es ado~\e TIl;se rules are se!lll~aY Dist:
Side 1 Setba . ificalion Cen\t'~i 0 IllroUgh OAR 95 'lflll't Trees Rqd:
Side 2 Setba' bAR 95Z-0Cl1-D blain copies ollhe f :.atid'Drive Rqd:
Rearyard Setlt.a~.: You may 01 r (Nole: Ille le\e.~~ot Coverage:
Solar Setbacks:ca\\in9 Ille cen oer'egon Ulility Noll' .
r \Ile _ 44.
cenler IS I PUBLIC IMPROVEMENTS I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Availahle:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
NorICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
.. AUTHORIZED UNDER THIS PERMIT IS NOT
. :;~::::,;cNCED OR IS A A
Valuation Descrition r ) DAY PERIOD.
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount.
Value
Date Calculated
Page I of 2
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Status
Issued
225 Fifth Street, Springfield, OR
54 I -726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,Total Value 'of Project
L Fees Paid ,
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amount Paid
Date Paid
$7.56
$3.15
$63.00
5/19/10
5/19/10
5/19/10
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Total Amount Paid
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$73.71,'..
I Plan R~views ~
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00642
ISSUED: 05/19/2010
APPLIED: 05/1912010
EXPIRES: 11/19/2010
VALUE:
Receipt Number
2201000000000000534
2201000000000000534
2201000000000000534
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. '
L Reouired InsD~ctions ~
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Electric Service: Approval required prior io'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 permission of the Community Services Division, Building Safety.
I further certify that only contractors and employee~,.,,:,ho ~r~)n compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections'are r'equested 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 construction.
pi.
Owner or Contractors Signature
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Pa2e 2 01"2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000534
II :27:39AM
Date: 05/19/2010
Job/Journal Number
COM20 1 0-00642
COM2010-00642
COM20 1 0-00642
Payments:
Type of Payment
CreditCard
cReceintl
Description
Service Reco'nne~t
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
JKG ELECT / JEFFREY
GUCKENBERGER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
63.00
7.56
3.15
$73.71
Amount Paid
nJrn
025660 In Person
$73. 71
Payment Total:
$73.71
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