HomeMy WebLinkAboutPermit Electrical 2010-5-21
Electrical Permit Application
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225 Fifth Stmt+Spdngfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
bEp'~~TMENTUSE ONLY
CO"""'" 7-00'1- C (Ose
Perm it no.:
Date: $-2 (~t 0
This permit is issued under OAR 918-309-0000. Permils are nontransferable, Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
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',i ~/ .1_"_,., .' 'l!OCAL:GOVERIIIMENT"AI',F!ROVAl:Si:!.:,f,i't'.,1s\K:. ~~::f,~t{~;F:'t1:}~'1*;~.~~r;:H~1~',~-~EE~_SCHE[j"Ut1l;t~~lA'f~*!+~.\t~~~~~
Zoning approval verified? DYes DNa iN: U"l~ef .;f.i";;;~~ti~ns'p;fit~~: (),",..'I Q1y,' Cost Total
~,CATEGORy;::rOI':'.CONSTRUC'-ION1:,l'- "'.1.,' .. .' _'!_, - ,- ."_ - '..;', .., ">";'_ ~'".,-! >,', 0" .," .. .!~ ,"\.-":'."" ,"' _.", ;;;;'ea;:y' 'cQ~L .'.-
M Residential I 0 Government I 0 Commercial Residential, per unit, service included:
\ $n<{
~~\'''OB],SITE,~INFQRI\IIM;IOIIIl!AIII[jmCOc':ll,l'ION~''l:'~\@,~cl~ 1,000 sq. ft. Or less (4) $134.00
Job site address: I 0 (0 I..{ (---C s-8-- Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City: S~nOi I State:O~ I ZIP?,/Ij. 7) Limited energy (2) $ 32.00 $
,U'(
Reference: '\ 70'$:1 51\ I Taxlot.:DG,(O= Each manufactured home or modular $ 63.00 $
.' .'DESCRIPTION,. OF WORK' ,1;,.,,, .. :;r.::;~~~:r;'~/'~ .~-'!:~ dwelling service or feeder (2)
rW h.-cQ elec SuS , Services or feeders: installation, alteration, relocation
\ 200 amps or less (2) $ 81.00 $
, 'PROF!ERTY OWIIIER . , 20] to 400 amps (2) $ 95.00 $
Name: 'P €..-le.V' '1)1 J'<,TR\. ,A 40 I to 600 amps (2) $158.00 $
Address: IV (0 t..j, 1=? 5'P 601 to ] ,000 amps (2) $205.00 $
City: S-oPd I State: o'K I ZIP:11 7IL I~- Over 1,000 amps or volts (2) $469.00 $
Phone: S4~ -7lf:c' tj~1 0 I Fax: - Reconnect only (2) $ 63.00 $
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E-mail: ATTFNTION' iPorary services or feeders: installalion, alteration. relocation
o '
This installation is being made on residential or fantqblrn;pel1Jles e o ~or '~iHllih. $ 63.00 $
owned by me or a member of my immediate famil::NCllIIlcation Ce &_lltlUet~ $ 87.00 $
property is not intended for sale, exchange, lease, qlirEl)\~-OO
479.540(I)and47~~!]\ 12Z 0090. Youma o .-";" $126.00 $
Signature: ~ A' calling the c ~~,<t8t ~~ee services or feeders section above
. ' . .CONTRAC1;OR INSTALLATION' numDer ronr e~~on, exlensionperpane!
Business name: OW,I/ t:'^- . :tcrma uits with purchase of a service or feeder fee:
Address: Each branch circuit $ 6.00 $
City: I State: I ZIP: b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - I Fax: - - First branch circuit (2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: I BCD license no.: Miscellaneous fees: service or feeder '}ot included
Signing supervisor's license no.: Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: Each sign Or outline lighting (2) $ 63.00 $
Signature of signing supervisor: Signal circuit or a limitedMenergy panel, $ 63.00 $
alteration, Or extension (2).__-,.~;,~,~;'J'~>.'
~~ NOTIC~..l,,~;;!~~:i:i~;ali:spectio '," \ '-~ . r',,('ri~'~:~~~"'"~'O" .,.,
THIS PE ". A\i~l:o~~i"i"C"."i:""i"il'"':''';'''c'''''
AUTHOR ~. ~:~'M~~fOf\ $ )5 t(
t>~ COMME II""J,(91iI . 0) .
~~ ANY 1SF lJ\'A'trl?dt~1;l.4nrcharge (.12 x [A]) $ I be
(C) Technology Fee (5% of[A]) $ 6 7
TOTAL rees and surcharges (A through C): $ ISb
B
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78
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440.2584-J (9/08/COM)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01050
ISSUED: 07/21/2009
APPLIED: 07/21/2009
EXPIRES: 11121/2010
VALUE: $ 5,000,00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 1064 F ST
ASSESSOR'S PARCEL NO,: 1703351106100
Springfield TYPE OF WORK: Foundation
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace foundation
Owner: DUSTRUD PETER
Address: 1064 F STREET
SPRINGFIELD OR 97405
Phone Number: 541-852-2751
~;:,c:; . cd j
I CON'fRACTOR INFORMATION ~
Contractor Type
Geueral
Electrical
Mechanical
Plumbing
"
Contractor
OWNER - ~
OWNER ll\tell '10~\\\\\'1
O",NER \&'f/ te~te<;\O\l \\0\\'(1
OWNER ~,,:~~~~e &telle .r:/y\'
~~~e9~~ N
\C)\~'?tcf.\\O" ~'\~_\n~Q\e \~e \e ~W\ca\\O
~0\"i.P.,~'l; .. Oll"""', ~e~\\'J:~o
\(\O~-~oU~ oe~tlei 1tl'S'W.'2.~
~~. ~g~ \"e~~~ 66~:
\OC~et Wlier Type:
ce Range Type:
Energy Path:
Sprinkled Building:
.'~.
License
Expiration Date Phone
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
, DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Comp'~'<;1.'
_' c<"'''~'''~Q~~'
~~ ;\ ....
I PUBLIC IMPROVEMENTSl \.tI-'\'\ o<oy..\tI'\ ~,!\f(.<' .
~ s.\\~\,; ~~CO ,\.- x.~ ,v -'.
\,\O't~ \>~~~~j,\)~~J ~~~\l~ ." .
\~\S \\\If(.\1.~w~A<ih rains: -
r-.\j\ ~'t.~C't.'0 \>'t.~\Q .
C\l~ CO\) '0~
jI.~'{ '\ .
\ '
..Q.~r!~y" ~i~t; ..
# Street lirees Rqd:
:;j:~red'liriYte Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
'j:
Page 1 of 3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
DescriDtion TVDe of Construction
Bid Amount Use Bid Amount
Fee DescriPtion
+ 12% State Surcharge
+ 5% Technology Fee
Foundation Permit
Minimum/Adjustment Mechanical
Minimum/Adjustment Plumbing
Plan Review Residential
+ 12% State Surcharge
+ 5% Technology Fee
+ 5% Technology Fee
Sidewalk Repair Permit
Water Line - 1st 100'
+ 12% State Surcharge
+ 5% Technology Fee
Residence Wiring 1000 Sq Ft
Total Amount Paid
Structural Review
07/21/2009
Structural Review
08/17/2009
:'h'~' ' ''r ')i."..
'~I;~,~;:'1 '~;.'~:. ~".,:"
:~'?~iYl'
,~.."i",
I Valuation Descriotion I
$ Per Sq Ft
or mu1tipli~r
$1.00
, Square Footage
or Bid Amount
5,000.00
Total Value of Project
~
Amount Paid
$26.91 U,'"
$11.2 e::~',
$87 25;'~;';'
. "ITrr~"
$79.00:,""
$58.00 '
$56.71
$9.12
$0.78
$3.80
$15.50
$76.00
$16.08,
$6.70 "
$134.00
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Date Paid
7/21/09
, . 7/21/09
7/21/09
7/21/09
7/21/09
7/21/09
8/3/09
8/3/09
8/3/09
8/3/09
8/3/09
'?/21/10
5/21/10
5/21/10
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01050
ISSUED: 07/21/2009
APPLIED: 07/21/2009
EXPIRES: 11121/2010
VALUE: $ 5,000.00
Value
Date Calculated
I,
$581.06
07/21/2009
08/17/2009
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APP DJB
APP KLK
$5,000.00
$5,000.00
07/30/2009
Receipt Number
1200900000000000818
1200900000000000818
1200900000000000818
1200900000000000818
1200900000000000818
1200900000000000818
1200900000000000865
1200900000000000866
1200900000000000865
1200900000000000866
1200900000000000865
1201000000000000530
1201000000000000530
1201000000000000530
Revision to foundation and
stemwall- concrete.
To Request an inspection call the 24 hour 4~~rdi~~"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...ReolliredJnsnections ~
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Undertloor Plumbing: Prior to insulation or decking,
Paee 2 of 3
CITY OF SPRINGFIELD
Building/Combination Permit
Status
225 Fifth Street, Springfield, OR
541-726-3753 Pho'ne
541-726-3676 Fax
541-726-3769 Inspection Line
~ /1' '.~ I.~~...
PERMIT NO: COM2009-0I050
ISSUED: 07/2112009
APPLIED: 07/21/2009
EXPIRES: 11/21/2010
VALUE: $ 5,000.00
Issued
_. i,t.
Underfloor Mechanical.
Prior to insulationill8'~cknl~'~~nd including required testing.
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Final Building: After all required inspections have been requested and approved and the building is complete.
Water Line: Prior to filling trench and including required testing.
Sidewalk - Setback: After forms are erected but prior to placement of concrete.
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
, .
Final Electric: When all electrical work is complete.
By signature, 1 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 all
"m"'~"O~~...f;::; S {21 liD
Owner or Contractors Signature ri,e!(- " , Date t- I
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Page 3 of3
225 Fifth Street
Springfield, Oregon 97477
541-1'26-3759 Phone
ii-'
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000530
Date: 05121/2010
1:56:29PM
Job/Journal Number
COM2009-0 1 050
COM2009-0 1 050
COM2009-0 1 050
Description
Residence Wiring J 000 Sq Ft
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
Check
Paid By
PETER DUSTRUD
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
134.00
16.08
6.70
$156.78
Amount Paid
djb
347
In Person
Payment Total:
$156.78
$156.78
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5/2112010