HomeMy WebLinkAboutPermit Electrical 2010-5-25
Electrical Permit Application
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1t3ltliN OF SPRINGFIELD, OREGON
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225 Fifth Street+Spriogfield, OR 97477+PH(541)726-3753+FAX(541)726;3689
DEPARTMENT USE ONLY
r~ pe~it~o.( 10- a:io75
Date: 5-- d-S- .-- I ()
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of is sua nee or if work is snspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
o Residential 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
Job site addres;~ I \ q ::::>
City:
Reference:
ZIP:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Business name: S'V1:;\JEWS ~R\C
Address:f>O SoX !obp
City: fLC':'9S(/\f'Sl IlL State:dC.. ZIP:'17LfS-S
Phone: 5'1( 'ltf).-').Xio Fax:31/- 71.f6 ~O ~f 62-
E-mail: rOGL.EGHRrJ@INISN.CC;fr/\
CCB license no.:q~<f7 g, BCD license no.;80- 31'3c
Signing supervisor's license no.: 'fo crl} - S
Print name of signing supervisor: sTC.\l'a'l G a~
Signature of signing supervisor:
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440-2584-J (9/08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq. It. 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) I $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 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, alteration, relocation
200 amps or less (2) $ 63.00 $
20 I to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services\or feeders section above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase ofa 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 $ 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: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ 1)1. lP
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ 1"1. ~<f
(C) Technology Fee (5% of [AD $ 0'8
TOTAL rees and surcharges (A through C): $1l.f.tJ. 8"
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00675
ISSUED: OS/2512010
APPLIED: OS/25/2010
EXPIRES: 11/25/2010
VALUE:
Status
Issued
SITE ADDRESS: 718 19TH ST
ASSESSOR'S PARCEL NO.: 1703362116200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Electrical to shed
Owner: OLIVAS JESSIE M
Address: 1390 PARNELL DR
EUGENE OR 97404
I CON'I'RACTOR-INFORMATION I
Contractor Type
Electrical
Contractor
STEVEN R GEISLER
License
95472
Expiration Date
11/2312010
Phone
541-726-0618
BUILDING INFORMATION I
# of Units:
Primary Occnpancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
TYpe of Heat: .
W'atertype:
, 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:
nla
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot C?,v~rage:"
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
';;' 'CNIION: OregSkl IJ<eT e'
No:!gw ~'es adoPteaJw,~ q?JPres you to
In O~R~~; Center. - rnos~~OI1'atilily
0090. You :'-0010 through ~A~e9~etforth
calling th Y obtain Copies of th 2-001.
Notes: n e Centel (N t e rules by
or,., , :,.: umber tor the 0," 0 e:}he telephon
THIS PER'M/T SHAll EXPIRE IF \{:::b~':Ii~~~ri S I'BOO-332-2344). ,'cation
AUTHORIZED UNDER T .' ,..' i"
D 't' 'OMMEM0.L:n.""""""'t H,Ij/S PERMIFJSSJjl;T Square Footage
escr", IOn 'ill/J.lWVF1're M oIhON'"'" t=" - .
^'Y ~180 D' AY P iW OIT I'Il'R'pher ,. _~r B,d Amount
'ERIOD, .. . -,_.
Street Improvements:
Storm Sewer Available:
Special Instruction:
Value
Date Calculated
Paee I of2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00675
ISSUED: OS/25/2010
APPLIED: OS/25/2010,
EXPIRES: 11/25/2010
VALUE:
. .~ ..,..,.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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,,~~1i?t~I,Y*lue of Project
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I +'Fees Paid .
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid Date Paid Receipt Number
$14.04 5/25/10 1201000000000000558
$5.85 5/25/10 1201000000000000558
$36.00 5/25/10 1201000000000000558
$'81.00 5/25/10 1201000000000000558
Total Amount Paid
$ 136.89
" 1/ ~HlR 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. '
Rough Electric: Prior to Cover
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Final Electric: When all electrical work is complete,
Electric Service: Approval required prior to utility company energizing service,
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 a..nd 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,
1 further certify that only contractors and employees who are iu compliance with ORS 701.005 will be used on this project,
I further agree to ensure that all required inspection~:'are request~d 'at the proper time, that each address is readable from the
street, that the permit card is located at the fro~t;'Of iIi~ propertY, and the approved set of plans will remain on the site at all
times during construction. .'
Owner or Contractors Signature Date
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225 Fifth Street
Springfield, Oregon 97477
541"726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000558
Date: 05/25/2010
3:02:14PM
Job/Journal Number
COM20 I 0-00675
COM20 I 0-00675
COM20 I 0-00675
COM20 I 0-00675
Payments:
Type of Payment
CreditCard
cRecciotl
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Amount Due
81.00
36.00
14.04
5.85
$136.89
Paid By
STEVENS ELECTRIC I
STEVEN GEISLER
Item Total:
Check Number A!Jthorization
Received By Batch Number Number How Received
njm 464524 In Person
$ I 36.89
Amount Paid
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"'7'/'
Payment Total:
$136.89
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5/25/2010