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HomeMy WebLinkAboutPermit Electrical 2010-5-27 Electrical Permit Application ~tiTy OF SPRJNGFIELD, OREGON '>:1'1,. . u 225 Fifth Streett Springfield, OR 97477tPH(541)726-3753t FAX(541)726-3689 ~~ Date: This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuan~e or if work is suspended for ]80 days. ~!~l1!0:<::/!..!-'\[~:~:t~E:a.I'lMJ:I'l[llr~RR}{0Y:/!..'L___ Zoning approval verified? 0 Yes 0 No lff~iJlJi~i')ffi%:<::I:\;pE:G:OR?'-0ij~~0JQSillRt9$'F10N~'il~ifi11lll]t~ o Residential I 0 Government I 0 Commercial :~~;:~~:\:~I;t~~~0N0~ffi~~~'1? Gitv:.5f71 tl ~ / I State:m ziPY7<.Zl2( I~Sbd~.~~ ~ ~..~..:. u ""', n: T ~ "J:"JL..t...-- ot no.L.-' ('~_ :. ~ /!~~':j~~~~0~:' . / , ~7/. - t'l ,?;'~ AddreS.lj: //;J/ /. {!"h-,' d-- ('}.-yj h.b-:?, ,"';::7 I <.. Citi'/7~ # 1~J' H' State:C!<) ZIp:CfjL7/e Phone: _ _ Fax: _ _ -'t7 E-mail: This installation is being made on residential or fann property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: ~;;0;~t~$m/!..'l1!f: ro~ Address:.fJ h () ~ 100 7 City:W'4 -/rV:/I'O State:Orf zIP'1IL/<i'l Phone)l. "17 iY- Fax: i-l..J.l.J. 104'7 E-mail: hVVy~I7..)YOsr.I.IlTf..fr~Onll.nf .(C'I?' CCBJjcenseno:/?J{o~~ I BCDlicelJeno.:,.;)6 -tfL.J:1" .L '7:21 s ~ '0: ;hllflrf') vYrtM I lull h A AAUAJ I V vV'VL/VV ..,\..., "--- Signing supervisor's license no,: Print name of signing superviso~ Signature of signing supervi~ I ~~ ro:lY \S>\,.,Q ~~~<(' ~ 440.2584-) (9108/COM) 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) $ 61.00 $ 201 to 400 amps (2) $ 95.00 $ 40 I '0 600 amps (2) $156.00 $ 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 fceders: installation, alteration, relocation 200 amps or less (2) $ 63.00 $ 201 to 400 amps (2) $ 67.00 $ 40 I 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 of a service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase ofa service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ $ 6.00 $ Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited.energy panel, alteration, or extension (2) $ 63.00 $ $ 63.00 $ $ 63.00 $ Each additional inspection: (I) $58.00 f,*iR~ W~t!lltil!ls~.~ $ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (8) Enter 12% surcharge (.12 x [A]) (C) Technology Fee (5% of(A]) TOTAL rees and surcharges (A through C): $x/.'lSV $ q .1-. '- $ q,() $'14.'111 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541.726.3676 Fax 541-726-3769 Inspection Line ; to' CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010.00684 ISSUED: OS/27/2010 APPLIED: OS/27/2010 EXPIRES: 11/27/2010 VALUE: Status Issued SITE ADDRESS: 5335 DAISY ST 143 ASSESSOR'S PARCEL NO.: 1702330001300 SPRINGFIETYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: 200 Amp Service 'ii".; ,.,1' ...;-..\.; '.~ ':""/l" \, n~:'. Owner: Address: ',,,,.:i SANTIAGO ESTATES ASSOCIATES~LC 11211 GOLD COUNTRY DR STE 100;): GOLD RIVER CA 95670 Contractor Type Electrical I CONTRACTOR INFORMATION ~ Contractor License BURRELL BROS ENTERPRISES INC 136446 BUILDING INFORMATION ~ Expiration Date ,Phone 08/2012011 541-747-2724 # of Units: Primary Occnpancy Gronp: 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 I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ilt Other: Occupant Load: n/a Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION ~ ):i.,' , "0:'1"" : ' REQUIRED PARKING , ;~~~r1ay\:;ii~:" . NTlOI>I: Oregon law r~~~~b~~i;~y '''~:Sireet Trees Rqdf.r; rules adopted by the h~\\'Wf~ith Paved Drive Rqd: ~tmcation Center. Those rUn em~!72-001' % of Lot covera~ OAR 952.001.001 ~ t~~Ui~S 01 the rules by 0090. Vou may obtain oie: the te'eph~ne O egon II PUBLIC IMPROVEMEN ber lor the. ~ 800-332-2344). Center IS - :sioewalk Type: ~~ Street Improvements: Storm Sewer Available: Special Instruction: Downspouts/Drains: Notes: NOTICE: ,,J: THIS PERMIT SHALL EXpiRE IF tHE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED I 0/"\ WV"L ' ANY 180 DAY P - Maluation Descri tion Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated (, ! ::g~...-.:;....,{:,~., ( . , ;",):'; loPaee'l.of 2 ~'-r:.'-}":~ _..~;.."- , ' '~;dL~~) "'t", '. lt~,,,,,,,, . .. _..:;t.'",' 1tr~:'~I"'!ilF.!If.ILi;!j '. g ", ~;--".." j ... ::.. ,/,;\~ ..h<",~ , ::;~().}t i\ .::\!;:'{_l. Status Issued 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541.726.3676 Fax 541-726.3769 Inspection Line :; Total Value of Project LFees Paid ~ Fee Description + 12% State Surcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Amount Paid Total Amount Paid $9.72 $4.05 $81:00 .i{;~; $94.77:;:,". ".';':;:iI::.' .-.....,- " '. 4'.'"'., I . ~I~~ Reviews I Date Paid 5/27/10 5/27/10 5/27/10 ,d, CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00684 ISSUED: OS/27/2010 APPLIED: OS/27/2010 EXPIRES: II/27/2010 VALUE: Receipt Number 3201000000000000246 3201000000000000246 3201000000000000246 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 after7:00 a.m. will be made the following work day. Reouired Insoectioris ~ ,.;. .-,,".,. ;,~ Electric Service: Approval required prio':-io'ii;iility 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 1 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. 1 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 inspecti~~~t~~~eTe.qu.~s~ed at, ~~e proper time,.that each address is readable from the street, that the permit card is located at the front of.t~:e:pr6pel:ty, and the approved set of plans will remain on the site at all times during construction. .::.:..""::~'~ ~=:1 11(". Owner or Contractors Signature ,,,.Lf ..j)i,\ . ' , ' ',1' Page 2 of2 Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone S~<!!;I_~,.~"" .,. ~. . -...:.. . City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 3201000000000000246 7:45:00AM Date: OS/27/2010 Job/Journal Number COM20 1 0-00684 COM20 1 0-00684 COM20 1 0-00684 Payments: Type of Payment Cred itCard cReceinll Description I Perm Serv/Fdr 200 amps or less + 12% State Surcharge + 5% Technology Fee Paid By . JOSH BURRELL Amount Due 81.00 9.72 4.05 $94.77 Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid njm 045430 In Person Payment Total: $94.77 $94.77 . . 'Wf' 1;, ,;'~, <;{J '., " w 1l"",1,I;.,~." "'}>::;;';;"~'r,. .,,~ '..'. ''''''.' ,1;'., ... "';~, ;,t', 'i'GiJ ~; : k,:.,tJ '1". o ::,,,,' ~i~;,lr :}';.' " ~,~~~)~ :~,~~:)~~d "." Page 1 of 1 ,I . f 5/27/2010