HomeMy WebLinkAboutPermit Electrical 2010-6-3
Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477t PH(54I)726-3753 +FAX(54I)726-3689
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DEPf.RTMENTUSE ONLY
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Pennitno.: VtJ ~(XJ7/~
Date:
-S-IO
This permit is issued under OAR 918-309-0000. Permits 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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Zoning approval verified? 0 Ves 0 No
;. :;j'f:::.L:!:CATEGORY:iOF..;:;CONSTRUCTION'P:~'
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,'DESCRIPTION,.
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:PROPERTYOWNER. .
Name: \,0-,5 ,",' '1..; r"r \--"es
Address: ";,.(; 0 -;}c-h,
City: rl ~ State:tI'{l ZIP:~lln)
Phone:S 'II - ~ '5- ., 'I 0... Fax:
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 479.5,60(1). r-/'
Signature:rv ~l /le.:
;,CONTRACTOR INSTAllATION.
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Business name: ,/,-,"-'Y~
Address:
ZIP:
City:
Phone:
E-mail:
CCB license no.:
Fax:
BCD license no.:
Signing supervisor's license no.:
Print name of sign ing supervisor:
Signature of signing supervisor:
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440-2584-J (9/08/COM)
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",','-.-. '.' ,,' - """'-', '",,: , .'>'.' . Cost Total
:'Number"of.inspeetlo'ns-per item",(',), A< Qty. ,
';' "'" ,~,' ;.",\, ':_,,' \;~'_n,.;-',~..',.';r-;"i ',"i_;.' ,'_ '''"::.'~'', ''.,':''. J. <~a/;', ,'cost. '.:
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) $ 81.00 $ S1 I -
201 to 400 amps (2) $ 95.00 $
40 I 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 $
201 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 I $ \'2.
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 $
Mi.scellaneous 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 $
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(A) Enter subtotal of above fees 9;3 - -
(Minimum Permit Fee $58,00) $
(B) Enter 12% surcharge (.12 x [A]) $ II-!...: ::.
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(C) Technology Fee (5% of [A]) $ '-1cS ~
TOTAL fees and surcharges (A through C): $ lOr J
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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: COM2010-00713
ISSUED: 06/03/2010
APPLIED: 06/03/2010
EXPIRES: 12/03/2010
VALUE:
Status
Issued
SITE ADDRESS: 222 58TH ST
ASSESSOR'S PARCEL NO.: 1702334100204
SPRINGFIETYPE OF WORK: Electrical Work Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Electric and two circuits.
Owner: '. .BENSON VERN W
Address: . - 940 HWY 99 N .'
EUGENE OR 97402
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION ~
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
. ,.'
...."
.# orStories:
..Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
. n/a
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occnpant Load:
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:.
# Street Trees Rqd:
. Paved Drive Rqd:
0/0 of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
. ,,"~1,1;i.'i'.'t:'.1',
NotiCE: T SHfl,ll EXPIRE If 1 ~ on Descri
THIS PERMI U DER 'THIS PERMI
DescripiibhlHORI~,Qe U;lP,/!I1stn1tN00NEO~fl~ s.q ~t Square Footage
. r.OMMENCttJ lJ!tlv,.II:'" or multiplIer or Bid Amount
'J'( 1:)0 DAY PERIOD.
I PUBLIC IMPROVEMENTS I
A1TENnON~~= trieiequns you to
follow rules ~~,Qe,Glrsgon Utility
..,., . ,'Co Notiflcation Center. Those N1890~e = ~
.. i'" in OAR 952-001-0010 through "" ..... ,0
".:.,e :,,,:,,,: 0090. You may obtain copies 01 the rules bf
,(.:i"" _,'.;; callin the center. (Note: ~otelephone
er or
tion Center is 1-800-332-2344).
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Value'
Date Calculated
Paee I of 2
,
;"',
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20I0-00713
ISSUED: 06/03/2010
APPLIED: 06/03/2010
EXPIRES: 12/03/2010
VALUE:
225 fifth Street, Springfield, OR
541:'726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
: .,~,,(.. j' ! I ,',..
"A;otal yalne of Project
L Fees Paid I
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amonnt Paid
Date Paid
Receipt Nnmber
Total Amonnt Paid
$11.16
$4.65
$12.00
$81.00 .
$108.81 '
6/3/10
6/3/10
6/3/10
,6/3/10
2201000000000000620
2201000000000000620
2201000000000000620
2201000000000000620
I Plan 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. ;::;:' , ." '
,
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Retluired...lnsDections ~
Rongh Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Electric Service: Approval reqnired prior to ntility 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 S,tate of Oregon pertaining to the work descrihed herein, and
that NO OCCUPANCY will be made of any strnctnre without pe~mission 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 inspectio'ri's 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
times during construction.
('/' ~ L<) c/JI/o
Owner or Contractors Signature
Date
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Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
220]000000000000620
Date: 06/03/20]0
12:59:56PM
Job/Journal Number
COM2010-00713
COM20 1 0-00713
COM20 10-00713
COM20 10-00713
Payments:
Type of Payment
Check
cReceintl
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
;3J"~-:),
Paid By
JEANNE XIARHOS
. .,,1 ; Check Number
.R'e'c'eived By' Batch Number
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Page 1 of 1
Item Total:
Authorization
Number How Received
Amount Due
81.00
12.00
11.16
4.65
$108.81
Amount Paid
7286
In Person
Payment Total:
$]08.81
$108.81
6/3/20 I 0