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HomeMy WebLinkAboutPermit Electrical 2010-6-7 Electrical Permit Application .~_.l'" . ~~ '" . _."..-~..ti..,,"" ~.. ~~..~ .:r.,,,,",,,,", . _ ". ~CITY~OE.SPRINGFIELIf/ OREGON,,"'. ~~~F<.';:t<""'..'t:. ~ ",rM~..;.Jrt;,c~'f ..~_~.';",,'f....t'f,!:,h}" "'.,I'>f"V">. 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753t FAX(541)726-3689 . DEPARTMENT USE ONLY' Pennit no.: Date: ---;' -- /0 This permit is issued under OAR 918-309-0000. Permits are nantransferable. Permits expire if work is not started within 180 days of issuance .or if wark is suspended far 180 days. . . . LOCAVGOVERNMENTAPPROVAG:::,.... Zaning appraval verified? 0 Yes 0 Na ':..: "CATEGORyjOFCONSTRUCTION">.' Taxlat.: DESCRIPTION: OF WORK ".,., :se\V'~.c PROPERTY. OWNER c.Je: VY) .e- Name: Address: City: Phane: E-mai]: This installatian is being made on residential .or fann property owned by me .or a member .of my immediate family. This property is nat intended for sale, exchange, lease, .or rent. OAR 479.540(1) and 479.560(1). ZIP: Signature: E-mail: CCB license no.. Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~~v ~.~. \p(V- 0. .\'V \.0' Z? ~~~ ~ 440.2584.) (9/08/COM) ;'<:" :- ;'(:~'~?:L:;;~?~~:r~{i~.tV~~~;~fl!:\\T~ f,EE:X S' p H E_D.U I] E~; \;~n~~:i'lfp(';;~;f~.t?~~'(.~~%t~':'!;f*,j~ Number ofinspe~tions perit~~O' QIy. .' Cost Tatal . .:..' ." . '0"'. ....", 0' ....: eil:'. c.ost, Residential, per unit, service included: ],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 $ 8/ 20 I to 400 amps (2) $ 95.00 $ 40] to 600 amps (2) $158.00 $ 60 I 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) 201 to 400 amps (2) 40 I to 600 amps (2) $ 63.00 $ $ 87.00 $ $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 $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ $ 6.00 $ Miscellaneous fees: service or feeder ':lot included Each pump or irrigation circle (2) $ $ $ 63.00 $ 63.00 Each sign or outline lighting (2) Signal circuit or a limited-energy panel, alteration, or extension (2) Each additional inspectioo: (I) $58.00 $ :~(~y/:::>~fg;&~~~t~~:~~it;,';:.~~~Af{~ilTCANT~:ft.)S>l:~~i-~,t(:;,~'.~~~~~~if::i~::itt,~.,:i;-~-.(:;;>; ~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ 63.00 $ (B) Enter 12% surcharge (.12 x [A]) (C) Technolagy Fee (5% of [AD TOTAL fees and snrcharges (A through C): ?;). ZeD 7' 2- ---- --4. c ) 'f2/" 77 $ $ $ .I Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00727 ISSUED: 06/07/2010 APPLIED: 06/07/2010 EXPIRES: 12/07/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 208 17TH ST ASSESSOR'S PARCEL NO.: 1703363102900 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Service Change Owner: SHULTZ JEFF Address: 208 17TH ST SPRINGFIELD OR 97477 Contractor Type Electrical I CONTRACTOR INFORMATION I Contractor License COMPLETE ELECTRICAL INSTALLATION 184274 BUlLIllNG INFORMATION I Expiration Date 10/14/2010 Phone 541-225-7827 # 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: Lol Size: Sq Flls1 Floor: Sq FI 2nd Floor: Sq FI Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay' Di,t:'" # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: ., Total: Handicapped: Compact: Street Improvements: Storm Sewer Av,.ilable: Special Instruction: requires you\O PUBLIC IMP , i' ,~pted by the le~eare set forth . . ter Those ru 52001- N tilicatlon en . ~~~hI9M19 - InoOAR 952-001 -001 . 0 ies ofttie rules by c', , 0090. ~'(oumay obtilJ\l~Bf!!?\lI~""ll:iD\lpne . ,:"!,;M.' j);';"',,,.,'callingthe center. ton Utility Notification number for \heO~~~OO_332-2344). ',", . Center IS , Notes: NOTICE: THIS PER I ,~_ \j ';, f~:;~E~~~~ ~~~~R THIS' PERM "/\laiN -on Descri tion '1NY 180 DAY P ABANDONED . D ., T FRlon. $ Per Sq Ft escnptlOn ype orConltructlOD . I' I' or mu tip ler ..,. ;,r Square Footage or Bid Amount. Value Date Calculated , ! Pa2e 1 of 2 Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 12% State Snrcharge + 5% Technology Fee Perm Serv/Fdr 200 amps or less Total Amount Paid .'-",'" " T",: Total Value of Project L Fees Paid ~ .. Amount Paid;~:;' '.'; >. >:~y. $9.72',;..,,:. $4.05:.: $81.00;' : Date Paid 617110 617110 617110 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM201O-00727 ISSUED: 06/07/2010 APPLIED: 06/07/2010 EXPIRES: 12/07/2010 VALUE: Receipt Numher 2201000000000000650 2201000000000000650 2201000000000000650 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"in~pections requested after 7:00 a.m. will be made the following work day. $94.77 I Plan Reviews ~ L Reouired Inspections ~ Electric Service: Approval required prior to utility company energizing service. . . ',.-:;):", .,~ ,>",., , "' . By signature, I state and agree, that I have carefullylex,.mipedjthecompleted application and do herehy 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 ~!wg'of th,,1State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will he 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 he 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 times during construction. ~, :' .~ ; Page 2 01"2 -;;u;\. Date 225 Fifth Street Sprin,gfield,.Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000650 Date: 06/07/2010 12:19:14PM Job/Journal Number COM2010-00727 COM2010-00727 COM20 I 0-00727 Item Total: Amount Due 81.00 9.72 4.05 $94.77 Description '''' Perm Serv/Fdr 200 amps or less + 12% Slate Surcharge + 5% Technology Fee .' .-.~.' Payments: Type of Payment CreditCard Paid By MATTHEW GROVER Check Number Authorization Received By Batch Number Number How Received njm 181847 In Person Payment Total: Amount Paid $94.77 $94.77 ~',: :r.~' ~', ,'.... {, ' cReceintl Page I of I 61712010