HomeMy WebLinkAboutPermit Electrical 2010-6-7
Electrical Permit Application
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~CITY~OE.SPRINGFIELIf/ OREGON,,"'.
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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 ".,.,
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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:
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440.2584.) (9/08/COM)
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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):
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7' 2-
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$
$
$
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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.
. .
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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.
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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 .'
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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
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cReceintl
Page I of I
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