HomeMy WebLinkAboutPermit Electrical 2010-6-9
Electrical Permit Application
CI'fY'OF SPRlNGFIELD,-OREGON'-
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225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
DEPARTMENT USE ONLY
CO....... Z-c.';Iv- 00 72.7
Pennit no.:
Date: 6-'7-/0
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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.
. . 'LOCAVGOVERNMENTApPROVAI;;',,"',ATTE ~T ON:,er!i9onII8W:redjllllliissmillttilUJ.jEi'i:i;Witr;?i~i!~i?;'6~V:~(!~'
Zoning app.r. o. val verified?. . .. DYes... D No .~1I.0W r~ ;~~q,ql?~E\.(tl)Yet~~n9~~PR~mqt\lltyTQty. Cost Tot.aI'
'.'. ..',.'CATEGORY'iOFCONSTRUCTION"',' ,.... _, II ~'IIr,'.TI!~ . ." ea.. I. cost
.... ..... . .... ,,,riAD 952tMI.tOOM,~QA.Ad3Iil2hlln1!.
:-Q Residential . 10 Government , T 0 CommerOO90. 0 . . v, "'" ru,es-oyr
~~W.OBYSITE':rNFORMATIONFAN[jt:t:O_CATION:~f~"u, ~ ' . ',~_ .
Job site add]:ess: 266 /7f$T' I 7 -ti.-... r C!~~~~!l~~~~llrelWon
City: t;!?r; 06.';';!'r';} Statem I ZIP: Limited energy (2)
Reference: \ 7'6:5<: 63 ( I Taxlot.:62 '7 Oc::. Each manufactured home or modular
DESCRIPTION: OF WORK' ,..:. :'" ..{..:.':.." dwelling service or feoder (2)
'; /' '\,... ~ '\..-~ . \ t' r \- ^ T~ r ","- Services or feeders: installation. alteration, relocation
C. Tl#' /"C(7~ n.. ,":',- 200 amps or less (2) 'I> $ 81.00 $-
PROPERTY OWNER 201 to 400 amps (2) $ 95.00 $
Name: ")\...tAl-t"z ":)c.~ 401 to 600 amps (2) $158.00 $
Address: Zc> g- ( r 'So)- 60INJ~T<ffl&ps (2) ;,;" Z\;~;.:,; ,,$.2,q5~00 $
City: '5'?~~ State:oL. I ZIP: "771{77 ov~r\l,b'o6'~&r-8Hf(~t EXPIRJ:III:~ $
Phone: _ _ I Fax: _ _ Re'i\\6J~~ UNDER THIS P RMIlr fS6I1I9Yr' $
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E-mail; TeiYfJ?eT .:r"r ~e!.v~~~s\J""'dNlBl trttJ!lOtUllllC[uaJifTfllio.n, .~e.location
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: Cb yo{\ Deft -+- ""g-~ '\
Address: '33Ci~V /~f'r"a'.(, <"""",'h r;:).:::l
City: C' ~"5v'~':.S" State: (( I ZIP:
Phone:54i-2z..~r~-'/1 Fax: - -
E-mail:
CCB license no./~i7.f15K/ I BCD license noC...4/lfl
Signing supervisor's license no.: 4\'5/_"')<:
Print name of signing supervisor: ~G~~
Signature of signing supervisor~ ~./ /"''i
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R~ ."
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V r 'w~<r
~~
440-2584-J (9/08/COM)
$134.00
$
$ 25.00
$
$ 32.00
$
$ 63.00
$
200 amps or le's's12)r . ,,_ '$ 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 of a service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
,3. $ 6.00 $ I f
Miscellaneous fees: service or feeder ~ot included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Eaeh additional inspection: (1) $58.00 $
~~~2.i:4~~~!12{~~~i~AR~LICANT~~)JSE~i:~~~("~~{~&~~:~;~.l~g:":.:(~;}~;.: ,: .'
$ 63.00
$ 63.00
$
$
$ 63.00
$
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
$ Ie,
$ Z 10
$ ,fO
$2/ o~
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00727
ISSUED: 06/07/2010
APPLIED: 06/07/2010
EXPIRES: 12/09/2010
VALUE:
, 'I
, ,
....
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769Inspeetion 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: Electrical Service Change
Owner: SHULTZ JEFF
Address: 208 17TH ST.
SPRINGFIElD OR 97477
Contractor Type
Electrical
Plumbing
CONTRACTOR INFORMATION
AlTENT10N: regon, w reqUires you 0
ContvliHwtrules adopted by the Oregon UtililYicense
co~ifljli!t~~l<<cU.~1I~~~;lpr1l\274
OW AR 952-o01-0010,throughOAR 952-001-
calflng the c rBm lNf: ION
number for th gon II Y 0 Ilea Ion
Center is 1#lGtlSia~44).
".' R,3 " Height of Structure
.. ~',:. ,,,.....,..,. .
. ',' Type of Heat:
VB Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Expiration Date
10/1412010
Phone
541-225-7827
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION i
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
N~feE:~~~l~"Rqd:~' ,':::". ':~-~'~~~'~~~*~t"<:r'"~ '. ~:~~:icapped:
Tf1i~vPlflQ\7\fI; BlMll EXPIRE IF THE WORK .:Compact:
Au~..rl(!)~!i!(![J>tmm:R THIS PERMIT IS NOT .if
COMMENCED OR IS ABANDONED FOR ._,>,:t' '
,
PUBLIC IMI
,::;,:~,~'C'.~~~" ~ ~". ,: "
Street Improvements:
Storm Sewer Available:
Spedallnstruction:
,'!\;::
',.,',,
Sidewalk Type:
Downspouts/Drains:
.'C.,..',
Notes:
1 "I " . .. P~2e 1 of 3
-,'
'~d :1
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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I Valuation Description I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Sqnare Footage
or Bid Amount'
Total Valne of Project
~
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 12% State Surcharge
+ 5% Technology Fee
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Fixture
Minimum/Adjustment Plumbing
". '
Amount Paid
, ,
$9.72
$4.05
$81.00
$2.16
$6.96
$0.90
$2.90.:
$18.00 h.; ',I
"; .. ..'. h .~;l;~ ~~;: \: ,
$19,OO,i:C
$39.QOt:.:
Total Amount Paid
$183.69
Date Paid
617/10
617/10
617/10
6/9/10
6/9/10
6/9/10
6/9/10
6/9/10
" 619110
619/10
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00727
ISSUED: 06/07/2010
APPLIED: 06/07/2010
EXPIRES: 12/09/2010
VALUE:
Value
Date Calculated
Receipt Number
2201000000000000650
2201000000000000650
2201000000000000650
2201000000000000666
2201000000000000664
2201000000000000666
2201000000000000664
2201000000000000666
220]000000000000664
220]000000000000664
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. , "
.! t
l...PeouirecUnsnections'
Electric Service: Approval required prior to utility company energizing service.
Final Plumbing: When all plumbing work is complete.
Rongh Electric: Prior to Cover
Final Electric: When all electrical work is cohiplete.' :!,
f~.'::r., 'U',;., '~,".
'lit':,:
Paee 2 of 3
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,.
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00727
ISSUED: 06/07/2010
APPLIED: 06/07/2010
EXPIRES: 12/09/2010
VALUE:
Status
Issued
By signatnre, 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 acco,'dance with
the Ordinances of the City of Springfield and the Laws of Ihe Slale of Oregon perlaining 10 Ihe work described herein, and
Ihal NO OCCUPANCY will be made of any slrncluftwill!'ou:U,ermission of the Communily Services Division, Building Safely.
1 furlher certify Ihal only conlraclors and employee,who are in compliance wilh ORS 701.005 will be used on this projecl.
I fnrther agree to ensure Ihat all required inspecliliils are requested atlhe proper time, Ihat each address is readable from the
slreet, Ihallhe permit card is located allhe front of the property, and Ibe approved sel of plans will remain on Ihe sile al all
times during construction.
Owner or Contractors Signature
Dale
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"j. ~,p'~:e:e:3 of 3
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Pnblic Works Department,
RECEIPT #:
2201000000000000666
Date: 06/09/2010
J1:41:30AM
Job/Journal Number
COM20 I 0-00727
COM20 I 0-00727
COM20 1 0-00727
Description
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge"'." .i, ,~,,'
+ 5% Technology Fee3',c;,,'
< . .;~
Item Total:
Amount Due
18.00
2.16
0.90
$21.06
Payments:
Type of Payment
CreditCard
Paid By
COMPLETE ELECTRICAL
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
401961 In Person
Payment Total:
$21.06
$21.06
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Page I of I
6/9/2010