HomeMy WebLinkAboutPermit Electrical 2010-6-11
225 Fifth Street+Springfield, OR 97477+PH(S41)726-3753+FAX(S41)726-3689
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.' DEPARTMENT USE ONLY
CC~ zoo9~Olf?l-{ry
Perrott no.:
Dale:b -((~(6
EI'ectrical Permit Application
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. CITY' OF .SPRlNGFIE'LD"'OREG'ON '~~
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This permit is issued under OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
"L()CAl.<;;OVERIiIMENT APpRoVAl:>
Zoning approval verified? DYes' D No
.'. .:....' .CATEGORY;OFCONSTRUCTION';" u'
O'Residential 0 Government I 0 Commercial
th~~ii\0J9I3iiSIT,="INFQRMATIONJ'ANb~'l1oC'AtJoN\1~'W:tn ] ,000 sq ft. or less (4)
Job site address: 1;" ~ l~rV\ ST, ~~~~oa?ditional 500 sq. ft. or portion
City: .sonVl'" JJ () . I State{ V' I ZIP:Cf7\flfJ Limited energy (2)
Referenct (qJ 'J'L11'~ o?-{)O() 1 Taxlo!.: Each manufactured home or modular
f)PAll '",.. ~~~~~,^N(~U~~~ ::~:~::::~~::eo:s~~::~~/~~;ion, alteration, relo:al::~OO $
h1 ri oJ1..- 1.1' lvW1lh~" n. lI\ ~,' .., 200 amps or less (2) $ 81.00 $
{PROPERTY' Owt<lER 201 to 400 amps (2) $ 95.00 $
Name: ",,- L (,J\9 '" 401 to 600 amps (2) $158.00 $
Address: '),)~,~ IlJ 11\ ~...... 601 to 1,000 amps (2) $205.00 $
City:~\AJU., :..r 01lA State: -erV 1 7m, ~iC8h~ \a~O%llj\~ \ olts (2) $469.00 $
Phon~r 1'1\ I~ \ I Fax: ~I\~::' rules adoPte~,IJJ e ~l)t~rth $ 63,00 $
E-mail: n \rAJ Notification ':'^<.0010 h k';!iog\l~~ry~e~1l" feeders: instal/alion, alteration. relocation
This installation is being made on residenti!I' jifia1J:jllbta\ c~POO%lT\~e $ 63.00 $
owned by me or a member of my immediat,o . 'Il centel. tN~~qi.~tf~~?n. $ 87.00 $
property is not intended for sale, exchange, leaUS, e <WOle~~ \ .
479.540(1) and 479.560<1). . IIUmbelce~tel ia t aOJ4Jll4O'OOU amps (2) $126,00 $
Signature:..6." .0 -n V~_I)J.i ) _ ' Over 600 amps or 1,000 volts, see services or feeders section above
.' 'tONTRACTOR INSTALLATION . Branch circuits: new, alteration, extensjonperpanel
Business name: Ot.-J'tV" 6VL a. Fee for branch circuits with purchase of a service or feeder fee:
':",
'."<;(-,Ot,;'s?:\_:;,'~\:\;~~~lrt,i~;.;~;.:Y'~-fEE~~;,SC:H EP.QmE~D;~Hi'~:'~;;Wi_~~;iiW~;:i:~~~r~;~~~~y
. "". .'". .......
,N~m,~~r ~rjn,~p~ctio.~~ ~~F ,it~.~,' P ,:(. Q'iy.
Residential, per unit, service included:
CoSt
.;. 'ea:',
Total
. cost
$134.00
$
$ 25.00
$
$ 32,00
$
Address:
City:
Phone:
E-mail:
CCB license no.:
Each branch circuit
$ 6.00 $
State:
I Fax:
I ZIP.
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 $
I BCD license no,:
Miscellaneous fees: service or feeder ~ot included
.:fl.
$ 63.00 $
$ 63.00 $
$ 63.00 $
$58,00 $
~)"c.,;,
$56
$ b7b
$ zrv
$b7~
/
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a 1imited-~nergY' panel,
alteration, or extension (2) - ~.:':~J
. \Cr~EaCh add.itio i fli!Jff0111~--'-' 0 .
~I "..1. "..:l- NOI~" .'
M\\I\. ~ ~lrVV\ ft2- ,\-IIS?t i!%\i\;- . "<,,
(M r ~ .(MA~ i\\J~~~~~~iQ~~~ ee$58.6s. ....i:....
~ to ~~.\'0~'1 '\8 (6t-En~H~o/,surcharge(.12x[A])
\0. ,.JC')~ (C) Technology Fee (5% of[A])
~ '1)'\ TOTAL rees and surcharges (A through C):
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
440.2584.) (9/G8/COM)
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
~;;" ;".; ".
PERMIT.NO: COM2009-01849
ISSUED: 12/3112009
APPLIED: ]2/3112009
EXPIRES: 121] 1120]0
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3522 MAIN ST
ASSESSOR'S PARCEL NO.: 1702313102000
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace 100lfwater line
Owner: OLSON BRENDA L & JEFFERY C
Address: 3522 MAIN ST
SPRINGFIELD OR 97478
I.CONTRACTOR INFORMATION I
Contractor Type
Electrical
Plumbing
Contractor
OWNER
BAXTER PLUMBING & ROOTER LLC 169028
I BUILDING INFORMATION ~
, ",,: ~W
# of Units: .# OfSt'\.li\m '401,)\\~\\'\~
Primary Occupancy Group: R-3 '~IlIl~~'~li~Yi~\l~\.
Secondary Occupan~y Group: 0~O~ ~~Ne% ~'t~ (lJ~'\'j '0'4
Primary Construction Type VE>~' 0\ Q\eO ~f fb;J'!-i(. e \\}\0~e
Secondary Construction Type: ~~~~~0. e.O~\e\' "'\~gt\.~\\~ ~e'V~O \\of>
# of Bedrooms: t' ~\()'Il ~~o~ c.0~.\)\)\~~er;jl9t.a.~ ~o\\\\C'<>
\Oo'i.~\c-tl <6~'l,.t:J\)e.'4 o'O~~~~~lig;
\~~\). " T INFORMA TION
1JIo'- ~\~"
~iI'>v}. C0~\0
(\~ Overlay Dist: .
# Street Trees Rqd:
Paved Drive Rqd:
0/0' of Lot Coverage:
License
Expiration Date Phone
03/13/2012 541-935-6696
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
REQUIRED PARKING
Total:
Handicapped:
Compact:
Frontyard Setback:
Side I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I -r ~ ~Cl~ i\
Sidewalk Type: 'X\'?-~ \~~" \'0 \\\)
f:ownspou~~IiIl~\S \l~\l( :t,\) fcCl'?-
. ~ru\\C ~~'xl\\\ 'O~\\\)~'?- ~"i>-\\\)C)~ .'
.5., .i., \\\\s \l Cl,?-\1.~\) C)'?- \S \)
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Notes:
';'
Page I of 3
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01849
ISSUED: 12/31/2009
APPLIED: 12/31/2009
EXPIRES: 12/11/2010
VALUE:
,';
Status
Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
:'):i:'
I Valu~~io~~~~~riPti~n ~
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Water Line - 1st 100'
+ 12% State Surcharge
+ 5% Technology Fee
Minimum/Adjustment Electrical
Amount Paid
'-' Date Paid
Receipt Number
$9.12,;
$3.80-
$76.00
$6.96
$2.90
$58.00
12/31/09
12131109
12/31109
6/11110
6111110
6111110
2200900000000001446
2200900000000001446
2200900000000001446
1201000000000000677
1201000000000000677
1201000000000000677
Total Amount Paid
$156.78
l.i~i~h;R~yiews'l
,.c:ad(
;"I'.I~,',;i,~
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.
~eolliredJnsnections ~
Water Line: Prior to Iilling trench and including required testing.
Special: See Plan Review and/or Inspector notes.
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Page 2 of 3
CITY OF SPRINGFIELD
Building/Combination Permit
Status
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
:',1;!
PERMIT NO: COM2009-01849
ISSUED: 12/3112009
APPLIED: 12/3112009
EXPIRES: 12/II/201O
VALUE:
Issued
it
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 State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any strnctunLwithont permission of the Community Services Division, Building Safety.
I fnrther certify that only contractors and employeerWho a're:iinompliance with ORS 701.005 will be nsed on this project.
',,~,",,_-;IJ( ~~ F _, " i" .
I further agree to ensure that all required inspection(are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of ih~ propehy, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000677
Date: 06/11/2010
11 :37:50AM
Job/Journal Number
COM2009-0 1849
COM2009-0 1849
COM2009-0 1849
Payments:
Type of Payment
Check
cReceintl
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
58.00
6.96
2.90
$67.86
Description
MinimumlAdjusnnent Electrical
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
BRENDA OLSON
Amount Paid
djb
$67 86
$67.86
9769
In Person
Payment Total:
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6111/2010