HomeMy WebLinkAboutPermit Electrical 2010-6-10
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Electrical Permit Application
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',CITXOF SPRlNGFIELD":~OREGON ,c
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
DEPARTMENT USE ONLY
CO.......e.OIO. 00 71.( ~
Pennil no.:
Dale: (, -(0 -I D
This permit is issued under OAR 9]8-309-0000, Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for ]80 days.
L()CAL .c;OVERNMENT Ap,PROVA13' .,,,.ie,.:".';'
Zoning approval verified? 0 Yes 0 No
'.'I':.' "C,6.TEGORy\i(jF:CONSTRUCTIOf>j'): i..
ct Residential I 0 Government I 0 Commercial
. i$i~rJ~(~.oBi$rrE';INF()RJVtATIONrANJjI':I.:C:l.CAtION:;~F""JN'
Job site address: 'i I Lj S U. WI 0'11 teRR..
City c:dtl I State: DR ZIP~Y""I
Reference: ',?-, OSI 2- I Taxlol.:('){ &-D 5
DESCRIPTION OF WORK". .:.,.r..:.....
P,v0 On ~L,n._ , :'F
I
PROPERTY OWNER
Jr\^l.I,N\I~ ~f f( i'
Do '//":Z,;zf
". < '^ ! I StatOr<
- -jI!? 20&':;; I Fax:
Name:
Address:
City:
Phone:
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 renl. OAR
479.540(1) and 479.560(1).
.
ZIP: t171/o I
Signature:
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NUIll~~r ~rinsp~ctio.,speri~~Ill()'J.. Qty. .... c.~~t., .~~1~1
Resjdential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
. Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134.00 $
$ 25.00 $
$ 32.00 $
$ '63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) -' $ 95.00 $
40 I to 600 amps (2) $158.00 $
601 to 1,000 amps (2) ._ '" u to $205.00 $
/4.. " .allflig!l9v.1~~I~Olegon lJtilit $469.00 $
10 IGWcWlIlBt ffll1Vn)Th~se rules a~e.s l~ -, 1.$ 63.00 $t, ';? bit>
~,~ A"'IQ!I/;!~qlilesJ2tlration, relocation .
In ~'tlIaIJ:~~'I~..\~te: the tele hO~ _$ 63.00 $.
~~i'egon Utilit'l_'~~, . $ 87.00 $
1I~ll!~-8 $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INSTALLATION
Business name: f'4r..!'Ab'I'l\/ :;:.~ j...J.r.,.Jl ,
Address: P iJ (.;;1..:5 Each branch circuit $ 6.00 $
City: I. 1::1] o;r;:;:;tP ~ I State: OK ZIP: Q7'1'1f- & $ Fee for branch circuits without purchase of a service or feeder fee:
Phone: 7JL{-; i"'P.SCf I Fax: - - First branch circuit (2) $ 55.00 $
E-mail: I Each additional branch circuit $ 6.00 $
CCB license no.1C:> 3D Y I BCD license no.:2 D- 30:;2.. CI- Miscellaneous fees: service or fteder ~ot included
Signing supervisor's license no.: ~'"7/ 7:J _ -<{ Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor; \. Alrl-e'P ,-( CJCl N,!\hhV- Each sign or outline lighting (2) $ 63.00
Signature of signing supervisori ..J\ \ --.--:c i( /I\.A "" .~ Slit gnat I cirCUit orta limite(d2')energy panel, $ 63.00 $
A r- a era lOn, or ex enSlOn
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~~" ICE" W;,:~~~~Ji:w.:~::t;;:'"''''&'''7~~
o....o....\\. NO~ PERN\li s\-\I\\..\.. tf,.:\~ ~\1~ ~'n!er 12% surcharge (12 x [A]) $ 7Sb
~1\10RI2EO UNO~: ~BJI,NOONEO Technology Fee (50/0 of [A)) $ ;;-1 J-
COMMENCED OR 100. TOTAL fees and surcharges (A through C): $ 73?l.
JI,to\'I '\ 80 OJl,'I pER
440-2584-J (9/08/COM)
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits'.with purchase of a service or feeder fee:
$
$
Status
Issued
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: COM2010-00749
ISSUED: 06/10/2010
APPLIED: 06/10/2010
EXPIRES: 12/10/2010
VALUE:
i',1:;.
SITE ADDRESS: 4745 UNION TER
ASSESSOR'S PARCEL NO.: 1802051201803
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Service reconnect
TYPE OF USE: Repair
Residential
Owner: OTERO LINDA G
Address: 845 19TH ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION .
Contractor License
WALTER J CANNON 76304
BUILDiNG INFORMATION ~
Contractor Type
Electrical
# of Units:
Primary Occnpancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
# of Stories:
R-3 ~eight of Structure
Type of Heat:
VB Water Type:
ATTENTiON: ~:.~~~ T)l\p'e(~qUires yout,o
follow rules adg8ip'QY?l~l!li ,Ol:egon Utility
Notification CemJV"KB'MIlIIHl'!Be set forthn/a
~nO~~HylM~~~
Callingthecent~:
number for th~\8-llW\:hlmity Notification
Center iPslr~som~Wi~'
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS ~
Expiration Date
09/0912011
Phone
541-747-0959
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Fl Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Haudicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
". :'~h5/ ",:',;~ ~tl.:;"i';"'L. ," ,
NOTICE: ,','" EXPlRE lnl-lE WORK
AU 0 EO fOR
CO .
AN',S '1'ilesq,4)! PERIOOsquare Footage
or multiplier or Bid Amount
Type of Construction
"<.'
Paee I 01'2
I . .,:;f~
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR .
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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"-:totafYalue of Project
I Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amonnt Paid
$7.56
$3.15
$63.00
, .
Total Amount Paid
$73.71..
I Plan Reviews ~
Date Paid
,6/10/10
6110/10
6110/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00749
ISSUED: 06/1012010
APPLIED: 06/1012010
EXPIRES: 12/1012010
VALUE:
Receipt Number
1201000000000000642
1201000000000000642
1201000000000000642
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, insR~.ction.s. requested after 7:00 a.m. will be made the following
work day. -.,. .......
.....,....~ 't>'"
"
I Reciuired InsDections I
Electric Service: Approval required prior to utility 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 State of Oregon pertaining to the work described berein, and
that NO OCCUPANCY will be 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 be used on this project.
I further agree to ensure that all required iuspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the fron't ~nhe property, 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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Paee 2 00
225 F,ifth Street
Springfield, Oregon 97477
541 -726-3759 Phone
WIt. T..;.......~.:m.I!U>.... 'ii.' '..
. ..... ...
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000642
Date: 06/10/2010
8:58:18AM
Job/Journal Number
COM20 I 0-00749
COM20 I 0.00749
COM20 I 0-00749
Payments:
Type of Payment
Check
cReceintl
Description
Service Reconnect
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
WALTER CANNON
.1_.
'1;1.; .:~, ;;' I
Amount Due
63.00
7.56
3.15
$73.71
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
$73.71
$73.71
23475
In Person
Payment Total:'
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