HomeMy WebLinkAboutPermit Electrical 2010-6-14
_ Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477+PH(541)726-3753HAX(541)726-3689
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DEPARTMENT USE ONLY
10 j)h3
Date:
Tbis permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days. '
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
Lj Ji
, Name:
Address:
ZIP:
Phone:
E-mail:
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: .$1Jl::\Ja.-.,~ 'E-ce::'TK\C
Address:f'O 60>1' lob?
City: fLC:41SW'll 1 IA_ State:c::R. ZIP:Cf 7L/-5'S
Phone: SJ.j( C{/f)..-;J.c'So Fax:5fl- 1'f6-Q't:/ 0l-
E-mail: -POGLEGHRN @) IMSN, C()[ffI
CCB license no.: Cf'9+7 CJ., BCD license no.::90- 3T3c
Signing supervisor's license no.: "to qtj- - S
Print name of signing supervisor: sTEVEN G 8'>U:F;
Signature of signing supervisor: .
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440-2584-J (9108/COM)
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FEE 'SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 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 $7( I
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 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
OM. ././
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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 ~ee:_
Each branch circuit '0 $ 6.00 $(nf?
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
. APPLICANT USE
(A) Enter subtotal of above fees $1'1l~ -
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ ~ r
(C) Teclmology Fee (5% of[AD $ ff.5-
TOTAL fees and surcbarges (A tbrough C): $~I
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b-
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1/1$
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00763
ISSUED: 06/14/2010
APPLIED: 06/14/2010
EXPIRES: 12/14/2010
VALUE:
Status
Issued
SITE ADDRESS: 1466 A ST
ASSESSOR'S PARCEL NO.: 1703363200700
,
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Commercial
PROJECT DESCRIPTION: New 200A service and 10 circ
Owner:
Address:
HECHTINVESTMENTSLLC
329 E 8TH AVE
EUGENE OR 97401
Contractor Type
Electrical
Contractor
STEVEN R GEISL
I CONTRACTOR INFORMATION 'OU to
ATTENTION: Oregon law '''''I''''Von UtIIIW .
lIow rules adopted by II'tl~g ~G set.iration Date
.' alion Center. Those ~ 2~1.II/23/201 0
11l1ll theN s
, telephone
IIig~~.El,center. 0 '.. N ~ .
ca'lf16~ffflf~ Oregon Utility 0 Lot Size:
nuq\ltltCbl\{tft!wlt.8Q0-332-2344). . Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
'Raiige'Tfp'e: Sq Ft GaragelCarport
!'Eiiergy Path: Sq Ft Other:
Sprinkled Building: nla Occupant Load:
Phone
541-726-0618
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION ~
-IOTICE: .. If THE WORK
'11~~F.~~~sSH~ ~~~~ERMIT IS NOT
U" 1~11RI'EI5i1;v= ED "OR
. !,.a-;e,!i ~Yff I ~S ABANDON r .'
f) ORoH~ot Co er~J!jl;D' '. . .
,:~y 180 DAY PEhlU . .' '.
REQUIRED PARKING
Total:
" Handicapped:
Compact:
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I V alu\ii;~Ii'Description I
n."; . "
Description
Tvpe of Construction
$ Pe{SqlFt
or multiplier
l'~;,-"' . Square Footage
or Bid Amount
Value
Date Calculated
Page I of 2
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00763
ISSUED: 06/14/2010
APPLIED: 06/14/2010
EXPIRES: 12/14/2010
VALUE:
Status
Issued
,; ,"I
,
. . ','j' .~., ,,"
. .:?tal Value of Project
i""Fees Paid;. "
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Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
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Amount Pai~,; ,.
$16.92
$7.05
$60.00
$81.00
Date Paid
Receipt Number
6/14/10
6/14/10
6/14/10
6/14/10
2201000000000000691
2201000000000000691
2201000000000000691
2201000000000000691
Total Amount Paid
$164.97
I Plan Re:-:.ie~s ~.
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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.
LReouired Insoections ~
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Rough Electric: Prior to Cover 't.~~~ ,ia~i~l.i'''1 ; I:' "
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Electric Service: Approval required prior to:utility company energizing service.
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Final Electric: When all electrical work is complete.
By signature, 1 state and agree, that 1 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 accordance with
the Ordinances oflhe 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 structure without permission of the Community Services Division, Building Safety.
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
1 further agree to ensure that all required inspections are reqtiest,~d:at.the proper time, that each address is readable from the
street, that the permit card is located at the front of tbe properfY,ilDd,the approved set of plans will remain on the site at all
, '1 '. f.~__ ><." .
times during construction. !' " ".
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Owner or Contractors Signature
Date
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000691
Date: 06/14/2010
2:59:20PM
Jdb/Journal Number
COM20 I 0-00763
COM20 I 0-00763
COM20 I 0-00763
COM20 I 0-00763
Payments:
Type of Payment
CreditCard
cReceintl
Description
Perm Serv/Fdr 200 amps or less '.;~';.
Add, Alter, Extend Circ Ea Add""
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
STEVEN GEISLER
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Amount Due
81.00
60.00
16.92
7.05
$164.97
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc
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Page I of I
Amount Paid
433681 In Person
Payment Total:
$164.97
$164.97
6/14/2010