HomeMy WebLinkAboutPermit Electrical 2010-6-15
Electrical Permit Application
225 Fifth Street+Springfield, OR 9747HPH(541)726-3753+FAX(541)726-3689
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Permit no.:
~
Date: 6 - / S- - I 0
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.
; ". EOC.o..l;:GOVERNMErljT'AF1P.ROVAt'c:"'i";i:::;'?\
Zoning approval verified? DYes DNa
"\.. i1C.o..TEGORY::.OI;CQNSTRUCTIQt'J!;/.' ".
61fesidential 0 Government 0 Commercial
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Job site address: Z. [f lJ ....;.. ;-+/
City: Srr;~ StateoL. ZIP: '17Lf77
Reference: {70]: 2 7l.( L{ Taxlot.: Dlf SO c::,
'." DESCRIPTION:. OFWORK'i!.; . ....
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Name:
Address:
City:
Phone:
B-mai!:
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. OA~lT
479.540(1) and 479.560(1). . fOlio
. Notifi
SIgnature:
B-mail:
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor: .
Signature of signing supervis
.
~tG~ / NOTICE:
....0.... ~ 'S><v ~ THIS PERMIT SHALL EX
l\.~ 'CV'\'~ \A~~~' AUTHORIZED UNDER TH
V 'lid uJ..y COMMENCED OR IS AB
~ ~ ANY 180 DAY PERIOD.
440-2584-) (9/08/COM)
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Number' qf jn~peCtio.ris.p~r item' (.), .". 'Q~. .."
" , !. ':. -'>, " i . ; ~:". " "," ' ': ',. .":'.":,'; '.;- . ': .. \.' '.' . ',:;. ~",. : ,:" : .' ~, ,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 $ Sf
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
200 amps or Jess (2) $ 63.00 $
lfltlJJ ,An li~ reauires YOU to $ $
87.00
. leSladGllltid.Ji;\(~ . $126.00 $
I _ or t ~ or feeders section above
C ullnayiDbtairitCopieSi~l1helf,ulG~n per pallel
tb~nta'a~~.. . ~~~ of a service or feeder fee:
r - :"r";--l!~2344\. $ 6.00 $
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 $
MisceUaneous fees: service or feeder !,-ot 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 $
fi#?)~~*1~~t~li~;},~~~A'Re'iJTG)~f:.jT~~OS):~~~~;A~J3}1~;~ft~~;~In~;iWE;-:;':'
\~ W'lf~ilMQ\?'K.bove fees $ 8r
.. \If 1'3,,*OFee $58.00)
.m1i!lNW;l'iA;)!fircharge (.12 x [A]) $ 17~
(C) Technology Fee (5% of [A]) $ 'for
TOTAL fees and surcharges (A through C): $ crt( ?2.
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20I0-00767
ISSUED: 06/15/2010
APPLIED: 06/15/2010
EXPIRES: 12/15/2010
VALUE:
-~ ". ':.
Status
Issued
I;:'"
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 428 W CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703274404500
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace service
Owner:
Address:
HICKOK MARY G
428 W CENTENNIAL BLVD
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
....
Contractor 'License
BIRCH CONSTRUCTION 165702
BlJ'iLDiNG'II;'FORMATION ~
",J;
Expiration Date
08/01/2011
Phone
541-895-5721
VB
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:'
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
n/a
I DEVEI"Qg~'INFORMATION ~
le'l~ ~n
OT\ \Il\N OlagO \ lol~
O~'. Ole~eo '0'1 \nall\~lfI~WSt!'\'
:(t€.~~ . e.do9 ,nose I ~ffi~lli\~e~qd:
~\\O'fl1~;~ ceT\\~~,\o \nIOIl~l?~~'ll,\~rR~d:
~o\ii~: 902-00'\' 0'o\9.1T\ C~~a" ~%~lI'tBaVPrage:
\(101" \(OU tl\e.\T\\el. ~ T\ \,\\\\\\'1 ",,,,,,,).
. C 0 _'"
ce: ~hel \01 ~ I III
(\\1"- ceT\\8
Street Improvements:
REQUIRED PARKING
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
Sidewalk Type: , ,,\,.;'1':" "
,,, ", a?-."'- "
DownspoutslDrains\r ,\\'C. ~ ~a' '
. tJ-'i'\?:r. ?-~\1 \S .
~O\\ct. ~\1 S\\!>.\.~\\ ,\\\S "~~'C.\) ta~;;~~
1\\\S,:'C.\\ :L'C.\) \)~\) S !>.~!>.~\),',"'c '
;.. \ '~x.~c, ot,?-.\a
Valuation Descri tion',l N\I" D!>.'i'
, ~~'i 'I'OIJ
Square Footage
0'1' Bid Amount
"t~JFf
~!" . .
. :~~;"~!. "'.
,'\ ,
Storm Sewer Available:
Special Instruction:
Notes:
Description
, Type of Construction
$ Per Sq Ft
or multiplier
Value
Date Calculated
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P'2e 1 01'2
Status
',' .
Issued
,,,..;'T.J\1d
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
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Total Value of Project
Fees Paid ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Perm ServlFdr 200 amps or less
Amount Paid
$9.72:;,; .
$4.05
$81.00
Total Amount Paid
$94.77
Plan Reviews ~
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Date Paid
..1.
6/15/10
6/15/10
6/15/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00767
ISSUED: 06/15/2010
APPLIED: 06/15/2010
EXPIRES: 12/15/2010
VALUE:
Receipt Number
1201000000000000699
1201000000000000699
1201000000000000699
To Request an inspection call the 24 hour 're~~rding,at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after7:00 a.m. will be made the following
work day.
LReauired Insuections I
Electric Service: Approval required prior to.utility company energizing service.
By signature, 1 state and agree, that 1 have carefully e~amined thec~';'pleted application and do hereby certify that all
information hereon is true and correct, and I further' certify ttiat Iin'y and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the 'L~ws of the State of Oregon pertaining to the work described herein, and
11.
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
t further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
t 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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Owner or Contractors Signature Date
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225 Fifth Street
, , . l
Sprmgfield, Oregon 97477
541-726-3759 Phone
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Wit~ .'
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000699
Date: 06/15/2010
11 :26:2IAM
Job/Journal Number
COM20 I 0-00767
COM2010-00767
COM20 1 0-00767
Description
Penn SeryfFdr 200 amps or less
, + 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
Check
Paid By
BIRCH CONSTRUCTION LLC
Item Total;
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
81.00
9,72
4,05
$94,77
Amount Paid
Jj2,
2190
In Person
Payment Total:
$94,77
$94.77
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6/15/2010