HomeMy WebLinkAboutPermit Electrical 2010-6-16
Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477 +PH(541)726-3753 HAX(541)726-3689
Dale:
This permit is issued uuder 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.
" . LOCAL:. GOVERNMENTA~PROVAG':,A"( .: ','
Zoning approval verified? D Ves D No
.... ." 'CATEGORY)OFCONSTRUCTION'}' ...,,(.
t'Bl Residenlial I D Government I D Commercial
~~':{El';{JOI3'iSITE!INFPRMATIPNT7AND;;'Lb.CA,[ION+))!,.,~r~j
Job sile address: 8""1.:A _ ~A-,rJ N}5:'rrl2- C-i
Ci1y: 5~~ GA?- t.LJ State: C>P I ZIP: ~
Reference: I '1t)'?:{:J.. ^r'2A I Taxlot: O'\l:it1JJl!J
.. DESCRIPTION OF WORK...;....'.,.:".,'
1..J-517/-IJ ;2l I 5D177'/./. A pd'd'} o":iTl..I>oT
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PROPERTY' OWNER
Name: hJlJ.-I-! fl-M f]. .JJ.3AJ'>M .IL
Address: 8''3;!... Jfl-..vJ'h.:1-TTZL c:;-
Ci1y:"96JI0NGr/~ State: ~I ZIP:'7?<'I-?7
Phone;Stf -6C;L} Ob& 0 I Fax:..
E-mai1:.,!,.,k.. ).en.<;eyLt0 Con-tc" -T Y\.e.-T
This installation is being made on residential or farm properly
owned by me or. a member of my immediate family. This
properly is noti~~;ded for sale, eX;j!chan--1ge, le.ase, or rent OAR
4 79.540( I ).an~;560( I).
Signa~ /' ,r:;y/'. /' c:>f,- .;;p;.
CONTRACTOR INSTA1<CATION
Busin~ name: V
Address: _______
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Ci1y:
Phone:
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CCB licen~ I BCD license n~
S~upervisor's license no,;
=-Print name of signing supervisor:
E-mail:
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Signature of signing supervisor:
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440-2584.) (9/08/COM)
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,Numher or;nspeciio:ns per if;in O.,Qty. . Cost
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Residential, per unit, service included:
Total
cost
1,000 sq, ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
$134.00 $
$ 25.00 $
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
60] 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 less (2)
20] to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$1i6.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branc~ circuits: new, alteration, extensio,! 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 of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
i $ 5500 $ Q;..s;-S
/ $ 6.00 $ &, _ (YV
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
$ 63.00 $
$ 63.00 $
$ 63.00 $
Each additional inspection: (I) $58.00 $
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(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):
$ C/ ,~
$ 7- ~t?
~-
$ :J"-O~
$(/-.$' 7
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00781
ISSUED: 06/16/2010
APPLIED: 06/16/2010
EXPIRES: 12/16/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 832 JANNETTE CT
ASSESSOR'S PARCEL NO.: 1703342401428
, . ',~pringfield TYPE OF WORK: Electrical Work Only
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TYPE OF USE: New
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PROJECT DESCRIPTION: Electrical outlets for closet
Owner: WILLIAM B II & KATHRYN G JENSEN FAM
Address: ,'832 JANNET,TE CRT
SPRINGFIELD OR 97477
I CONTRACTOR INFORMA TION I
Contractor Type
Electrical
Contractor
OWNER
License
Expiration Date Phone
'Bli'iLDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
!Cri_ergy Path:, "
Sp rin kled', B'uilding:
- Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nfa
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I . 'IOU to
law requires , 't
Street Improvements: ftHION', oreStlfewalk {flCPe.:gon Utili 'I
An - s adopted 0'1 u \ Ip.o are set Jorth
Storm SewefiI~~i1able: '-";::; " Jallow rule centep.O:WtfsjJoills18~5Z-001-
SpeciallnstrudtiJ.GE: " " , Notilleatlo;.OOi_OOiO through \the rules bY
THIS PERMIT S in OAR 95u ma'l obtain COP\~~h~ telephone
Notes: AUTHORIZED U~~ll EXPIRE IF THE WORK 0090;r:~ the center. (Not~ti\iW NotiJication
CnMnu:^,~~_ ER THIS PFR AI '" ,,~_ ell. 1 . he oregon 4.
1MYI8'v~uun/::'ABANDON:flFC1R".'" . enterlS
- 0 DAY PFRI(11) . , ValuatIon DescrI
Description
Type of Construction
$ Per Sq,Ft , Square Footage
or muhiplier~,.k 'I" ~~.'i.r.,' or-Bid Amount
Value
Date Calculated
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00781
ISSUED: 06/16/2010
APPLIED: 06/16/2010
EXPIRES: 12/16/2010
VALUE:
Status
Issued
Total Value of Project
Fees Paid I
Fee DescriPtion
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid'..
,:~tf:?( .;,\. r F':.,
$7.32. _.
$3.05{;c'y \:,',-
$55.00""
$6.00
,. Date Paid
Receipt Numher
6/16/10
6/16/10
6/16/10
6/16/10
2201000000000000707
2201000000000000707
2201000000000000707
2201000000000000707
Total Amount Paid
$71.37
Plan Reviews ~
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,'iilc~pections requested after 7:00 a.m. will be made the following
work day. "
l;.Reauired Insoections I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is co"!p,lete.
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By signature, I state and agree, that I have carefully:examined the completed application and do herehy certify that all
information hereon is true and correct, and I furthe;' c,~rtil'y tiiat any 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
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certif'y 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 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 011 the site at all
times during construction.
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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 #:
2201000000000Q00707
Date: 06/16/2010
3:13:41PM
Job/Journal Number
COM20 I 0-00781
COM20 10-00781
COM2010-00781
COM20 I 0-00781
Payments:
Type of Payment
CreditCard
cReceintl
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
WILLIAM B JENSEN
Check Numher
Received By Batch Number
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Page 1 of I
Item Total:
Authorization
Number How Received
Amount Due
55.00
6.00
7.32
3.05
$71.37
Amount Paid
716128 In Person
Payment Total:
$71.37
$71.37
6116/20 I 0