HomeMy WebLinkAboutPermit Electrical 2010-6-21
EJectr-ical Permit Application
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
DEPARTMENTUSE ONLY
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Permit no.:
Date: (P 'J-. \
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.
200 amps or less (2) $ 81.00 $
PROPERTY OWNER 201 to 400 amps (2) $ 95.00 $
Name: H\ . .~ir/\ 11.\. ,^ fll J'... () _' 401 to 600 amps (2) $158.00 $
Address: L II, ~ /l 601 to 1,000 amps (2) $205.00 $
City: c;.)t7V" I State~ ZllA~Jif:ipr Over.~o__oM"_I'ol.O\ $469.00 $
Phone: _ ~/') in /<:.$(b I Fax: _ _ ~ 0 t%S:~4!:1e>OJ$~n Utility I $ 63.00 $03, ~ <:)
E-mail. i';-";;,, Q~"'_~~ -~l;i~d;i~~>!l~~~: ,"stallatlOn, alteration, relocatIOn
This installation is being made on reSIdential or faoo9lO;>pY~ ma 0 ~ lliT't ~- rules bv $ 63.00 $
owned bl: me or a member of my immediate family.l!1iiIin,g the c nt ao(~iPioo aIifj,;mphone $ 87.00 $
property IS not mtended for sale, exchange, lease, orn/ll1\b'eNbr the r I U' "
479.540(1) and 479.560(1).. Cente i ')IqJ;!,{ _ _ $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
.,C.QNTRACTOR INSTALLATION' Branch circuits: new, alteration, extension per panel
Business name: r ^^ ....... <) ~ A i. A, a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 0711 A-'_( 'v Eac'0>ranch circuit $ 6.00 $
City: I ,-rl\ A A, I A"" lJ1 I Stater) (Z zIP(:;j7~/Rq ,I c. jJ'):..~or branch circuits without purchase ofa service or feeder fee:
Phone: -7'1/ oq S I Fax: - - First branch circuit (2) $ 55.00 $
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: 1[., 7?t:5 'Lf 'BCD license no.: 2.0,,-6 b)..1,4' Miscellaneous fees: service or feeder ~ot included
Signing supervisor's license no.: 3j"'J q -':3 Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor: I, f ~ ,-,'v-e. t2- <) e.- ^ h sign or outline lighting (2) $ 63.00
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Signature of signing supervisor: I^ J~ I' _ , IgnaCJrcUltora lmlte -energy panel, $ 63.00 $
" ^ ^ I. alteratIOn, or extensIOn (2)
JII Each additional inspection:(I)
ti?~~~~~i~~D ~~~~ !~~~~""'." :~'~'~';
u:: ANY 180 DAY PERID '(C) Technology Fee (5% offAl)
TOTAL fees and surcharges (A through C):
'LOCAL' GOVERNMENT APPROVAt':",f"'r':,':
Zoning approval verified? 'KJ Yes 0 No
'; 'C,lHEGORY,c5FCONSTRUCTIOI>j1?',",
~esidential I 0 Government I 0 Commercial
tg;t~ri+ii'JO'B' :;!:i1TE:INFO' RMNnONl:AN'D',,;,"O'C"A" 'trl'O,N','i,:.1.;,,'!"",",:
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City: ~ I StateiW::; iIPPJ.fl-(rl/'
Reference: Ii 0]' ~ S" I t/ I Taxlot.:C ~ 100
, DESCRIPTION OF WORK""'"
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Job site address:
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~~~
440-2584-) (9/08/COM)
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. .. .', , . "'..,, .'Cost Total
,Num~e~ ofinspectio~s per .it~~" p'", Qt)<. . ea. . cost
ResideQtial, 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
$
$
$58.00
$
$
$ ~,
$77 ;,-"C
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00798
ISSUED: 06/2112010
APPLIED: 06/21/2010
EXPIRES: 12/2112010
VALUE:
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Springfield TYPE OF WORK: Electrical Work Only
SITE ADDRESS: 1258 D ST
ASSESSOR'S PARCEL NO.: 1703351409100
PROJECT DESCRIPTION: Service reconnect
TYPE OF USE: Repair
Residential
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Owner: WADE KERRY G"
Address: 1258 D ST
SPRINGFIELD OR 97477
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I CONTRACTOR INFORMATION I
Contractor License
W ALTER J CANNON 76304
I BUILDING INFORMATION I
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# of Units: ~.~.f St~ries: ()\l ~O
Primary Occupancy Group: R3 ::IJeig~I1e.'It~~~~1\\\
Se~ondary Occupa~cy Group: ~\ti.\fP.ej~~~e\'O ,_
PrImary ConstructIOn Type VB~. O~~ eO~a~N~\ rjO?.o'i:J '0'1
Secondary Construction Type: ~~~i\O e.oof/l ~~~~~e~u\e' It
# of Bedrooms: "~\()'II ,~~~ ce(\\:;\~~~~~~E!~~~~
'\Co'(\~\C~~ rJ.$' o'o~~o'W'.~~~~ n/a
~....o. '1o~ FORMATION
QUu:~\\1\<) .
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Frontyard Setback: ~ Ce Overlay Dist:
Side 1 Setback: # Street Trees Rqd:
Side 2 Setback: Paved Drive:Rq'd: :
Rearyard Setback: % of Lot Coverage:
Solar Setbacks: : '....",., . ~.
Contractor Type
Electrical
I PUBLIC IMPROVEMENTS.
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amoilnt'
Tvpe of Construction
Page I of 2
Expiration Date
09/0912011
Phone
541-747-0959
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Value
Date Calculated
'l,
_ 'c>:'
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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:;Total,.Yalue of Project
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I;.;.;.Fees ~
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Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amount Paid
Date Paid
$7.56
$3.15
$63.00
Total Amount Paid
$73.71
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6/21110
6/21110
6/21110
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00798
ISSUED: 06/21/2010
APPLIED: 06/21/2010
EXPIRES: 12/21/2010
VALUE:
Receipt Number
1201000000000000737
1201000000000000737
1201000000000000737
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.
I ReQuired InsDect~
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Electric Service: Approval required prior to~,~mity.co'[;jpany energizing service.
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By signature, I state and agree, that I have carefully examined the completed application and do bereby certify that all
information hereon is true and correet, 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 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 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
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Page 2 of2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000737
Date: 06/21/2010
1:23:34PM
Job/Journal Number
COM20 I 0-00798
COM20 1 0-00798
COM20 1 0-00798
Payments:
Type of Payment
Check
cReceintl
Description
Service Reconnect
+ ]2% State Surcharge
+ 5% Technology Fee
Paid By
W ALTER CANNON
Item Total:
; Check Number Authorization
Received By Batch Number Number' How Received
. djb 23507 In Person
Payment Total:
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Amount Due
63.00
7.56
3.15
$73.71
Amount Paid
$73.71
$73.71.
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