HomeMy WebLinkAboutPermit Electrical 2006-5-26
225 FIFTlI STREET. SPRINGFIELD, OR 97477 . PH,(541)726-3753 . FAX' (541)726-3689 s~~
ELECTRICAL PERMIT APfLJCATION
City Job Number e.A 0 . \ rN !/ Date fI.5 . 2.10 .() Lo
CITY OF u,JR,INGFIELD, OREGON
Supervisor License Number Lf f17 4- -S c. Temporary Services or Feeders
Expiration Date J (J /0 7 ATTENTION: Oregol~~~il}lilY~Bl~~~tiofbor Relocation
/ . tallow ~ules adopted20Ji)*'mp])p~~e~~1 Utility $ 50,00
Con,?tr. Contr. Number ~O -.5" ~11fl~~ Center, Tt20:tfArop.s:!.oQ4Q9~'PP0rth $ 69,00
c:c. ~ ) {po.-/Cf I n u~ 952-001-001 0 WQl)~y\p's~Q\c?~Q)&.l!lesJ1- $100,00
Expiration Date / / j't@/JVCfrwmall obtain e~nni6~.O-oc.f +1-00 .""'''OO')Mi It "B" b
/. . J. I"'" 'ver ., 1\1llpS 0r~1\0' 'yO s see a ove.
.!GElding (he center (~'. ".-,": 'h'h"o-.I ,
Signature of Supervi ing Electrician b " "' . D: '-BrancO' d'rt!ultSJne
num el lor the Oregon UU!t'/ ;\!~)tiiic8tion
(;'''-I'''''r is 'I' 8' ,New-AIteljation or Extension Per Panel \
~v ,." I - VV-00.c-'::::v'+4).
. One Circuit $ 43,00
Each Additional Circuit or with
Service or Feeder Permit
I r
Owno" N~ ~{tR..'<- Sondo. ~il-->
Addres~'()W S. 'h S-0<---\> L E. Miscellaneous (Service/feeder not included) -Each Installation
City (1 d.-.- Phone 13 \0 .l33 r; Pump or irrigation $ 50.00
",\\ Sign/Outline Lighting $ 50.00
OWNER INST ALLA nON Limited Energy/Residential $ 25,00
The installation is being made on property 1 own which Limited Energy/Commercial $ 45.00
is not intended for sal~\lI,AfliI-~ 19l",r~nt. Minimum Electric Permit Inspection Fee i~~~UrChargeS
bJ\lJUiL&:. ~
Owners Signature: THIS ~ERMIT SHALL EXPIRE IF f.H~mTAL OF ABOVE ~S) (tJ
AUTHuRIZED UNDER THIS PERMIT IS NOT ~ 0
COf\.':~,r:~~~S~~ 8:11~ AOANDONED FU'KS'tate Surcharge , ' W
ANY i 80 D/-W PERIOD. 10% Administrative Fee .7:1)
~2:>. \0
1. LOCATION OF INSTALLATION 3.
~Q.{) ~~. S5'\-r\ 'V~
LEcr~C;:DZ\\ () \? cD
J~;CR't~~0~ (1lIlli 4P 1
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor M" c a~<....~ r:( C
,
95 7 noN-~('\clq ~ ,
City Sr1d
Address
Phon~ .?i(dJ(
Inspection Request: 726-3769
~ q~1):\gDD
COMPLETE FEE SCHEDULE BELOW
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$ I 06.00
$ 19,00
$50.00
B. Services or Feeders - Installation, Alterations or Relocation:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60] Amps to 1000 Amps
Over 1000 AmpsNoIts
Reconnect Only
$ 63.00
$ 75.00
$125,00
$163,00
$375.00
$ 50.00
4StcU.
$ 3,00
TOTAL
Shared Drive(T:)/Building FonnslElectrical Permit Application 1-06,doc
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00642
ISSUED: OS/26/2006
APPLIED: OS/26/2006
EXPIRES: 11/26/2006
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 820 S 55TH PL
ASSESSOR'S PARCEL NO.: 1802041101200
Springfield TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Add one electrical circuit for heat pump
TYPE OF USE: Addition
Residential
Owner: MARK SANDAFER
Address: 820 SOUTH 55TH PLACE
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
License
162191
Contractor
MNB ELECTRIC INC
BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: Height of Structure
Secondal'J Occ";e.ancy Group: Type of Heat:
Primary~bbJtNJJlib"ti:'tYijtgOn law requires you tcWater Type:
Second~~I.~{:fn~t~fiC:tiOnOf,~pe: by the Oregon Utilit~ange Type:
# of B~'f-oomS'~tlon Center. Those rules are set fo~nergy Path:
in OAR 952-001-0010 through OAR 952-0GlP.rinkled Building: nfa
f'\l'\r"\n. '/_ , '.__ . I',' . ..
- - -..... .......... 111\..A"J VlVl\...Ull \...oVJJJC;v VI Lllt-= (lilt-'...... J HI
calling the center, (Note: the telrJ~rE,V.-EJ.,OPMENT INFORMATION I
number for the Oregon Utility Notification
Frontyard Setb~f{)nter is 1-800-332-2344). Overlay Dist:
Side 1 Setback: # Street Trees Rqd:
Side 2 Setback: Paved Drive Rqd:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks:
I PUBLIC IMPROVEMENTS I
Phone Number: 541-736-1337
Expiration Date
11/19/2006
Phone
541-726-8601
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
~~~i~~~MIT SHALL EXPIRE IF~oHEnWOuRsKDrains:
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 1 Rn nDV p!=Rlnn
I Valuation Desctiption I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Page 1 of 2
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00642
ISSUED: OS/26/2006
APPLIED: OS/26/2006
EXPIRES: 11/26/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid'
Fee Description
+ 10% Administrative Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
Date Paid
Receipt Number
$4.50
$3.60
$43.00
$2.00
5/26/06
5/26/06
5/26/06
5/26/06
1200600000000000719
1200600000000000719
1200600000000000719
1200600000000000719
Total Amount Paid
$53.10
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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.
Reouired Insoections I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
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 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.
Owner or Contractors Signature
Date
Page 2 of2
22S F.ifth Street
Springfield, Oregon 97477
541-726-3759 Phone
C.aof Springfield Official Receipt
~lopment Services Department
Public Works Department
Job/Journal Number
COM2006-00642
COM2006-00642
COM2006-00642
COM2006-00642
Payments:
Type of Payment
CreditCard
cReceint 1
RECEIPT #:
1200600000000000719
Date: OS/26/2006
Description
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
MNB ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
IIh 524586 Phone
Payment Total:
Page I of 1
12:02:31PM
Amount Due
43.00
2.00
3.60
4.50
$53.10
Amount Paid
$53.10
$53.10
5/26/2006