HomeMy WebLinkAboutPermit Electrical 2010-6-29
Electrical Permit Application
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225 Fifth Streett Springfield, OR 97477 + PH(541)726-3753+ FAX(541)726.3689
I. DEPARTMENT USE ONLY
COIM'ZO\O. 00 SZ7
Permit no.:
Date: t.-z'7-ro
This permit is issued uuder OAR 918-309-0000, Permits are'nontransferable. Permits expire if work is not started within 180
days of issuance nr if work is suspeuded for 180 days.
,
!.:bCAL>GOVERNMENTAP.PROVAL.,", .... .'
Zoning approval verified? 0 Yes 0 No
\,'c '>,';CATEGORy}0FCONSTRUCTION)\ ...'"
.0"Residential I 0 Government I 0 Commercial
f:,~i&m;;UOa~SITEi'INF:ORMA"!:IONffAN[j7'LotAtION'ii;ii',?'H
Job site address: '34 aq VDfAoA-doA
City: s,pe b State: 0 JL I ZIP: 77477
Reference: /70 Z. I 94. z.. I Taxlot: 02 $00
'. ' DESCRIPTION OFWORK";,;ii/'"
WfvU[ '>f".lr HvAL UJI(\,
Name:
Address:
City:
Phone:
PROPERTY OWNER
et.. J iN \C-....,~ U--S-
'J1f 8 11/,) IA----~.A
Si>F ~ State: ",a.. I ZIP: > 7'(77
- - I Fax: - -
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~umber ?fjn_;pectio~sp~rit~'? ()', Qty. ,~~~t ;1~~1~I
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 .
dwelling service or feeder (2) $ 63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81,00 $
20 I 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 vo~te9J" ~ M... $469,00 $
Reconne ~af\' $ 63,00 $
r" FO a ~lteratlOn, relocation
~. 1:',,\e9~ $ 63.00 $
"~'o\e" ~,::" \1.1)\\"1" $ 87,00 $
~ . e~O" U,::;;.;,'3'\"" $126,00 $
<\~li.P\s ,t&~lts, see services or feeders section above
ranch ~~~~its: new, alteration, extension per pane!
a. Fee for branch circuits with purchase of a service or feeder fee:
.k't
This installation is being made on residential or fann property ,~\(
owned by me or a member of my immediate family, This ~ O~ ~ '9ftJ
property is not intended for sale, exchange, lease, or rent. OAR 1\'
479,540(1) and 479.560(1), 0
E-mail:
Signature:
,CONTRACTOR INSTALLATION
Business name: '- --r '8 P[ ~t 1', ]::;v-
Address: 'f6fJS- -r>- I . ,/~ r-/
City: PUA~ State: /J'/€-I ZIP: 0Y~2-
Phone: ..q.I/ -t>~'1~.Y7-7h I Fax: ~/---J(o:J"g.;J.9t
E-mail: . t,L. 6Y) _ {f_ ' , '-<;.-'A~. '" '--'
CCB license no,: lol/'I;l..q BCD license no,: 3~ ~"--c;..
Signing supervisor's license no,: Sf?' 7;2-5
Print name of signing supervi~~ ----r;;f.,.~. ,/... ~
Signature of signing supervisor: 1, ~ ->r-"""'-
.
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NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK ._
AUTHORIZED UNDER THIS PERMIT IS NO\5r
~~~~8EON~;~ ~:RII~~.BANDONE~FO~:\:~~
~ V<i'
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440-2584-J (9/08/COM)
Each branch circuit I $ 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
I
I
$ 55,00
$ 6.00
$ 55
$f-.,
Miscellaneous fees: service or feeder ':lot 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 $
:';f[i~%;;,~~~;-~6~~~t;a-~~:t1~tAR;e'([icANTi;};tJ'S'E:l,::2\.;~~/~~;A:,7i;,-~~\~\jlJ;~~,;;/;;!~~-, . ~
(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 througb C):
$ bl
$ 7'3Z
$ 30Z.
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-00827
ISSUED: 06/25/2010
APPLIED: 06/25/2010
EXPIRES: 12/2912010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3489 YOLANDA AVE
ASSESSOR'S PARCEL NO.: 1702194202500
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Install ductless heat pump
Owner: KNIGHTS ELGIN
Address: 3489 YOLANDA
SPRINGFIELD OR 97477
I CONTRACTOR INFORMA nON ~
Contractor Type
Electrical
Mechanical
Contractor
JB ELECTRIC
MARSHALLS INC
License
, i04929
".....,;~, ''''~m,., ,.....'t, 25790
BUILDING INFORMATION ~
Expiration Date
03/14/2012
12/23/2011
Phone
541-687-5770
541-747-7445
VB
# of Stories:
Height of Structure
Type of Heat:
Waler Type:
Range Type:
Energy Path:
'Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor':
Sq Ft Basement:
Sq Ft Ga rage/Carport
Sq Ft Other:
Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
u/a
I DEVELOPMENT INFORMATION ~
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Ov'erlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact: ,
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
.,j-"..", ,,,-,.
Sidewalk Type:
Downspouts/Drains:
'd"::"';,:'. """,;1.. ,.~t',r,., .'" ~,.
<:Tr1l" ,";"5;
f~TTENTION: Oregon law requires you to
o ,ow rules adopted by the Oregon Utility
!'J~1catlon Center. Those rules are set forth
In R 952-001-0010 through OAR 952-001-
0090.. You may obtain copies of the rules b
calling the center. (Note: the lele hone Y
number for the. Oregon Utility Noti~calion
Center 18 1-800-332-2344).
Notes:
NOTICE:,\~,,'\:"ii';:;,,~,.,-" "
THIS PERMIT SHAll EXPIRE IF THE WORK "
AUTHORIZED UNDER THIS PERMIT IS NOT ::',
COMMENCED OR IS ABANDONED FOR ;..',"
ANY 180 DAY PERIOD. "" ':"'"'
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Status
Iss u ed
. 225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
:. ~
I Valii~ii'o~6~scriPtion I
- ,,'o.:...,.~.,
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvne of Construction
Total Value of Project
~
':"
Fee Descrintion
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
$9.48
$3:95
$79.00 ..
$7.32
$3.05
$55.00
$6.00
6/25/10
6/25/10
6/25/10
6/29/1 0
6/29/10
6/29/10
6/29/10
Total Amount Paid
$163.80
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00827
ISSUED: 06/25/2010
APPLIED: 06/25/2010
EXPIRES: 12/29/2010
VALUE:
Value
Date Calculated
Receipt Numher
3201000000000000336
3201000000000000336
3201000000000000336
2201000000000000757
2201000000000000757
2201000000000000757
2201000000000000757
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.
l.JeO~JiretUnsnec~ions I
"
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
~. ". . {. .'
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00827
ISSUED: 06/25/2010
APPLIED: 06/25/2010
EXPIRES: 12/29/2010
VALUE:
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 Commnnity 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 inspectioI!s~~~re r.~qn,e~ted at the proper time, that each address is readable from the
s.treet, thM tbe permit ~ard is located at the front oq,~'~ pr,oR~'ity; and' the approved set of plans will remain on the site at all
times dUring constructlOn.;.Ai,;'i,', I
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Owner or Contractors Signature
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Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000757
9:41 :38AM
Date: 06/29/2010
Job/Journal Number
COM20 I 0-00827
COM20 I 0-00827
COM2010-00827
COM20 10-00827
Payments:
Type of Payment
CreditCard
cReceintl
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Amount Due
55,00
6,00
7.32
3,05
$71.37
Paid By
JOHN BRUMBACK
::').1";; ~..~; \~: ,Check Number
Rec,~ived By.. 'Batch Number
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Item Total:
Authorization
. Number How Received
09546z In Person
Payment Total:
$71.37
$71.37
Amount Paid
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