HomeMy WebLinkAboutPermit Electrical 2010-7-7
Electrical Permit Application
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'CITY OF $PRINGFIELD~ OREGON' .
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22S Firth Street. Springfield, OR 97477 +PH(S41)726-37SH FAX(S41)726-3689
, DEP,J\~TMENT USE ONLY
LC0^Z-C, 0- C> c 3'S" I
PermIt no.:
Date: 7-7-/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.
- 'lbC';l: GOVERNMENT ApPROVAL:,,""" 'i
Zoning approval verified? 0 Yes 0 No
',:CATEGORY),bF,CONSTRUCTION')!:' '.c,
City:
Phone:
E-mail:
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 r sale, exchange, lease, or rent. OAR
479,540(1) and 479,5 (1),
Signature: .~ s-=
,'CO RACrOR INSTAllATION
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
ZIP:
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Signing supervisor's license no.:
Print name of signing supe .
Signature of signi
440-2584-) (9/08/COM)
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,Num~er' ofinspect"io'ns per it~in' (.)', : Qty.
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Residential, per unit, service included:
Total
cost
Cost
/ ea..
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)
q;(
$
$
$
I $ 81.00
$ 95.00
_...,," ~~8.00
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Over 1,000 amps or volts (2) . ,~. ~~, ~ll'6'9:qQ $
Reconnect only (2) -l~~ . ~:i:oii $
Temporar .servicliN\.~~ ~~~lJ)Mn, alteration, relocation
20 r -j', \~'V~"- \>-~I" $ 63.00 $
2(jt~'\~ v -,1' 'V~~~\)'V. $ 87.00 $
401 ~~I.'m~ :~ ,?V $126.00 $
Over 6l!b-~p5. '0}}} ,ODD volts, see services or feeders section above
Branch If;~uits: new, alteration, extension per panel
a Fee for branch circuits with purchase of a service or feeder fee:
20 I to 400 amps (2)
40 I to 600 amps (2)
60 I to 1,000 amps (2)
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
$ 55.00 $
1 $ 6.00 $ b
Miscellaneous fees: service or feeder ~ot included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
$ 63.00 $
$ 63.00 $
Signal circuit or a limited~energy panel,
alteration, or extension (2)
Each additional inspection: (I) $S8.00 $
"{+:ji:f,~~&~~1~ifJiJ:1"~~~ARF!;ljCA.NT~I:OS-E\SIC~;((~~~~~;,;;~~~i,.:/:;r~',;.".
$ 63.00
$
(A) Enter subtotal of above rees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A])
(e) Technology Fee (5% of [A])
TOTAL rees and surcharges (A through C):
$y;r
$ /04'1
$ "f '] J
$ 101 ?:L
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225 Fifth Street, Springfield, OR
541,726,3753 Phone
541,726,3676 Fax
541,726,3769 Inspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00851
ISSUED: 06/29/2010
APPLIED: 06/29/2010
EXPIRES: 01/07/2011
VALUE:
Status
Issued
SITE ADDRESS: 634 HAMILTON ST
ASSESSOR'S PARCEL NO.: 1703341206400
Springt1eld TYPE OF WORK: Heating System
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Electric supply to heat:p.ump ,.' .
,;;.jl;:hX1 .~:(.+
Owner:
Address:
- ";.' ?"~
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Phone Number: 541-953-2130
SCHOENBERG MARK A & DEBORAH
634 HAMILTON ST ",
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORM'A.T10N I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
it Of Stories:
,,' Height of Structure
Type of Heat:
Water ].yIte: '.
. Ra'nge Type:
,:..
Energy Path:
Sprinkled Building: n/a
. . d Pf){~~~~:~rATlON I
"'liION. ' d~ ra~~
p..i1~" s adopte "'~\lules il,. '.'52.00\-'
. IloW r\lle tel. i\\O;d<."l<iE\6l?t~ . 0"
,0 10ncen ot uoY'~y ,,<:iNles 'J
N01\liCa\52._00\-00\ .~: ~\1l!etoHe~~~e
in Op.,R. ~ou roa'/ obta\~l!J"~d'b,~it~o~!l~tiOl\
0090.. 9 the center. g(jndV1I,'iJl!~hj'!age:
cal\ln lor tile Ole 00-332-2 .
ropel is "\-6
I PUBLIC IMPROVEMENTS I
VB
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
R-3
REQUIRED PARKING
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
SoJar Setbacks:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
,
, ,
. <',- ..
Sidewalk Type:
Downspouts/Drains: ..,0""" '
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Notes:
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Description
Type of Construction
I i O\\C . ~S ~'" ~\)o
Valuation DescriPtion ~ S '?t."'~<-\) 'Uv.\) S t>-~lI'
\'t\~ 0",\1-\. 0'" ~
$ Per Sq Ft Square Foop&,i1 x..v.~t.\) w'ft,\O\)'
or multiplier or Bid Amoe,l!!~~ COIJ \)~ e
. \'-~'{'\
Date Calculated
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00851 .
ISSUED: 06/29/2010
APPLIED: 06/29/2010
EXPIRES: 01/07/2011
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Total Value of Project
. J iFees Paid-t
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
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6/29/10
6/29/10
6/29/10
6/29/10
7/7/10
'7/7/10
7/7/10
7/7/10
Receipt Numher
3201000000000000343
3201000000000000343
3201000000000000343
3201000000000000343
2201000000000000803
2201000000000000803
2201000000000000803
2201000000000000803
$8.04
$3.35
$55.00
$12.00
$10.4{:,. ,
.. ':\i ',-:~
$4.35,:"
$6.~~.
$81.00', ,
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, "
Total Amount Paid
$180.18
I Plan Reviews I
;"'.
To Request an inspection call the 24 hour recording,~t 726-~769. 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. -:;. .,
Reauired Insnections I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Electric Service: Approval required prior to, nlility,.company energizing service.
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By signature, I state and agree, that I have carefully~~~mined the completed application and do hereby certify that all
information hereon is true and correct, and I furthe~ c'ertitY .-hat 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
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Paee 2 01'2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000803
1:21:08PM
Date: 07/07/2010
Job/Journal Number
COM20 1 0-00851
COM2010-0085 I
COM2010-00851
COM20 I 0-00851
Payments:
Type of Payment
CreditCard
cReccil1tl
Description
Penn ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add.,:;;;,,;,.
+ 12% State Surcltarge
+ 5% Technology Fee ':',':'
Paid By
MARK SCHOENBERG
Amount Due
81.00
6.00
10.44
4.35
$101.79
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Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
b72273 In Person
. Payment Total:
$101.79
$101.79
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7/7/2010