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HomeMy WebLinkAboutPermit Electrical 2010-7-7 Electrical Permit Application ,'.... .... ,. , .' _,' .' ,_.,f[ ~, . . 'CITY OF $PRINGFIELD~ OREGON' . ~. . _~ .-_ ;. " - . . . >':I" ~...,..'" , '. 'I 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: O\).,~ ot;>. ~\O\ 'O'i> '/J.\ 9;S'I: 'i> '0'1 i\,ll 0'i>0 It;>. ,<<,'0 It;>.0<0 . t;>.\,d\' .'>)'S' 0<\\'0 ~'o \'0 ~\\\V e ". c; ,'<' . \>' 0 \O"~. e"-\O rz,./:)'>) . 0'0" ~O '\:i-.:c..\ ~ol>.' ~\O\~\.o. 9J? ~e.'1 ~e\' "ot;>. ~....'I:'[; ... 01"'" ""o\) ell 0\ '0'" ~\);:Y" \<' fij ,,<<,0:r-0 \,'1) ~ (IS ~~"~0\ \0\;0\ " \9r,. \ \) ~u~ v f\ .~~ ~ Signing supervisor's license no.: Print name of signing supe . Signature of signi 440-2584-) (9/08/COM) (i;'~ ':;"h~\~),\~'~i~i:,;tf~F~j'1r.{~j'~F3EE~~:SC f.t E_D.LJ t1Er1i.'!~{!~'i.f;~~\f:;.!}~?~'i,~~~~W1~;g;~ ,Num~er' ofinspect"io'ns per it~in' (.)', : Qty. '. '-' - . " . .- . . . -'" ,', . . ,,' ";"" -. ~-. ' 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 ,'.,0' "_,~ ~:~.OO 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 ~...,~",.O.I'1'.'I..'iI.'iiJ.l~!c...... .!....... r6:'~ ! .'. ! t .,,110II ie .' ''''';..".- .,' . -,,'-.'''-.<'' .. . ,.' 225 Fifth Street, Springfield, OR 541,726,3753 Phone 541,726,3676 Fax 541,726,3769 Inspection Line .:.i ;, ',-, 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: - ";.' ?"~ "I ~ 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""" ' .~.,.~..Yh;;,...:llo.' ,t .,&;;1,P~'" ,,,\~;'?,~ ' ..,!~,-., ,,'t\~ 'l' ~O\ ',; ~,?\"'~ \~~ \;", ,>'. Notes: ;' ; ~ . I';.'; 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 . '.!, ,~"i' :)?;'j. ::;'~Pae:e l' of 2 . ,r:" . .~"~; ", !'r.'l_'" '/,.t . '1' ,c';"~' if' ;' , ,..i .' ,"",.. 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 . ,'" 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 ,,'. .."', 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', , ,~:;:":' f' , " 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. ", ""', 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 . l,. 't',,~~:' ). 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 t;.:"l' Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid djb b72273 In Person . Payment Total: $101.79 $101.79 :':'.' ,?'. ..'~ ';' ',. ,lJ! , .j ;';,J,\'1;\) . .i:, ~:., .. " . , ..,~l ,-,!, .' . ~ :.. :.:.y: .~ j :t~~jJ,;, . Page 1 of 1 7/7/2010