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HomeMy WebLinkAboutPermit Electrical 2010-7-8 Electrical Permit Application I<J;.'....... 'to;' ,:,~" . '-ri.~ -,;;.<,..!,J".':-__ '!t:-r~~., . (JI'FY;.QF SPR,IN GFiIELI2;.,O~J):GO~(:<,} ~1' . I....t .J . ~ ."l~, ~~ ,-",,;,;"0 ~ ..eo ...'$'1, ,"; r'~..-' _ '" '"l!:.._:t'.. ..r. 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726.3689 SPRINGFIELD L~ 'ff)' ~,&'I'" '. . ;,,',;,1'--"'" '." _' : : DEPARTMENT USE. ONLY C'OvlAZOIO ~oo 90? Permit no.: Date: 7- & - /D 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.' . . 'PROPERTYQWNER 201 to 400 amps (2) , $ 95.00 $ Name: tlJ1All-lf! 1/r1e-01/VSOAf' 401 to 600 amps (2) $158.00 $ Address: 7 ~ 8, 5"3 12--' PL 601 to 1,000 amps (2) $205.00 $ City: s.1>Pl.. I State: cJ- 1 ZIP: 9'J{(7g Over 1,000 amps or volts (2) $459.00 $ Phone: _ _ 1 Fax: _ _ Reconnect only (2) $ 63.00 $ E-mail: ! .,:rTENTI )N~SerVices.or feeders: installation, alteration, relocation This installation is being made on residential or farm ~a'~" s ~'!t:~~~"res you to $ 63.00 $ owned b~ me or a member of my immediate family. TIri'tl~~t'on 5?. nJm-.toT~lJ.iIW~~.on Utility $ 87.00 $ property IS not mtended for sale, exchange, \ease, or rtlll9 52 ~O, -,'I,I{ 1J11I11i" ~ 'VIm 479.540(1) and 479.560(1). '. OU r a' 1\f\ll9_bUU'lMli!~~R 952-''';;' $126.00 $ Signature: n~~~';,~ ~he c t1}e~r lflQ,w'jjp,coPLllllil WltsSs!l<yservices or feeders section above ,CONTRACTOR INSTALLATION. ...... ,,;:,:.. ~~~~~li'ei,{dbif!Y1Wt!J(!1',~\\~n, eXlenslonperpone/' Business name: I : 1=1 ...." a. Fee :r'8~~14:)J.its with purchase of a service or feeder fee: P.O, BOX 11708 City: EUGENE, OR 974<<) Phone:'1L/J."1/.(tj - '1'12--'1< 1 Fax5'f1-3'1'1lf'1tff E-mail: JtUf/;:;i L-i ViiJ;Jrf!..IL m.cJ7?IC O;JONi., a?/'V\ CCB license no.: S/1J091 I BCD license no.: :JO-99> -;:;9:;'-S IlfF:F .,LozltR.. Signature of signing supervisor: -. # tA A - 'LOCAL:'OOVERNMENTAP,PROVAl' '~ Zoning approval verified? DYes D No . . CATEGORY :OF'CONSTRUCTION> '- ID Residential T 0 Government 1 0 Commercial 'f!i1;~0;Xj:OEl5$lrE"..INFORMATlON;ANjj;:;LO_CA:rION;,~i; Ii;::!: Job site address: -; c1')( AI "53 cl' P/..A?:..L. City: C;ltt /i,U6/1l!L-(). I State: V't-- .1 ZIP: 9-;1'-/7<2 Reference: ) 7 D 2 ~ if 2 r 1 Taxlo!.: DC 1;;.08 '. DESCRIPTION OF WORK'" " ':".'- f<~J![;4d.. ~/ '(C I/fNU Address: Signing supervisor's license no.: Print name of signing supervisor: .~ f\~ .~ 'Y' 'tJ ~ , ~\\) f\'\~r ~~ ANY 180 DAY PERIOD. l~': ; ~;::,...:::,:t.~r'.:t:'~~~iXj;:;:;:P'I5EE-~ SOH EJ)Jj IJE-f:21,~.(~f~!r~~rY1;;j~'?.W~';~F}~ ..~umber' ?fin.spe~t'io'?~ .~er ,i't~.~;O ," Cost To'tal .. Qty. ;":.ea. : .' cost .' 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 $ 63.00 $ . dwelling service or feeder (2) Services or feeders: installation, al.teration, relocation 200 amps or less (2) J $ 81.00 $ 'l / ~ Each branch circuit $ 6.00 $ b, Fee for branch circuits without purchase of a service or feeder fee: _ First bra~ch circuit (2) $ 55.00 $ $ Each additional branch circuit $ 6.00 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) $58.00 $ "i~~~,;,~~h~Y}~~3~l~'i~:Kl,~~1:AR)~jjcA'NTDJJ~fEt:j,\,~;;:;>;:~~~.i;;f;i!:;:;;~t.;_;S. (A) Enter subtotal of above fees (Minimum 'Permit Fee $58.00) $ 63.00 $ NOTICE: THIS PERMIT SHAll E ~tW Jm&WIillilJ{ (12 x [A]) AUTHORIZED UNDER "HtSt1f!ilMtllSe~l,of[A]) COMMENCED OR IS A Illfl'd surcharges (A through C): $ <gl- $ '1,7'l $ 4.11 C; $-Q4, i7 440.2584.J (9/08/COM) '..; <. CITY OF SPRINGFIELD Building/Combination Permit "'~~!~~?) ...;,; [,J:.,:.,~.' ,. .......;',i'.-, .X}';I Status Issued PERMIT NO: COM2010-00909 ISSUED: 07/08/2010 APPLIED: 07/08/2010 EXPIRES: 0110812011 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 758 53RD PL ASSESSOR'S PARCEL NO.: 1702332100608 Springlie'd TYPE OF WORK: Electrical Work Only , ,:"., TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace electric panel Owner: MELANSON MARIE Y Address: 758 N 53RD PL SPRINGFIELD OR 97478 Contractor Type Electrical I CO~!RACT?R'INFORMA TION I ,,- :',;i'< C ",b L' ontractor +~:;..;, . tcense LIVE WIRE ELECTRIC INC 56697 BUiLDING INFORMATION I Expiration Date 05/1612012 Phone 541-344-4928 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: R-3 Height of Structure Type of Heat: VB Water Type: R~'1!l.w1il'il/tlires yOU \0 ATTENTION: ore~\J~oregon Utility toll oW rules adoPI'Sffii.M!~lliDiiRa .\ lorth . < ''';~oti()l'' Center. ' . -001- \~OAR 95. L lllH OOOO.Yoo (oe . calling the cenler. uiility NotilicatiOn number lor tM C{AAg~~:!>.!~\344). Center IS If Sl'reet Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Lot Size: Sq Ftlst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: ~. .~ I PUBLi<i~iMeR0V:El\-1ENTS I Street Improvements: Storm Sewer Available: Special Instruction: -', <,',~ .. Sidewalk Type: DownspoutslDrains: Tvue of Construction NOTICE: . . P'RE IF THE WOR\( THIS PERM\1 SHr..ll EX IS PERM\1 IS NOT OR IS ABPlN Valuation Des 6~" RIOD. PINY Ui\ PE :.Squa~e Footage ~ ttr. Bid Amount Notes: Description $ Per Sit Ft or multipli~r Value Date Calculated ~.\ /.! , :Ji, Paee 1 of 2 "./ ';,.. . 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line '\'1: CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00909 ISSUED: 07/08/2010 APPLIED: 07/08/2010 EXPIRES: 01108/2011 VALUE: Status Iss u ed rli:':'" Total Value of Project Fees Paid i Fee Description + 12% State Surcharge + 5% Technology Fee Perm ServlFdr 200 amps or less Amount Paid $9.72 ..' $4.05 $81.00. ' D,ate Paid 7/8/10 7/8/10 7/8/10 Receipt Number 2201000000000000808 2201000000000000808 2201000000000000808 Total Amount Paid $94.77 I Plan Reviews I To Request an inspection call the 24 hour r~~~rgt!l.~!,llPf6-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspectionsrequ'ested after 7:00 a.m. will be made the following work day. .'.,' .+'.:.:,i; "I l Reouired InsDections ~ Electric Service: Approval required prior to utility company energizing service. 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 ofthe State.'of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without p'ermission of the Community Services Division, Building Safety. I further certify that ouly contractors and employees\vho are iU'eompliance with ORS 701.005 will be used on this project. I further agree to ensure that all reqnired inspeetions ,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 un the site at all times duri,ng construction. Owner or Contractors Signature Date ! J~~t,~' ;~~'~'i"~-~ . .1." )~. ,-.,\ Page 2 of2 225.Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000808 II :27: 19AM Date: 07/0812010 Job/Journal Number COM20 I 0-00909 COM20 I 0-00909 COM20 I 0.00909 Payments: Type of Payment Check cReceintl Description Penn Serv/Fdr 200 amps or less + 12% State Surcharge + 5% Technology Fee Paid By L1VEWIRE ELECTRIC INC .1, f,' Amount Due 81.00 9.72 4.05 $94.77 "::1'.,:""-' Item Total: '~;)., Check Number Authorization Received By Batch Number Number How Received Amount Paid djb $94.77 $94.77 13153 In Person Payment Total: 1'.' i' , ~..I ~. iiY~ . ,',:);,1 . :'::,-:i}'" "-""'1',"'" t" It< ,. , ~, ',' (~' ".,l'f Page I of I 7/8/2010