HomeMy WebLinkAboutPermit Electrical 2010-7-12
Electrical Permit Application
o ellY OF SPillNGFIELD, 'OREGON
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DEPARTMENT USE ONLY
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Permit no.:
225 F;(th Street. Springfield, OR 97477.PH(541)726-375J+FAX(541)726-3689
Date: 7 - I 2.. - .I 0
Tbis permit is issued under OAR 918-309-0000. Permits are nonttansferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
esidential D Government D Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: lOb ( Ct:iA: L--'" ~ ~
City: ;j> F') State: oa.. ZIP: 771(7-
Reference: /70"3 ZbC(C/ /z..iDO
DESCRIPTION OF WORK
A- 5" C, rC<A~
PROPERTY OWNER
Name: cJ...lAC-. L tk vi
Address: N 2-~-r
City: (::-"t.\..'-~ 6r
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
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, alteration, relocation
200 amps or less (2) $ 81.00 $
201 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 volts (2) $469.00 $
!~ Cli&b\\\lht6\QMi~)You to $ 63.00 $
t :I"'~"'ers: installation, alteration, relocation
r. I T\,e.lll.Jl,n
(9lKj-li'I!~'jlOA'li\m2-001- $ 63.00 $
tr 1~~~1Ules uy $ 87.00 $
r ~dBi;tV1RR'M'~l~?;l;atio n $126.00 $
1-1l3er~~!4~.1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per pane/
a Fee.for branch circuits with purchase of a service or feeder fee:
- -'~Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit S' $ 6.00 $30
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extensiori'(2f' ':'011:
Each additional-iDS~fcl ~1 $58.00 $
.,. c.\-\r>.\.\. Lf~:.T'. ?t1<1liilll t/' NT USE
&">>tfQ"~9tty.I\9 \ ees $30
r 'I'~\ll'iln\im ermit Fee $58.00)
~) ~ surcharge (.12 x [AD $':?bU
(C) Technology Fee (5% of[AD $ I~o
TOTAL fees and surcharges (A through C): $ 3S~
Phone: e
E-mail: Notifioation Cent P
This installation is being made on residential or bIrQ~01- 0
owned by me or a member of my immediate fanOQed:hltou may b
property is not intended for sale, exchange, lease, 'lI'EIJmtg~en e
479.540(1) and 479.560(1). number for the 0
Signature: Center i
CONTRACTOR INSTALLATION
Business name: eAST SID f: EL EtT{I1G
Address: ~ 'ii).5' 3 150 S (/I G- E t. N ' ''''. ..., .~
City: 5 P f c..D State: 6 R. ZIP: 9 7 1./ n
Phone: .7l{/-1'{'19 Fax: -73b'Y960
E-mail: RKKOS75/i>E YAHo6, (0/11'1
CCBlicenseno.: }lj'7jO BCD license no.: )0 ,YO!)c
"/71.75
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Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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440-2584--) (9108/COM)
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N01\Cf.:
1\-11S I'E\'IWI
1\1.\1\-10\'111-
GOMME\'\
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00621
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
VALUE:
.r.o
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541- 7i6-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1067 CENTENNIAL BLVD.,,:-,
ASSESSOR'S PARCEL NO.: 1703264412800'; ,".'.
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace service and 3 circ
Owner: SHATOLA CHUCK
Address: W 25TH
EUGENE OR
. .31-:'~ . '1 ."~'., ,
I CON;FRA'CTO'R'INFORMATlON I
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Contractor Type
Electrical
Contractor ___.~-. License
.-
EAST SIDE ELECTRIC INC 117770
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I BUILDING INFORMATION i
~U\O
# of Units: leo.\l\leSo ~~'es:
Primary Occupancy Group: Q,Ofl \ll.'Il\ne 0le9 .Structure
Secondary occupanCl,kI:(!lltJ.:0199'ed '0':1 l\l\eS al~. 9 at: '.
Primary Constr~\t~p !-d~el. "("OS~\lQ," Oll'~ ~u\Il':e e:" ' , .
Secondary cons~~IlIrl.\~ell-OO\O\"~~\eso\ ~)\W::,,,...:
# of Bedrooms: "o\\{~ gfJZ-OO\ o'O\a\fll'\o\9" ~".e ~\P-"th:. .
. \fI 00, '(OU (\\a~fI\el. ~ ofl \l\\\~~kled B~ilding:
\ ~.
ce: ",'Oe1 \01 ~el \& \- DEVELOPMENT INFORMATION
~U'" cel'\
Expiration Date
10/04/2011
Phone
541-915-9828
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
REQUIRED PARKING
Frontyard Sethack:
Side I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Description
Type of Construction
Overlay Dist: Total:
. # Street Trees Rqd: Handicapped:
Paved Drive Rqd: c,o~pact:
.~_o of ~uo.!- <:?:e~ag~: ,'~J,i..'i:.}1;."'pc'" . 'j
. :., -, .,,, "<",i'~V"" :~\\)\'-.'{,. ,:,
."::-;;::':.~ -_::T':"';~~" "r"" ".(~-:~....... ~~.
I PUBLlCIMPROVEMENTS I _~~~\'-.t lv.~~ ~\)\'-.'J;';::
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~~\S ?t~~t~ \\~~~ce~~outslD':;i~S:
1>-\)\\'\~~~()t~ ~t~\\)~'
()\)~ '\ '?:,'U ~~
1>-~'l
, I Valuation Description ~
. o' "";'.' .t, ,t,. ~ . .
$ Per Sq Ft . " .: Square Footage
or n\~lfjp'lier' . ,,' or Bid Amount
Value
Date Calculated
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
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Paee I of2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00621
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
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
LFees Paid _
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Amount Paid'
. ..
: ..'.... Date Paid
Receipt Number
$11.88.;" ·
$4:95"': .
$18.00 .
$81.00
$3.60
$1.50
$30.00
"
5/17/10
5/17/10
5117/10
5/17/10
7/12/10
7/12/10
7/12/10
2201000000000000514
2201000000000000514
2201000000000000514
2201000000000000514
2201000000000000820
2201000000000000820
2201000000000000820
Total Amount Paid
$150.93 , '
1"~lllD Re~iews I
i.:..:..... .
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.
LReouired InSDec~
",
Rough Electric: Prior to Cover
. .
.,'
. . , ~ . ,
Electric Service: Approval required prior,touiilily company energizing service.
Final Electric: When all electrical work is complete.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 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 inspectio~S\~re 're9'~ested at the proper time, that each address is readable from the
street, that the permit card is located at the front of..the'!properly, and the approved set of plans will remain on the site at all
times during construction. -'\~,::~'., ' .
( Owner or Contractors Signature
Date
Paee'20f2
Ill.
225 F;ifth.Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000Q00820
Date: 07/12/2010
2:15:41PM
Job/Journal Number
COM2010-00621
COM2010-00621
COM20 I 0-00621
Description
Add, Alter, Extend Circ Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
"
Amount Due
30.00
3.60
1.50
$35.10
Payments:
Type of Payment
CreditCard
Paid By
ROGER KING
Received By
Item Total:
Check Number Authorization
Batch Number Number How Received
Amount Paid
djb
. .
037775 In Person
Payment Total:
$35.10
$35.10
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7/12/2010