HomeMy WebLinkAboutPermit Electrical 2010-7-20
This permit I,; i.'5ued under OAR 9]8-309-0000, Permits are nontr"i'sferable. Permit. expire if work is not started within ]80
days of iss,," "ce or if work is suspended for 180 days. JQ.,SOefl_ ~
'L C CAL' GOVERNMiENT APFiROYAl:, ..>",;" , ." i ,', "ii,;:'?:"!'!~,'I,,':I,i~;;'i:i':i"'EE:'.:S!O:REOUl!Er;;;~'i.;itr;,~i!;~(",~i,i;Yi(t\I~::ii
Zoning approval verified? DYes 0 NONu~b.r'ofin,p~cfion,per,;t~~:(.)' Qt)'. i ~~t ,~~~J
"C\TEGOR'r!::Of;"CONSTRUCl'ION',~ '
o Residontiai 0 Govemrnont 3 Commercial
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City: Stare: t> a- ZIP: '''1'1 11
Electricd Permit Application ,
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225 Filth Slm!! :;priH~ll,ld, OR 97477.PH(S41)n6.3753+FAX(S41)726-3689
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This mstallllrion is being made On residential or farro property
owned by me or a mef!lber of my immediate family. This
property is not intended ior sale, exchange, lease, or rent OAR
479.540(1) and 479,560(1),
Signature:
,CONTRACTOR INSTAllATION
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City:
Phone:'5
E-mail:'
CCE license no.:
Signing SUpervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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440.2584-) (91D8/COM)
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DEPARTMENT USE ONI.Y
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Pennit no.:
Date:
Residential. per unit, service inclu.dcdj
1.000 sq, ft. cr less (4)
Each additional 500 sq, ft, or pOrtion
thereof .
$134.no
$
$ 25,00
$
Limited energy (2)
Each manufactured home or modular
dwelling st:rviot: or feeder (2)
$ 32.00
$
$ 63.00
$
.
Services or r",~d.,r:il: installation. alreration, reloc~eion
200 amps or l.ss (2) \ $ 61.00
s ~~ eoD
$
s ....
$
$
$
20 I to 400 amps (2)
40 I to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 emps or volrs (2)
Reconnect only (2)
$ 95,00
$15B:OO
$206.00
$469.00
$ 63.00
Temporary aervicclS ur foc:dcn: instaltafl'on. alterQ#Dn, relocatiON
200 amps or loss (2) $ 63.00 S
201 to 400 amps (2) $ 67.00 $
401 to 600 amps (2) $126;00 . S ...
OVer 600 amps or 1, ,QOO YOlts, see services or f~eders scction abov!:
Branch drcuits: n.ew, alteration, e:ttensicUl pel' panel
e.. Fee for branch circuits with pu~chasc of a s~rYiQe or feeder fee:
Eoen branch circuit 2.( $ 6.00 S \'U.."
b. F~e for branch circuits without purchase of a'service;: or fl;':l;Odcr fee:
first branoh cirouit (2) S 55.00 $
Eacn additional branch circuit. $ 6,00 .. $
Miscellaneous fees: service or feeder (Jof'l'nal1.ld/1d .:
Eaoh pump or irrigation cireie (2)
Each sign or outline lighting (2)
Signal circuit or i1limitt:d.en~rgy piU1el,
u.lteration, or extension (2).
Eacn additional in'peetion, (I) $68.00 S
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$ 63.00
$ 63.00
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5;
$ 63,00
$
(A) Enter ,ubtotal of above fees
. (Minimum Pormit FeeSSS.OO)
(B) Enter 12% ,urcharge (.12 x [A))
(C) Technology Fee (5% of [Al)
TOTAL fee. and .urcharges (A through q;
$.;1<>,',,,..
$ o1<J;e-l
$ I':>.~
$ 2'-\2., ~q
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00962
ISSUED: 07/20/2010
APPLIED: 07/20/2010
EXPIRES: 0112012011
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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SITE ADDRESS: 3680 JASPER RD
ASSESSOR'S PARCEL NO.: 1802061202700
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Public
PROJECT DESCRIPTION: Electrical for bioler replacement
Owner:
Address:
SPRINGFIELD SCHOOL DISTRICT 19
525 MILL ST
SPRINGFIELD OR 97477
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T\ON' Oregon law re4U t .w.... ,~~ _ T~ -':, .
ATTE~Ules ~dopted by the Cjne0N~d\l;OR INFORMA nON ~
follow t Those ruh\1. __ ,--- I
.J>lotification Cen eL hOAR 952-001-
Contractor ~~~R 95~otmHlrhrO~;g " of the rules by License
Electrical 0, YoUIlR1.TONt'E~,~ C\~lephone 164857
\ling lev Ill...... ," .." -.., .,...
ca ber for the Oregon Utili Y UlL G INFORMATION
num Center is 1-800-332-
# of Stories:
Heigbt of Structure
Type of Heat:
Water Type,' '" ,
, ' ',. ',-I
'RangeType,'-" ,
'ri-J"EiJergy Pitt~i
Sprinkled Building:
Expiration Date
OS/25/2011
Phone
541-484-9800
# of Units: ,
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Storm Sewer Available:
Special Instruction:
Downspouts/Drains:
Notes:
,
,
DescriPtion'
Type of Construction
I Valu~tion Des'Ci'iption I
(,'.'. ..
$(p~/Sq Ft ," Square Footage
or multiplier or Bid Amount
Value
Date Calculated
Paee lof2
Status
Iss u ed
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00962
ISSUED: 07/20/2010
APPLIED: 07/20/2010
EXPIRES: 01/20/201 I
VALUE:
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225 Fifth Street, Springtleld, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Total Valne of Project
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm ServrFdr 200 amps or less
Fees PaidL.
"':~}J" ',,' ';." .;....,:'";
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Amount Paid. Date Paid
Receipt Number
$24.84
$10.35
$126.00
$81.00
7120/10
7120/10
7120/1 0
7120/10
2201000000000000846
2201000000000000846
2201000000000000846
2201000000000000846
Total Amount Paid
$242.19
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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.
I Reauired Insoections I
Electric Service: Approval required prior to'litilitYc~,",~a:h en~rgizing service.
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Rough Electric: Prior to Cover
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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 Springlield 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.
1 further certify that only contractors and employeesjYho"ar,e.in.compliance with ORS 701.005 will be used on this project.
1 further agree to ensure that all required inspectioiisiare'i'j!qti~sted'atthe proper time, that each address is readable from the
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Owner or Contractors Signature Date
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P~ee 2 01'2
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225 Fifth Street
Sp.ringfield, Oregon 97477
541-726-3759 Phone.
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
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2201000000000000846
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Date: 07/20/2010
10:49:24AM
Description 3'i~;:'.::;:;~ . "...:.}~,',,;
Penn Serv/Fdr 200 amps or less .;:; "
Add, Alter, Extend Circ Eo Add
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
SCOTT LISTER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc 04598d In Person
Payment Total:
Amount Due
81.00
126.00
24.84
10.35
$242.19
Job/Journal Number
COM20 I 0-00962
COM20 I 0-00962
COM20 I 0-00962
COM20 I 0-00962
Payments:
Type of Payment
CreditCard
Amount Paid
$242.19
$242.19
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7/20/20 I 0