HomeMy WebLinkAboutPermit Electrical 2010-7-28
EltX"'trical Permit Application
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ciTYOF SpRiNGFIELiHOREG'ON:
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225 Fiftb Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726:-3689
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DEPARTMENT USE ONLY
Permitno.:. e;" - /CJC)~
Date: 'I /~/lJ
This permit is issued under OAR 918-309-0000. Permits are Dontransferable. Permits expire if work is not started within 180
days of issDance or if work is suspended for 180 days. '
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
ZIP: ~r. 'f
Reference:
,
PROPERTY OWNER
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Name:
ZIP:9?y')
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 for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Business name: $1E\,l&-.,~ e~K'\c..
Address:fo 60X' lob?
City: t'L099~ I L.L- State:CR. ZIP:974-5".:)'
Phone:5J.f( ,?/f)..-;}J.::;S'c> Fax:51/- 71.f6-0't:/r;...
E-mail: f..OGI-EGHRrJ@)V1I\.SN , Co(rf\
CCB license no.: Cj'sLf7 g., BCD license no.::90- 3T3c
Signing supervisor's license no.: 'fo qt}- S
Print name of signing supervisor: sTEveN Ga~
Signature of signing supervisor:
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440-2584-J (9/08/COM)
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 $ )1
20 I 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 $
Reconnect oniy (2) $ 63.00 $
Temporary ~ervices or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
20 I to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a Fee for branch circuits with purchase ofa service or feeder fee:.
Each branch circuit I I $ 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
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 paneJ, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
APPLICANT USE
(A) Enter suhtotal of above fees $ fl
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ ,"3-
(C) Technology Fee (5% of [AD $ ,/"r
TOTAL fees and surcbarges (A tbrough C): $ 1'o/~
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20I0-0I00S
ISSUED: 07/28/2010
APPLIED: 07/28/2010
EXPIRES: 0112812011
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 170 44TH ST Springfield TYPE OF WORK: Electrical Work Only
ASSESSOR'S PARCEL NO.: 1702323100400 _
ATTENTIO~/'
PROJECT DESCRIPTlON:'lIc~~~e 200Q'S'elVlceaw require
., les adopted b S you to
if1r:~tir".., ,..... Y the nrc$'9A VI"
"D nt" -......HC'I. Inoser 1 . /lilY
Owner: ' CRUZ SUSAN,F~YE)2-001-0010 th \J es are set forth
Address: 170 44TH STV~(}, You m;q obt' rough OAR 952-001
SPRINGFIEIJb]10~ ?,1~7CSent a/n caples of the rutes b .
,.~, , er, (~/"t., !' -l'
-"'V~llurtheOre "."~~... .
Center is l~~~~'1~):,,~;~MATlON ~
Contractor .: '\~','?i' License
STEVEN R GEISLER 95472
J BVILDING INFORMATION.
TYPE OF USE:
Alteration
Residential
Contractor Type
Electrical
Expiration Date
11/23/2010
Phone
541-726-0618
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
NOTICE' Height of Structure '_"_'_.
THIS PERM~pe of Heat: .
AUTHORIZE/).=~r.tPf~PIRE IF THE WORK
2HMMENCE9'O .IS PERMIT IS Nnr
""y 180 DAtJ:li . Fa 'dl'll
I DEVELOPMENT INFORMA1'1ON I
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
SqFt Other:
. Occupant Load:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
. $ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
Wir:~~!'ft~!. cJ ;
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-01005
ISSUED: 07/28/20]0
APPLIED: 07/28/2010
EXPIRES: 0112812011
VALUE:
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid-l
Fee Description
+ 12% State Surcbarge
+ 5% Tecbnology Fee
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$9.72
$4.05
$81.00
7/28/10
7/28/10
7/28/10
3201000000000000479
3201000000000000479
3201000000000000479
Total Amonnt Paid
$94.77
Plan Reviews 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.
I Reouired Inspections I
Electric Service: Approval required prior to utility company energizing service.
Final Electric: Wben all electrical work is complete.
By signature, I state and agree, tbat I have carefully examined the completed application and do hereby certify that all
information hereon is trne and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of tbe 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 an 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
Paee 2 of2
225 Fifth Stree.t
Springfield, Oregon 97477
541-726~3759 Phone
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City of Springfield Official Receipt
Development Services Department
Pnblic Works Department
. "
RECEIPT#:
3201000000000000479
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Date: 07/28/2010
1:55:36PM
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Description
Perm Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Job/Journal Number
COM20 10-0 I 005
COM2010-01005
COM2010-01005
Paid By
STEVEN GEISLER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
81.00
9.72
4.05
$94,77
Payments:
Type of Payment
CreditCard
Amount Paid
CJC
155351 In Person.
Payment Total:
$94.77
$94,77 .
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Page I of I
7/28/2010