HomeMy WebLinkAboutPermit Electrical 2010-8-2
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Electrical Permit Application
.crrY'OF;:SPRINGFIELD, OREGON'. .
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225 Fifth Street. Springfield, OR 97477+PH(541)726-375HFAX(541)726.3689
DEPARTMENT USE ONLY'
C06N\ 'Z.O t ~ ~O' O:S.r
PennIt no.: .
Date:
-/0
,-
This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for ]80 days.
'LOCAL:~OVER/IIMENr APPROVAL;"
Zoning approval verified? DYes D No
. " ',CATEGORy,'Of'.CONSTRUCl"ION'),"
Job site address:
City:
Reference:
PROPERTY OWNER
Name:
Address:
City:
Phone:
E-mail:
This installation is being made on residential or fann 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:
Address :
City:
Phone:
E-mail:
CCB license no.:
BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
G"jf CJt.f{}/~7 . ~\\)
~'~~il;E~M;~~~L~ EXPIRE IF TH.'E~O~sr:
AUTHORIZED UNDER THIS PERMIT IS NOT
~...., COMMENCED OR IS ABANDONED FOR
\: ANY 180 DAY PERIOD.
440-2584.) (9/08/COM)
I(~ c ~ ';, ::~'!~~. :;.~;~~;~\~.~,.~,q:ff;\:~:~:' ~/~E,Ei:"~~"S C Ii EP.CJi;Ef:,i ::.n':';t rc,ii~:(fi:~~~9~~:i~0B'~~
. . '. . .. Cost Total
Nu~~~r' ~r~nspe.~t~?'~S ~e,r .~f~.~' (.). " Qty, .(". ~a~' 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) I $ 32.00 $SOz.
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 $
Reconnect only (2) $ 63.00 $
Temporary services 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
Bran . '. ~..iltterati~'J~ extension per panel
a. FfCl~rqrv\l'Nlf!ail'Rlilbful!l ~;;;'b;'e :t'll ~e ~eder fee:
~~~ areseU<Jl:tIl/ $:
b. ~; Iy8'lfllfiju, ~c.l:'.':i ~. 1,,- feeder fee:
~icCel)211r. (Note: ~E tele h~rM~o $ . .
Eac a l' n i\'?~~~~~ity Notl caticmo $
Miscellaneous fees: service or feeder ':lot i-;~luded
Each pump or ir:igation circle (2) $ 63.00 $
-
Eacb sign or outline lighting (2) $ 63.00 $
,. ..roo-
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
>N;1;~:;~~ic]~~ri~~EJ\0;',~~A~~~;i3c,AN*~tJSEt~~~~(':;:j(~~~:t,:;;\~~;~,;;,:;;;:;'rt~i, :,:' .,
(A) Enter subtotal of abov<;.kes $
(Minimum Permit tr.' $S~) S-I
(B) Enter 12% surcbarge (.12 x [AD $ b7b
(C) Technology Fee (50/0 of [AD $ Z "IG ,.
TOTAL rees and surcharges (A through C): $ 67l5P
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-01035
ISSUED: 08/02/2010
APPLIED: 08/02/2010
EXPIRES: 02/02/201 I
VALUE:
, .
Status
Issued
225 Fifth Street, Springfield,. OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1319 QUlNALT ST'Springfield TYPE OF WORK: Electrical Work Only
ASSESSOR'S PARCEL NO.: 1703264115600.";'.'J "".'
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TYPE OF USE: New
Residential
I PUBLIC IMPROVEMENTS I ~:\\\'t. ~ ~(;i\ \:
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Valuation Descri li~n
PROJECT DESCRIPTION: Low volt alarm
Owner:
Address:
MARTHA F MEIER LIVING TRUST
1319 QUlNALT ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor , " ,," " License
APX ALARM SECURITY SOLUTlO\'j'S INC 173349
1'B'iJlLDING IN-FORMATION i
ou\\>
# of Units: # Of~~i~~:~ \l\\\\\'\, \
Primary Occnpancy Group: R-3 0(\ \1te~():ljl~Pn~<ttdA!\
Secondary Occupancy Group: \,\', o\e~eO 'OIliii~lI\13m~:g,,~.()();~
Primary Construction Type :\I'€-\'\\~ SOO?t \"Wil!0!;l~\e lu\e!l {l
Secondary Construction TYP{b\\o'i'l (~ (\ ce(\\~O\() 'it\\~~'iell;ql~e\e?"o~\o\'l
# of Bedrooms: \,\o\i\\CS~~'2.-()O\- o'O\a~;€?6tlY, ~'f~~o\~~\C;>:
\\\ O~ .IOU (l'e.i \\\e(.slJ~\'l~@~W!cnug: n/a
~9(\ , \~~ce ~'"'~o 'e:I?t
\J ca\\\~~\ \rlf.V.1\nO~lViENT INFORMATION I
\\u\\1 C!\l
Contractor Type
Low Voltage Electrical
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
!?escription
$ Per S'~iFt ,!, "";",'Square Footage
or multiplier;,Je rr:~ ',.1 o'r:'Bid Amount
':',~,~;;:. " "
Tvpe of Construction
.""'-'..
~. "."" j' ;
.,~x.,..,:~
Pa2e I of 2
Expiration Date
01/0312011
Phone
801-377.9111
\.
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
~.. .'
:..;.~
Value
Date Calculated
, .
SE;!I!IJIIGcI!IEl,Q.r c
,
I
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Low Voltage - Residential
Minimnml Adjnstment Electrical
Total Amount Paid
,;r,':
of. '1
Total Value of Project
I..)eespaid ~ .
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,."
Amount Pai~,::::' c ,,,'i
"','''-'
Date Paid
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-0]035
ISSUED: 08/02/20]0
APPLIED: 08/02/20]0
EXPIRES: 02/02/20]]
VALUE:
Receipt Number
1201000000000000856
1201000000000000856
1201000000000000856
1201000000000000856
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.
Low Voltage: Prior to cover.
$6.96'1,'; "
$2.90
$32.00
$26.00
8/2/1 0
8/2/10
812/1 0
812110
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By signature, I state and agree, that I have careful'I~,e:i:~mi~~d' 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 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
$67.86
Plan Reviews, "
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"':".
Reouired InsDect~
"
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Paile' 2, of 2
Date
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City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
RECEIPT #:
1201000000000000856
Date: 08/02/2010
2:43:58PM
Job/Journal Number
COM2010-01035
COM2010_01035
COM2010-01035
COM2010-01035
Description
Low Voltage - Residential
Minimum/Adjustment Electrical""-'
;:"?;~;'
+ 12% State Surcharge '
+ 5% Technology Fee
Payments:
Type of Payment
Cred itCard
raid By
STEPHEN ADAMS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
32,00
26,00
6.96
2,90
$67,86
Amount Paid
djb
002814 In Person
Payment Total:
$67.86
$67,86
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