HomeMy WebLinkAboutPermit Electrical 2010-8-2
Electrical Permit Application
CITY,'OF,~SpRiNGFIELD~ OREGON .
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753t FAX(541)726-3689
DEPARTMENT USE ONL V
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Penmt no.:
Date: cg, Z - I 0
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.
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
Name: 40 I to 600 amps (2) $158.00 $
Address: 601 to 1,000 amps (2) $205.00 $
City: ZIP: Over 1,000 amps or volts (2) $469.00 $
Phone: Reconnect only (2) $ 63.00 $
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
\. ~ Q Each additional inspection: (1)
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NOTICE.. ."". ~'='~ (A) E b
" : nter su total ofabove fees
THIS PERMIT S \Yl-.. (Minimum Permit ~
AUTHORIZED uff:~ EXPIRE IF THE I (!i'lJ1/lhter 12% surcharge (.12 x [A])
COMMENCED OR IS THIS PERMIT IS IllOltechnology Fee (5% of [A])
ANY 180 DAY PERJa~BANDaNED Fat TOTAL fees and surcharges (A through C):
'LOCAL: <;>OVERNMENT APPROVAIj.:
Zoning approval verified? 0 Yes 0 No
. '. '. .;CATEGORVOFCONSTRUCTION.,.'
EfResidential 0 Government 0 Commercial
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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:
INSTALLATION
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
Signing supervisor's license no.'
Print name of signing supervisor:
Signature of signing supervis
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440-2584-J (9/08/COM)
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Nu~~e~ of.inspedion~ perjt~m () Qty. ~~t 1~t':1
Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134.00 $
$ 25.00 $
I $ 32.00 $-1l
$ 63.00 $
Services or feeders: installation, alteration, relocation
Temporary services or feeders: installation, alteration, relocation
200..mEr less (2) $ 63.00 $
201tllil~ PWm'J?\ vregon law req Ires .. O~"O $
4qf'iJ{'~~fjl;~nter. Th~~.;'~~.UI ego. IMtwt 0 $
0OO9l9.0~l/~)a~~~d/;1&0Ul1l'Y&A_lhion above
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a. r~'f\lfl!f!..liUhtl:ie:~l:Tfl ,_~~~~,~...,r feeder ree:
Each branch cTrcu'ff .. $'"'6.00 I $:
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch Circuit (2r- . _. .
Each additional branch c'ii~~t~--'~"
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder ~ot included
Each pump or irrigation circle (2)
$
$
$
$
$ 63.00
$ 63.00
$ 63.00
$58.00
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$~g-
$ {,/'G
$ ~fe.
$ 6j;l
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Status
Issued
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-01034
ISSUED: 08/02/2010
APPLIED: 08/0212010
EXPIRES: 02/0212011
VALUE:
SITE ADDRESS: 1235 C ST
ASSESSOR'S PARCEL NO.: 1703351413600
Springfi~ld TYPE OF WORK: Electrical Work Only
PROJECT DESCRIPTION: Low volt alarm
Owner: ROLDAN RICHARD
Address: 1235 C ST
SPRINGFIELD OR 97477
TYPE OF USE: New
Residential
I CONTRACTOR INFORMATION ~
Contractor Type
Low Voltage Electrical
Contractor .. .'.:, ,. .. License
APX ALARM SECURITYSOLUTIONS INC 173349
BU"tLDiNGiNFORMA TION'
Expiration Date
01103/2011
Phone
801-377-9111
I PUBLIC IMPROVEMENTS ~ .....;"c" o.t
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Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories:
Height of Structure
Type of Heat: u \0
Water r~'lO\.\\\~I\'J
fj~d~~~ 'O\\OI\"f,.
'OQ,O(\ It! 15000:tf: S '1..00\
~,Ol ~'OO '~~l!liji'ti~?:I:';'? 'o'J
c ~\O Oo? "f, , ,'O~ '0
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\o\\o'l'l \\0(\ C, E . , TION
~O\I\I~~ 96'2: e.'J 0 't' \l \.\\I\W,II.II.'\,
\{\ 01" ,\01.1 {(\ c'O(\\~;"'c.ot"''D\sr~
090. \"f,'O '0 IJV"J<~\:;J-.' .
a c~~I{\Q, 1 \01 \~ 1 \gI'slfeet Trees Rqd:
{\u({\'oe c,'O{\\e Paved Drive, Rqd:
% of Lot Coverage:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
VB
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
n/a
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:
Description
. I;\\IlI'"
Valuation Des[ri i a;
1""
Squa,re Footage
or Bid Amount
Type of Construction
$ Per Sq Ft
or multiplier
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Page I of2
Value
Date Calculated
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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
Fees Paid I
Fee Description
+ 12 % State Surcharge
+ 5% Technology Fee
Low Voltage - Residential
Minimum/Adjustment Electrical
Amount Paid
$6.96
$2.90
$32.00 '
$26.00
Total Amount Paid
$67.86
I Plan Reviews I
'./-,'''''
Date Paid
812/10
8/2110
812/10
812/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-01034
ISSUED: 08/02/2010
APPLIED: 08/02/2010
EXPIRES: 02/02/2011
VALUE:
Receipt Number
1201000000000000855
1201000000000000855
1201000000000000855
1201000000000000855
To Request an inspection call the 24 hour r~cording'at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, irisp,e,'ctiorisrequested after 7:00 a.m. will be made the following
work day. ."... '
l Reouired Insnections I
Low Voltage: Prior to cover.
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 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 employ~es 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
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Date
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225 Fiftli Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000855
Date: 08/02/2010
2:43:34PM
Job/Journal Number
COM2010-0l034
COM2010-0l034
COM2010-0l034
COM20 I 0-0 1 034
Description
Low Voltage - Residential. .' ,
.1'
Minimum/Adjustment Electrical'
+ 12% State Surcharge
+ 5% Technology Fee
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Amount Due
32.00
26.00
6.96
2.90
$67.86
Payments:
Type of Payment
CreditCard
Paid By
STEPHEN ADAMS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
'. ,,;,
,-
~. ~' .'
002814 In Person
Payment Total:
$67.86
$67.86
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