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HomeMy WebLinkAboutPermit Electrical 2010-8-6 Electrical Permit A lication" ' . . . A .,. ~ , ," " ., - ~ ,. ~,~ _ CIty ,@]', $~R&I:l~iG:Emi!IttlVQ'Q;lDGc)N:: :1;,': ~ ~ J ,,~"'\,":-"~' ~'* -~. ,. ~'~-):~+'~~~'t:3U:'.~",->~ 225 Firth Streett Springfield, OR 97477+PH(541)726-3753+FAX(54J)726-3689 r .... " i~PRINQPIru.O ~?;;i{ q L .~.Ji j.._/1i::.-~./')~ 1 ""::"""""'"".. .-'-'.._.........~."..'.: i\1" ~ "<; "'-- ;-"",.~, 'DEPARTMENTUSEONLV, . c. - .0.. " . Pennitno,:{1/!J-! cJ?3 Date: :1' &/10 , , This permit is issued uuder OAR 918-309-0000, Permits are uontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. '[OCALiGOVERNMENL,.APJ?ROVAL.. Zoning approval verified? 0 Yes 0 No;;:: ," ',.'~' "CATEGORY OF :tOJllSTRO.CTIOJll o Residential 0 Government 0 Commercial , .:",.,,~JOB', srtE'IJIlF()RMA'TI0NhANDLOCATION~, I 15 I'Y1 :S~I'S I City: 'L ZIP: Reference: ., '''''''PR'OPERTY' "'O'WNER- d', ""i;oM,'- "'0'" +,\<. -,.' ,:'\+.?-;;;;;r~,*,fl5iii&,'fiT ,,~>R' t" '6~ ", :':i\,~.~tr '0" , ~" 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:: ,2Jl:;, property is not intended for sale, exchange, lease, or reil.(OAR'Si;t' .. 479,540(1) and 479.560(1). ,~jRi\f": :~;','i Signature: ZIP: -~l . .~ OJ., City: Phone: E-mail: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: i..,' .) " ., r~~' ... :1" ~~~'.l:*.1 \.).( ",', !/ lr~: ,'T ~..~ . ";~n :~:"i'" 440-2584-) (9/08/COM) . ~,., "';"'FEE>SCHEDULE , , , ' ,'c;- " ., Qty. Cost 'Total ~.N!I~be~,~~f i.nsp~tJo~s per:,item ( ) ,~' 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 $ dwe,1ling service or feeder (2) , Services or feeders: instaliation, alteration, relocation ,200 amps or less (2) $ 81.00 $ : "201 'to 400 amps (2) $ 95.00 $ 40 I 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. aitermion, relocation 200 amps or less (2) $ 63.00 $ ~qlto 400 amps (2) $ 87.00 $ 40 t 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 of a service or feeder fee: Each branch circuit $ 6.00 $ b. Fee for branch:circuits without purchase of a service or [eeder fee: F~rst branch circuit (2) I $ 55,00 $ >1 -' '; Each additional branch circuit 1<4fP1 $ 6,00 $ u'- M,iscellaneous fees: service or feede; not included , 'tach 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 extension (2) Each additional inspection: (1) $58.00 $ 2007,," ':'if APPLICANT USE. .:i ' . i': ,.' "".:;1 ,<., . ., <:o<c.' . , (A) Enter subtotal of above fees $(ot - (Minimum Permit Fee $58.00) (B) Entcr 12%surcharge(.12x [AD $ '1'J!::-- (C) Technology Fee (5% o[[AD $ .i ':1- TOTAL fees and surcharges (A through C): $ '1/12. ". .' Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-01073 ISSUED: 08/0612010 APPLIED: 08/06/2010 EXPIRES: 02/0612011 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1415 MISSISSIPPI AVE ASSESSOR'S PARCEL NO.: 1703344309300 ;', ."Eugene ~ ~ .' ).. '. TYPE OF WORK: Electrical Work Only ,(t"~7-7.('~-n08- ~ SI JaluaCj - PROJECT DESCRIPTION: <Oircuit'e'xtensionfalteration"'wnu uO!leO!I!ION M!1!H I uuu'''U V~."_, .,'~~ , _"_..~_,_, ~'" '",n,,) 'JalUao 811IBu!\!eo ; - ;,.: 'I=Sa.crlo"> """[10 Aew nOA '0600 NORM}{N'!,:OUlS rKXN'K REOWC~BLErlNUUUl 2511 LIU\'l()\;Y.Ei l:IVO L1onOJYI ,u(J- ,UlT,," " ' EUGENI;!JfORl~91408alnJ 8soLll 'J81U80 ~o!leO!lI\oN Allllln uoBaJO 8L11 Aq p~ldope saln~, MO~!OI NORMAlYl \1Q,V!SJERANKEI,m~O€ll.BUEI:(1R1Jsitj 2511 LILY AVE ' . EUGENE OR 97408 TYPE OF USE: Alteration Commercial Owuer: Address: Owner: Address: Contractor Type Electrical I CONTRACTOR INFORMATION ~ Contractor License MY ELECTRICIAN INC 87506 BUILDING INFORMATION ~ Expiration Date 11120/201l Phone 541-729-1454 # of Units: # of Stories: Primary Occupancy Group: Height of Structure Secondary Occupaucy Group: . . Type of, lIe.a.\:. j' Primary Coustructiou TtH'Jj a:JNOaN aO(l:!:JdwatjliJfNP~NIf Secoudary ConstrugtB','J SPliWl:!:J 1f8V SIl:!O S~!Jre]i,W~bJ # of Bedrooms: )Jl:!OM:JH d SIHll:!:JaNrJ_~ rf~\~'), '.... 1:J( :Jl:!IdX:J lllfHS llW~ 'd<<~3J,lding: n/a I DEvELOPM:E/'iTlmFORMATION . Lot Size: Sq Ft ht Floor: Sq Ft 2ud Floor: Sq Ft Basemeut: Sq Ft Garage/Carport Sq Ft 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 Co~~r~ge: REQUIRED PARKING Total: Haudicapped: Compact: I PUBLTCIMPROvEMENTS ~ Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Dowuspouts/Drains: Notes: ~/IJ d. "_~}. ," \Vii, r':l':'ill.. l;~;i, \ " S:"t .'~~:,/'C ',' Pa~e 1 of 2 225 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: COM2010-01073 ISSUED: 08/06/2010 APPLIED: 08/06/2010 EXPIRES: 02/0612011 VALUE: Status Issued . ;.!...ll~'.';'\. . 'l." : L' j;'. ',,-:;.":1,' Description , Type of Construction I Valuation Description I $ Per Sq Ft Square Footage or multipl,ier ; '.' _ " or Bid Amount "\J "'J'! .').' Value Date Calculated :;1'otal Value of Project . -1.';'; . I Fees Paid . Fee Description + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid Receipt Number $7.32 8/6/10 3201000000000000524 $3.05 8/6/10 3201000000000000524 $55.00 '8/6/10 3201000000000000524 $6.00 8/6/10 3201000000000000524 Total Amount Paid $71.37, ,.; ,:. .,:,.:,';1;'""'. . " I Plan Reviews , 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. ..."1' '. ' , -,\1-;1 ; \: Remiired HISDections I '._~"'-;" Rough Electric: Prior to Cover 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 auy and all work performed shall be doue 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 incompliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspe~ti~,rif~te reqti~~(~d at ihe proper time, that each address is readable from the street, that the permit card is located at the fro'rihiffh'e:propei'tY', and the approved set of plans will remain on the site at all times during construction. . . f f6S/IO Date Owner or Contractors Signature ~ -' . ,I :,';:j" .' '<.2- ':~ .' Pa2e2 of 2 .~ ;" .j'il;?L";, ~ r:~,~:~' I " 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ( ,; ~ . i ~:~Q~;jI WiL, . City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 3201000000000000524 Date: 08/06/2010 '11 :50:56AM Job/Journal Number COM2010-01073 COM2010-01073 COM20 10-0 I 073 COM20 I 0-0 I 073 Payments: Type of Payment CreditCard cReceintl Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Fee Paid By EDWARD GUIDRY Amount Due 55.00 6.00 7.32 3.05 $71.37 Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid cjc $71.37 $71.37 316005 In Person Payment Total: .'. " ~' f:;~". .. .':,-;'.'t" "~' .,. ", " . . ,'.. '/o!,{;,. Page 1 of 1 8/6/20 I 0