HomeMy WebLinkAboutPermit Electrical 2006-8-16
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225 FIFTH STREET 0 SPRINGFIELD, OR 97477 " PH:(541)726-3753 0 FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number _ ~;;J..tJD to - (j I o-e 9
1. LOCATION OlF INSTALLATION
1)?> ~ ~'YL IlL
LEGAL DESCRlPTI~' \J ~---I
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JOB DESCRIPTION
New Alteration or Extension Per Panel
One Circuit / $43.00 1'.-
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
. . ~' .
E. :, Miscellaneous (Se~:6?~der not included) ,-Each Installation
, .' ~':701f>~"
Pump o~ irrigl\tj..o~ ~ '% ~ $ 50.00
Sign/Outline Lil~:1~ ~ ~ $ 50.00
Limiteq Energy/Resid~~ ~ $ 25.00
Limited Energy/co~rf?~ ~ ~ _ $ 45.00
Minimum Electric Permit I~~~n<:ft~<&'~45.00 + Surcharges
VA "2 ~ ~
Owners Signature: , 4. SUBTOTAL OF ABOVE) ~ ~ ~ J1 ~ _
.A,~'TE:\JTION: Oregon law requires you to . ~ ~ -0~ .
tC!:QVV rules adopted bv thp. Oregon Utility 8% State Surcharge ~ ~ % -S. (po
i'~C"'" -'''''~ . t" .' (<).. ~ \ 'L.. . r. ,.-,)
, ',,,, ~,^!Jon venter. Those rules are set fortH 0% Administrative Fee vA" /() ~.v...... ...,.. ~ v
In. ?P,R 852-001-0010 through OAR 952-0011511 4-e-c(A..-u> /t''Y1 -f.U- 0, U -1;- '-''i~ 2... 2.5
Inspection Renuest:fo1:Z'"13769.ob.ta',n 'f TuTAL -r 0, '/ C;~ "'--
-~-~,. ~. ""Y copies 0 the rules by .~ J.7~
cal/ln? t,he center. (Note: the telephone Shared Drive(T:)/Building FonnslElectrical Pennit Application I-06.doc
number TOr the Oregon Utility Notification ..
Center is 1-800-332-2344).
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Permits are non-transferable and expire if work is
Dot started within 180 days of issuance or if work is
Suspended for 180 days.
2. : CONTRA<<..:1vR INSTALLA'flON ONLY
.' 0 . . ~
Electrical Contractor j'V\" 6 ~J~'N<....J
Address 9S7 Y'\ot4-h.'('\~.~
City ~ Phone 7~~' ff;,D!
Iln
.
Supervisor License Number W 7 <+ s-.
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tth q I CJ ?:>
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Sign,~: Electridan
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OwnersName kS~i.J.c,.. ftJ..~$o-yI..,
\
Address 57 ~+ ~ LcJ~
City ~ \ Phone 741- //8.3
I .
OWNER INSTALLA TIO~
Expiration Date
Constr. Contr. Number
C~~~- l(PdJ6t1
Expiration Date
The instaIlation is being made on property I own which
is not intended for sale, lease or rent.
Date
6 Ilf ol..
3.
COMPLETE FEE SCHElJuLEBlELOW
A. . New ResidenHal- S}ngle or Multi-~a~i1y per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. Services or Feeders',-, Instnllation, Alterations or Relocation:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps.
601 Amps to 1000 Amps
Over 1000 AmpsNolts-
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$3'75.00
$ 50.00
C. TempOI'ary Se~icesor Feooers
InstaUation, Alteration or-Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or lqOO Volts see "B" above.
D. ; Brancb Circuits
.
.
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2006-01009
ISSUED: 08/16/2006
APPLIED: 08/08/2006
EXPIRES: 02/16/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 83 HAYDEN BRIDGE WAY
ASSESSOR'S PARCEL NO.: 1703233307800
Springfield TYPE OF WORK: Heating System
TYPE OF USE: New
PROJECT DESCRIPTION: Install heatpump, air handler and ductwork
Residential
Owner: TERESITA EDMONDSON
Address: 83 HAYDEN BRIDGE WAY
SPRINGFIELD OR 97477
Phone Number: 541-744-1133
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
COMFORT FLOW
License
460
BUILDING INFORMATION.
Expiration Date
06/27/2007
Phone
541-726-0100
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
R-3
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
71,
fO//r.:.E:1V1/OA/. _
I PUBLIC IMPRO~'~Wf'ENii,:08 ad;:9?n law
C ' 'r["~ Can. eo n. req{ .
C';'Q \. (:;.)2-00 Sm.e~alkj'T$'p'g:O .tIres I,
. /0 1 -0 f70s "re .YOU J
0""1' urn- 01n. e~.," .gonu to
C.,/" !~. 'h qy 0 Qownsp'o.utsfDF!!IUS: Itlit
ouo-i' .. u I/Ie C lJtCiin UUgl7 C/.re se Y
uc-r lOr th eOter. (iI/CO/Oies 0/?4A 952t fOrth
Ct9" e Ore l ':Jte: t' the r: -001_
Iter is goo U. Oe tr::J' U/es b
7 -8Cn ')" tllit); ",!~:ephoh^ Y'
-v<-<341/"CCitio~
Total:
Handicapped:
Compact:
Jill/>-
0; v J/".
10' 1'0' A C'.f.
Street ImprQ.,V&m~i}D.:f'I)>1t
Stctrm SeW'~r.. A~~ilaa'1A':1' Si,
, 1. 'file '(J ''-'1.
Special InstructiOjl:. f'O 0'1/10 </ ('..
01 f 01)> <<'I)> :t~
Notes: '..~ ;)f'1?, IS 4.L'lI'&;S ~f' <<-
10/) (J-1/1I^ /)f'.o.. 0r-
""'UJI, "t.1,'. '- 'r
,t/f'/l/' 1(;0' vO,,;.. .
(J ,,( _Va'lu'3.tlOn Descn
u/f '-/ / .
Type of Construction $ Per Sq Ft / Square Footage
."t~. or mUltiPlie.1 or Bid Amount
~ -........-......,.
Description
Value
Date Calculated
· Paee 1 of 3
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Air Handling Unit Up to 10,000
Heat Pump
Minimum/Adjustment Mechanical
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Amount Paid
$10.00
$4.50
$2.25
$3.60
$8.00
$12.00
$25.00
$4.50
$2.25
$3.60
$43.00
$2.00
Total Amount Paid
$120.70
I Plan Reviews I
Date Paid
8/9/06
8/9/06
8/9/06
8/9/06
8/9/06
8/9/06
8/9/06
8/16/06
8/16/06
8/16/06
8/16/06
8/16/06
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2006-01009
ISSUED: 08/16/2006
APPLIED: 08/08/2006
EXPIRES: 02/16/2007
VALUE:
Receipt Number
1200600000000001223
1200600000000001223
1200600000000001223
1200600000000001223
1200600000000001223
1200600000000001223
1200600000000001223
2200600000000001150
2200600000000001150
2200600000000001150
2200600000000001150
2200600000000001150
To Request an inspection call the 24 hour recording at 726-3769. All inspection requeste~ 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.
Reouired Insoections I
Rough Mechanical: Prior to Cover
Final Mechanical: When aU mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When aU electrical work is complete.
Paee 2 of 3
.
, CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2006-01009
ISSUED: 08/16/2006
APPLIED: 08/08/2006
EXPIRES: 02/16/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 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
Date
Pa2e 3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
Job/Journal Number
COM2006-0 1 009
COM2006-0 1 009
COM2006-0 1 009
COM2006-0 1 009
COM2006-0 1 009
Payments:
Type of Payment
CreditCard
cReceint I
RECEIPT #:
r' "J of Springfield Official Receipt
,elopment Services Department
Public Works Department
2200600000000001150
Date: 08/16/2006
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 8% State Surcharge
+ 10% Administrative Fee
+ 5% Technology Fee
Paid By
MNB ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Ikw 485598 In Person
Payment Total:
Page 1 of 1
8:53:30AM
Amount Due
43.00
2.00
3.60
4.50
2.25
$55.35
Amount Paid
$55.35
$55.35
8/16/2006