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Home My WebLink AboutPermit Electrical 2007-5-7 (2) .. __~ WN LOL ..& _ INITIALS f'J "'^' -.- .A!. DATE :5-7 -cr, ~ ~ SOURCE --P:J' 5-7- 07 .. " \ J. CITY OF SPRfNuFIELD, OREGON 225 FlFnI S'I1lEET . SPRINGFIELD, OR 97477 . PH:(SlI)726-3753 . FAX: (Sll)~ ELECTRICAL PERMIT APPLICATIO!'f City Job Number CoW'! e.PO 7 - ~C> b 5" z.. 1. LOCA110NOFINSTALIA110N: ZL{ 2 g- ~W1~ ~ IL c:;>of/Z- LEGAL DESCRIPTION: (/o"JZ14lf JOB DESCRIPTION: -.ZOO -A""'''' 5 ~II L LA .o6-.eMle- Dale 3. COMPLETE FEE SCHEDULE BELOW A. New Residential- Single or Multi-Family per dwelling uuit. Serviee Included 1000 sq. It or less Each additional 500 sq. It or portion thereof $106.00 $ 19.00 Permits are noo-trausferable and expire if work is Each Manufact'd Home or not started within 180 days ofissuanee or if work is Modular Dwelling Service or $5000 Suspended for ISO days. Feeder S yoU to . . QP. laW requIre .>>w 2. C0N1'RACTOR1NSTALIA1101X~\ON.Oif!9,o'B9i~~Y~,,(~ation, Alterations 01. Relocation: ! IIQ."'I rul~ ~pte se rules are set 0 . / b Electrical Contractor \'t-\ 1!3 O~\ mJ2.~.~. ..er2~~~8b~~f\ 952-O0~ $ 63.00 J . IW f\952-001-O~O??iife~_lules b $75.00 Address \~.,K ~oIrl ~~~l ma,! Ob.t&ln~(ijljl~hOne n $125.00 c. ailinG the cenW~~~!I~RMti~at\o $163.00 City ~ Phone ~lor\~~,~lJm~Stb; $375.00 Reconnect Only $ 50.00 SupelVisor License Number 6>1 Ll ~ s \0/1 101 Expiration Dale Constr. Contr. Number \"1 \ I ~ ExPiration77I1..D IDea '-(7~ t/ /' I.JI I LA / Owners Name (AI t/ltlJ."'Y' \A l ~ r IV Address Z, 4 "2- ~ h""lM ,,(Is City S\;-~ Phone OWNER INSTALLATION The installation is being made on r.'r.'.:, I own which is not intended for sale, lease or renL Owners Signature: Ins, . .::" ,,_ Request: 726-3769 C. Temporary Sen.iees or Feeders InstaUatiou, Alteration or Relocation \\JOTlCE::zoo Amps or less $ 50.00 :!1IS PER~9~r~AA!(t4~9,~ IF THE WORK $ 69.00 AUTHORltgb^o'lm~r~OA.mr\l'ERMIT IS NOT $100.00 liuMMEN9rn ~fHa'Pl'.mNQjl9 Nf!@;~B" above. ANY 18l3'oAV'I!lf\\RilJuifs New Alteration or Eltension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Pennit $ 43.00 $ 3.00 E. Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting LimiJed EnergylResidential LimiJed Energy/Commercial Minimnm Electrie Permit Ins", .. :. . 4. SUBTOTALOFABOVE 8% Stale Surcharge ]0"10 Administrative Fee 5% Technology Fee $ 50.00 $ 50.00 $ 25.00 $ 45.00 Fee is $45.00 + Snrcharges SObJ S~ b:ro I :lfr $" 77'tJ- TOTAL Shared Drive(T:)'Building FormsIEIectricaJ Pennil Application S-06.doc: -~.""~:-~. . -... . . CITY OF ~rKll'jGFIELD Building/Combination Permit PERMIT NO: COM2007-00652 ISSUED: 05/07/2007 APPLIED: 05/07/2007 EXPIRES: 11/0712007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2428 DUMAS DR Springfield ASSESSOR'S PARCEL NO.: 1703234400112/fT'EN;. fOl/ow ION:Ore TYPE OF USE: Repair PROJECT DESCRIPTION: 200amp serviCrJ~MIl.PrI/Ule8 adopt gon law reqLI/ In 04D ~'~n Cef11", ~d, by the ,..,./es You tn u09Q -~c:.V01 . 'V::ie -"~" Utili . You m -0010 th~ rules ere 'I'~ne Number: Calling th ay Obtain c O~gh OAR 9~st fOrt numbe . e center. IN OP1Ss of th C!-oO~ "Orth__ "at.:....... 9',11,._. . ~ ~1"gOn I. , ;."w Il:Ile'lh - L I CONTRACTORTNfiORM~'~'taOt?e - lJ44J. IOn License Expiration Date 90725 05/03/2008 TYPE OF WORK: Electrical Work Only. Residential Owner: Address: WILLIAM WILSON 2428 DUMAS DR SPRINGFIELD OR 97477 541- Contractor Type Electrical Contractor DOUG PALME~J{B..RP - ~ ...'t': THIS BUiLDING INFORMATION I 4 U ,Vhf/7- THORIIt.or StliFtes: RJOMMEN H~i~lllf'Stfut/q'rft-IF ANI' 1 Cff.Y'?Jf?f H'iat:lfIS THE ~ VB 80 DA~f!'Ier-1)ri\SAN PERMIT IS OR/( Ran8>'Wv>e: DONED F, NOT Energy Path: OR Sprinkled Building: n/a Phone 541-434-5600 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I Frontyard Setback: Side I Setback: Side 2 Setback: Rcaryard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Strcet Improvements: Storm Sewer Available: Spcciallnstruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation DescriDtion I Description Tvpe of Construction $ Per Sq Ft or multiplier Sq uare Footage or Bid Amount Value Date Calculated Paee I of 2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00652 ISSUED: 05/07/2007 APPLIED: 05/07/2007 EXPIRES: 1110712007 VALUE: 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 + 100/0 Administrative Fee + 5% Tcchnology Fee + 8% State Surcharge Perm Serv/Fdr 200 amps or less Amount Paid Date Paid $6.30 $3.15 $5.04 $63.00 5/7/07 5/7/07 5/7/07 5/7/07 Receipt Number 1200700000000000509 1200700000000000509 1200700000000000509 1200700000000000509 Total Amount Paid $77.49 I 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 Reollired Insoect~ Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that 1 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 eacb address is readable from the street, that the permit card is located at the front of tbe 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 Street Spri~gfieJa, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2007-00652 COM2007-00652 COM2007-00652 COM2007-00652 Payments: Type of Payment CreditCard cRcceiotl RECEIPT #: _~. INQFlaD lM. ~.~. c;a of Springfield Official Receipt _elopment Services Department Public Works Department 1200700000000000509 Date: 05/07/2007 Description Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By DOUG PALMER Item Total: <"':heck Number Authorization Received By Batch Number Number How Received djb 121343 lnPerson Payment Total: Page I of 1 10:24:49AM Amount Due 63.00 3.15 5.04 6.30 $77.49 Amount Paid $77.49 $77.49 5/7/2007