HomeMy WebLinkAboutPermit Electrical 2006-12-6
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.1: ',. ",~" ',' INITIALS "-.J M.
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/';~ ~" SOURCE
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CD..... 700. b - 61 ::r-~S'
1. "io'i3dioN oFINsTAiuiioN/1; "~ <,
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gZO RILe-A LA!
200 Amps or less / $ 63.00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over IQOO AmpsNollS $375.00
RecMm;dtlnly $ 50.00
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IrrGO((f/eSi~!'%Y~'v.'(-,-,,_,_,- ,. . . . --,.--------- ....-
9!,i:p~ml'.~~4ryseiYiCfs,orFeeders::":" ..Of c;"';, j !
V.9Q-h'8$~' e&~7tJl::'(j" Iq~ -- "- ., .- ---~--"-'- - =--..-.1
11/ .'fn'~talJl{ti9\l~ter~fioThoP..R.lo(ll.tiOn
"'h "ll t. '~ 'va ''70 -'lis _'(Ii,
2~0/,~in~8rl~/./O~ \S'S'lt. 0...... "-6>,s"o $50.00
20d,"lltp~J{Jf!'4rJsJA(?rp.b 'I'o"ll/S,s",,~OI) i /-!Y199.00
40 I A7t1!ls/10~~~~P.s:'~~.s O~~~ ::.~~:i~ 00.00
~ver,6,?,O :,,-.mp~~ 10flj}~Vdl~~tl;~~~;:f. .. ,.~... .
D. ,Branch CIrc\'tt~kNI\<~.o~ ~o?:"::i.:',,' -',
/110 . ....-..,' ....----<8.{:,"fllb"O"s-..<fV ... , ..
~ . n J.l ' l'1t, IIC!'. New Alteration or Extensio~ pe~~,fl
P._ ~~ /J,.I'S,of; . OneCrrcuit $43.00
C. ~ 'itO 1?1f/ Each Additional Circuit or with
Owners Name F' ('Ed W",I!t ~ 11t~1f1fti1~l.?to l' $,S1'ice or Feeder Permit $ 3.00
'lzo . ':::;/ bt'\'+ IN ,t;o /}to C~1t~~~~&qa-;;~';ms~~~i~~/feede; n~tincluded) -Each lJ;~tallition-
-'Y,of; If /S4~'1''Ii;<~Llft//:c ",.. - ..". .", ".. ' ,,', - - . .,. "
S j>,= ~ Phone 747- 90fb l?/,cp.ump'Il\~ irrig-ation'ltJ' $ 50,00
/I ',/). 'T1- ('{r,
SignlOutIUJ~Ligh'!i~g. (/I?... $ 50.00
L. . dE l::/)m._.'a' A. 'aI" $ 0
,m,te nergym.coSl ent, 25.0
VII VI
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
".,~ . ,- . .-..... ".- -~ ~- - .~- ". . --.. .-"" "-.,, .....
4. ?SmiTOTAL'OFABOVE . ".'. ..
~~.; ~. ,.:'.;,,~~ :. _ ~....: ;.:.,..,,:. C' __. '.:~.;'. . ~ _~. .,..:.- '"",'_:~'::'~' ..'
8% State Surcharge
10% Administrative Fee
5% Technology Fee
LEGAL DESCRIPTION:
1 BOl- 0 hI I
00300
JOB DESCRIPTION:
f2.~i'lAc.E' ZOO~p Si~1I L
Permits are non-transferable and expire if work is
nol started within 180 days of issuance or if work is
Suspended for 180 days.
2. ;:coiiiRf.q9riN$!:Ai'4ticjj?jj'i1L1~t;
Elec:ic"~I'~o~t~c't:: " ,.~~ A:~:!:~~~~
C(py;;.t,
Address
PD
!<,jX
//93
City
~/I.A "l...-I (
Phone . <J{ 95' - ?ls/&G. .
Supervisor License Number
.2 9'7r?- S
Expiration Date
/0- LJ/- .0 7
Constr. Conrr. Number
/596"57
Expiration Date
'7' - IS- /..?X""
Signature of Supervising Eleclrician
Address
City
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Date ./ 2-S"-O~
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3. ';COMPLETEFEESCHEDULEBELO\V':' "',,~'-;:.
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"~J
-..""
. ~'"'''''..''' ..-..-TT"...."',..". .'~ '" '~." . .-.'. -.t. - '. .,.-_..-t,"'< '. .
A.;.:Nc';'.R~sidentiaI ::'Sillgle~r IViulti-F;plily p~r,~;ellirig utiii.:~ '
.. ,.,. 'h. _'. '.. __ . '......,.;. -',~... ,-- . . -.----"'-- ..~-"-,-~~-..-,-"",,,-,-.
Service Included
1 000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Mallufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
r'o ," id~~';:__t;) .....;r ~,,;:,~:I'::'i~:;':;'.' :"X:.>,. ..'''''. .~ ',("';;' -,."..',:'~~:-~>. ;,;-:- ;.:;-..'7":i"." :::=~!( ~ (..\
B. ,:Senices or'Feeders '-Installation, Alterations or>Relocation:" .
b.-_"...~:"""-':":;-':":q.,,";;"';'....:"--::';';;;;' . .'~.....;L''; ..............;.,'......._....::..:...;..:....:.::_..:.__'...1
63
G,:S
SOl(
630
3'[
TOTAL
77~
Shared Drive(T:)lBuilding FonnslElectrical Pennit Application 8-Q6.doc
--
.
.11 i' OF SPRINu1'lJ!,LJ)
Building/Combination Permit
PERMIT NO: COM2006-01555
ISSUED: 12/06/2006
APPLIED: 12/0512006
EXPIRES: 06/06/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 820 FILBERT LN
ASSESSOR'S PARCEL NO.: 1802061100300
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace 200amp service
Owner: FRED WILLIS
Address: 820 FILBERT LANE
SPRINGFIELD OR 97478
Phone Number: 541-747-9086
, CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor
C PERKINS ELECTRIC INC
License
159537
Expiration Date
04115/2008
Phone
541-895-4466
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
# of Stories: Lot Size:
Heigbt of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft2nd Floor:
A1'r~ler Type: Sq Ft Basement:
fOII~il~llfY~eQ{ego{ . Sq Ft Garage/Carport
"llh:.n .'" I/a...,.~ S F 0 h
Noti~' n~I'j;J"",a"'l!Pted b v(JUlfes yo ~ t t er:
in OA'~il~lnRlelll~lWp'inlZ: y the OAlf/on UtL.. upant Load:
R"Ot;O") ""'_ . . ITJO.f::o. _.,_ J .h,
I ti'i'VEU(i)P.M~iJM'~RNr.m:~~/i~~~t font
.._'''..~ maca t '.... VU/JI6S Ofth -001 REQUIRED PARKING
numbO'fH'Ih..~ ar. (Nota: the tft' a rulas b.l
y~ ay ';"~lregon U . Vlaphone.
# Srra;flTi!$f!l.YfJIt Wlty Notifica
Paved Drive Rqd: 332-2344). tJon
% of Lot Coverage:
Total:
Handicapped:
Compact:
R-3
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
iNIS' ....C: Sidewalk Type:
PERMIT
AUTHORIZ SHALL EXPI DownspoutslDrains:
COMMENC~g UNDER THIS ~~: THE WORK
ANy 180 OAY OR IS ABANDO MfT IS NOT
PERIOn NED FOR
I Valuation Descriotion I
Notes:
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
PalZe I ofl
~li:'
~J
.
.ITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01555
ISSUED: 12/06/2006
APPLIED: 12/05/2006
EXPIRES: 06/06/2007
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
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
Date Paid
Receipt Number
$6.30
$3.15
$5,04
$63.00
12/6/06
12/6/06
12/6/06
1216/06
1200600000000001729
1200600000000001729
1200600000000001729
1200600000000001729
Total Amount Paid
$77.49
I Plan Reviews I
To Request an inspection caIl the 24 hour recording at 726-3769. AIl inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the foIlowing work
day.
I ~e?~"tions I
Electric Service: Approval required prior to utility company energizing service.
By signature, I state and agree, tbatl bave carefully examined tbe completed application and do hereby certify that all
information hereon is true and correct, and I furtber certify tbat any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of tbe State of Oregon pertaining to the work described herein, and
Ihat NO OCCUPANCY will be made of any structure without permission oflbe Community Services Division, Building Safety.
1 further certify that only contractors and employees who are in compliauce with ORS 701.005 will be used au this project.
I further agree to ensure that all required inspectious are requested at the proper time, that each address is readable from the
street, tbatthe permit card is located at tbe 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 2 of2
225 fiftll Street
,~
Springfield, Oregon 97477
541-726-3759 Phone
iiiiAO '
. ,'_;P_"s ", 1,:
Mi;:,.\ i
,____... -...0
''-'-''''-'' ....",.."'-" .
CiaIl>f Springfield Official Receipt
~opment Services Department
Public Works Department
Job/Journal Number
COM2006,Ol555
COM2006-0 1555
COM2006,Ol555
COM2006-0 1555
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Date: 12/06/2006
1200600000000001729
Description
Perm ServlFdr 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
C PERKINS
Item Total:
<":heck Number Authorization
Received By Batch Number Number How Received
djb 032462 In Person
Payment Total:
Page 1 of 1 .
8:51:40AM
Amount Due
63.00
3.15
5.04
6.30
$77.49
Amount Paid
$77.49
$77.49
12/6/2006