HomeMy WebLinkAboutPermit Electrical 2007-1-8
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Date
ZON ~
INITIALS ~ '
DATE \f.!-!DI
SOURCE ~'~
I/g /07
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ~ R07J7 - ()(XJ37
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LEGAL DESCRIPTION:
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JOB DESCRIPTION:
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. :9?IJ!IMCTJ)RiJli~rtH-f1l;J~~,9!:[k~;~
Electrical Contractor Ap-D-x S'16~c;. \ II\.C-
Address 9 Q ~)( ~ Ll ~
City ~ Qf'2-Phone 7LfL{~7Lf!
Cf7'-tOS- '
Supervisor License Number I Lf 70 L I2.A-
Expiration Date 10 - I -- 0 ~
Constr. Contr. Number /0 0 d- q 3>
Expiration Date S - I ~ -0 ~
Signature of Supervising Electrician
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Owners Name I<fl~ /-ftltJ.)()A.J
Address _wItt 6Lau(g.~
City ~ .7/lItL- Phone 747-711~
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OWNER INST AL"'rl. nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3.COJ\.fPLETEFEE SCHEDULE BEL'OlV '
. ' ':_'. ';,';< ,_,-' . ~., "_"<<_~,.n' ':., . ' "',1
A. 'New R~sidential::' Siiigle6r,lVlult!- Fainilyper dwellin~funit
. ." '_ I.. ,..._, . ...... "._ ,,'., _..~. .: .< h ".. ,...:
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
, '.. ..~ < -- ; " ." " ' '.
B. . S~rvicesorFe€de~~ .,..lIista.Ilation, Alterations or Relocatiori: ,
Y',-.}!,j,\,,"',.)';',"" ,..t).., ;"":.".;,.,,;..J.>"~~,,,~ :;,........'. . "",,' .'"
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 10QO;\tnps/Volts $375.00
Reconnect Only $ 50.00
,0, f\TI1::1,'~i. ~~..j:y;.~.~~I.II':';Y"-~'iU', 'J~ i V ~.'~
C. T ~'tjji'o,f,awj8~n~e$ o:r~4~&~tl}rt11$Or~gQil'LJtl!' ,." '
, '" 'Not:Tlctdicr; Canter. l'flos8 r~;es aresry ~c. l
Installat;:oiDAHe"patibiVGhiR"eMc)UQmugh OAR 852..~:: '
200 Arr1~:PJtGesYou may obtain copies 0$ ~0fMules ~:
20 I ~lPS tS&tlb1A!ri1~~ C'9nter, (Note: th9$f69~OO'10:':~-
40 1 Ampsitb!w~W4~! the Oregon Utility ~'lro6!0eat;or:
" Center is 1..guU,,:':r1?..~344)
qver 600A,inps o~lOOO Volts see "B" above. .
D.': I}ral}~Jl::Ci!c~dts;
New AJteration or Extension Per Panel
oftk.1:1!Wi: $ 43.00
En~ @.1~~tWfJ~lfi!cuit or with
SA1:NR5Rl~t[/ P~nMtL EXPIRE IF TlI[ WO~~O
E. C~Mii~~~~:~~~~~e:Je~~~)l~m~rtl~JYQlac1i Illstallati~n"
ANY'lBObAYPERI(/~Dlij~./zIt1NttJFOR""" .
Pump or irrigation D. $ 50.00
Sign/Outline Lighting $ 50.00
Limited: Energy/Residential I $ 25.00 _~
Limited Energy/Commercial $ 45.00
Minimum'Electric Permit Inspection' eru45.0 . + Surcharges
4. ;SllBTo.TALOF ABOVE
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TOTAL
4-S-. (J[) ,
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4.sD
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S!:l. 35
Shared Drive(T:)/Building Fonns/Electrical Pennit Application 8-06.doc
8%HState.Surcharge
10% Administrative Fee
5% Technology Fee
Status
Iss u ed
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00037
ISSUED: 01/08/2007
APPLIED: 01/08/2007
EXPIRES: 07/08/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 619 BLACKSTONE ST
ASSESSOR'S PARCEL NO.: 1703233412200
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: Low voltage for security system.
Owner: HANSEN ALBERT R
Address: 619 BLACKSTONE ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Low Voltage Electrical
Contractor
APEX SYSTEMS INC
License
100283
Expiration Date
05/13/2008
Phone
541- 7 44-8949
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# 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:
n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
8PAliNQI!!IiEliJ,.,illl,
~1IIii:
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00037
ISSUED: 01108/2007
APPLIED: 01108/2007
EXPIRES: 07/08/2007
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
Low Voltage - Residential
Minimum/Adjustment Electrical
Amount Paid
Date Paid
Receipt Number
$4.50
$2.25
$3.60
$25.00
$20.00
1/8/07
1/8/07
1/8/07
1/8/07
1/8/07
2200700000000000031
2200700000000000031
2200700000000000031
2200700000000000031
2200700000000000031
Total Amount Paid
$55.35
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All 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 following work
day.
L Reauired Insnections .
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 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
Page 2 of2
225 Fifth Street
S'pringfield, Oregon 97477
541-726-3759 Phone
<A of Springfield Official Receipt
~Iopment Services Department
Public Works Department
Job/Journal Number
COM2007 -00037
COM2007-00037
COM2007-00037
COM2007-00037
COM2007 -00037
Payments:
Type of Payment
Cred itCard
cReceintl
RECEIPT #:
2200700000000000031
Date: 01108/2007
Description
Low Voltage - Residential
Minimum/Adjustment Electrical
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
PETER F. DESSER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 016371 Phone
Payment Total:
Page 1 of 1
lO:36:39AM
Amount Due
25.00
20.00
2.25
3.60
4.50
$55.35
Amount Paid
$55.35
$55.35
1/8/2007