HomeMy WebLinkAboutPermit Electrical 2009-1-16
225 Fifth S'reet.Springfield, OR 97477tPH(54t)726,3753tFAX(541)726-3689
1:'~-{_o1!~"i!F';'i(<.;?r~~*V;'1~+~W4ia"~~fl71~zl
1~i;[~~E>%~~~~~J1~~rt1~~~~
I . CC)Wlz...()09-0D07~
Permit no... _ _ -I
I Date: . I/;{,/O f I
. /
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days ,of issuance or if work is suspended for 180 days, '
E~ectrical Permit Application,
~iJI!0:C~l!\iG:~~E@MEN$~.6:ReR.<DYAL."~Ii"~1 ~~1llf!;,~~'i'~]jF,J~.E~s-:'e8EQiJl!E: 'I
I Zoning approval verified? DYes 0 No I '~~5ii1l';~R~~~,*fi"~jtr,~I[Q1~1. ~,',~I,~4_'III.[ :r,~~..,.lsat'_,1~,'1
1"~~G~ml;({0R.YilQF",~epNsm8.l!JcjliIQN~~l!1 "''''f'.''''''''''''''''''''''''",~'''''''l"",_,,,,,,,,,,;!l.il[!,~~, ""'" ''''' - ,W,l
i~~~~~i~[jtE~IN~~R.~~miN~AN[j]f~~C~;l~~~~11 ~~~~::tl:I,:,el:;,n(~; service included: $134.00 $ :
I J b. ddr ,{,1_<( f(LIt'----- I Eachadditional500sq,ft.orportion $ 25,00 $ I
o site a ess. w- . \. thereof .
i:=r[j~eR.'~~~f~;:;:J~~~~:~ I ;~~~:~~~;~~~;~; Fe~~~r (~)odular : :::::: i
. ~ \I\:i.'"'YL. Vvt2.:rO:.i\ ~~ I I Services or feeders: installation, alteration, relocation I
, ~~. I I 200 amps or less (2) $ 81,00 $ I
1i1l~.dl)I.'1lI:l~~;,r~ER0~ERm::i',g0WNERJi;\''''''iii}t~~'''t'$.!1~,IP;;~ I 201 to 400 amps (2) $ 95,00 $ I
~::So'b-.'u..;:n~?it~WJt.;;....jj.." -'=, A_'.",;, ~~~"'~"~AT"'tEf~'Tr()N rum ,(\) .
IName:---r-..,,-,,- l"V!,;; CrJ<-Lc:..... fnll"wru'.o,.' '!1X601<lfl1~IJ"esvn"t" $158.00 $ I
I Address: '<(5)~. -:f?.$'t:-3Pv2., I ~=. a ion r.: ~~~~\'6g.~!riEpl~gon Utility $205,00 $ I
" . -" 'u C~ dl#_~1<i Tonh ffi
City: Vt:Ncr.4- I State: c>fL I ZIP:n ~1f~~~l(MWPd1"1llll\X~~~ J&1- $469.00 $
Phone: I Fax: - calling Ih ~tbl!&iRe\JCQnly.(2:)1 the rules hv I $ 63.00 $
c '" v,, !!,\ju,,, ~TJ? t~, ~h -
I E-mail: numberlo.t~eTeffl!.~h~f~ltljl!"tS.1l!.~.elNli: ,"sta/latlOn, alteratIOn, relocatIOn I
e lWlR ;~ 1;1,Jvuf'''dllun I I
This installation is being made on residential or farm property ", '''\ ,.." '0OO-'2f~2'!"ti'441 $ 63,00 $
owned by: me or a member of my immediate family. This I 201 to 400 amps (2) . $ 87001 $ I
property IS not mtended for sale, exchange, lease, or rent. OAR I '
479.540(1) and 479.560(1). 401 to 600 amps (2) $126,00 I, $ I
~i~ature: 1 O~er 600 amps or 1,000 volts, see services or feeders section above I
~.MC0Nifi~t:jl1(;j8.1(;INSm~J.!I!~JIljjN~:!J!;,~4,,~~1 I Brauch circuits: new, alteration, extension per panel I
I Business name: '--~~~llk6l C:;;~~L- I I a. Fee for branch circuits with purchase ofa service or feeder fee: I
I Address: P, cf ~ v.3 L ',( 7... (;, i( I I Each branch circuit I' I $ 6,00 I $ , . I
I City: UfttIJr,uA'/Cp I State:rhl, I ZIP:Cj7lfg'i I I b,Feeforbranchcircuitswithoutpurchaseofaserviceorfeederfee: I
I Phone:C;,-q I - <;<)''(--:2.'-1f'J'i I Fax~ \ I I First branch circuit (2) I $ 55.00 $ I
I E-mail: I'~~ I I Each additional branch circuit I $ 6.00 $ I
I CCB lIcense no :2o:.J-'21"{c.. I BCD license fftjTirf{- I I Miscellaneous rees: service ~, feeder nol mcluded I
I Signing supervisor's license no.: JJe- ~ nIT SHAtL1E'3'l@lli\m If ;);\iit/WlJ;\:t~ (2) $ 63,00 $ I
I Prmt name of signing supervisor(",!.;> V'\.. C", " ~"o uI'/D{lIlal~l~<li~~LIiHllW(2) $ 63,00 $ I
I Signature of signing supervisor: /~~" , ItNCED at 13sI'gBA~Ii\'\\'Ilr1,/ Ir~d'energy panel, $ 63.00 $, I
' ~!-, '" R (l'/V'ratJon, or extensIOn (2)
A y l11U UI-IY r '
. Ea~h'!!lditional inspection: (1) $58.00 $
~~R~m!::~Nft.J1ili$'E=rt~J'!f'6_~
(A) Enter subtotal of above fees
(Minimum Permit Fee $58,00)
I (B) Enter 12% surcharge (.12 x [A])
I (e) Technology Fee (5% of.[A])
I TOTAL fees and surcharges (A through C):
~ ~'-~
~;s:> "'~ ~ '-J ~
\ b'"'' ~~ <Y
~
$ b")
$'75b I
$ "},() J
$(3~
440-2584-1 (9/08/COM)
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00076
ISSUED: 01/16/2009
APPLIED: 01/16/2009
EXPIRES: 07/16/2009
VALUE:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1804 14TH ST
ASSESSOR'S PARCEL NO,: 1703252301710
Springfield TYPE OF WORK:
TYPE OF USE:
PROJECT DESCRIPTION: Reconnect
Owner:
Address:
TIME MANAGEMENT COMPANY LLC
87585 ESPRIT CRT
VENETA OR 97487
I CONTRACTOR INFORMATION I
Contractor Type
Electrical
Contractor ' ileS yl:>idense
CAMPBELL ELE~T,l1lcnreQon laW"I~~rp.aon7j995!~
A\ \ t:,... , ' - . -~""",. ov .' - ..-........., .........
I '\OIl'!IIl'le'B"I'JICDING,INFORMAl:lONr'tY1-
NC:~\i\\ca\i~n vO;':Ol1i 0 tnrOU'd" ~i tne lules bY
in Of;r. 9::>2,0 ,~8f)~J~rieS,);e; ~ telepnone
O 090 You. maHeight of,iStrucrure'ot',licatlon
. \1 CO","'" \If\\tV ,~
Calling t e ,Ty,pepfcHeal: ~ ,,~'4)
lor n" v - "_A 33".""" '
numbel JXa,!l'" T;ype.
cen Range Type:
Energy Path:
Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION I
. Frontyard Sethack:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:. R\\
CEo # Street Trees 1Mf\i: II' l\-1t 'NO 01
NOi\ . ~1'\v~rfP.\!.\'.e\R'~k ERWlII IS ~
1\-11S ?tR~v.. 0~~~M!/l.v1~llief ~tD rOR
I\U\\-\O~~!~~f\ OR IS I\\)I\\,\DO ,
CL'6ii/Bi,i~fIMi'Rov~MENTS I
. ~I '
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
.
I Valuation DescriDtion I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Paee I of 2.
Expiration Date
05/24/2010
Phone
541"744-0705
n(a
Lot Size:
Sq Ft 1 st Floor: .
Sq Ft 2nd Floor:
,Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
CoIllpact:
Sidewalk Type:
Downspouts/Drains:
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00076
ISSUED: 01/16/2009
APPLIED: .01/16/2009
EXPIRES: 07/16/2009
VALUE:
.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Tota( Value of Project
Fee~ ~a.id ,.
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Service Reconnect
Amount Paid
Date Paid
Receipt Number
$7,56
$3.15
$63.00
1/16/09'
1/16/09
1/16/09
2200900000000000064
2200900000000000064
2200900000000000064
Total Amount Paid
$73.71
I Plan Reviews I
To Request an insp~ction call the 24 hour recording at 726-3769. AHinspections 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 Reouired Insnections .
Eleciric Service: Approval required prior to utility company energizing service,
By signature, I state and agree, that I have carefuny examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that auy 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 Servic~s 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 an 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 ofthe property, and the approved set of plans wili remain on the site at an
times during construction. j
c"~/~ D.re i((CP~
(
Paee 2 of2
225 Fifth Street
Spriugfield, Oregon 97477
541-726-3759 Phone '
RECEIPT #:
. Job/Journal Number
COM2009-00076
COM2009-00076
COM2009-00076
Description
Service Reconnect
-+- 5% Technology Fee
+ 12% State Surcharge
Payments:
Type of Payment ,Paid By
Check
GLEN CAMPBELLCJC
cReceint I
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000064
Date: 01116/2009' .
Item Total: .
Check Number Authorization
Received By Batch Number Number How Received
4319
In Person
Payment Total:
Page 1 of I
12:04:54PM
Amount Due
63.00
3,15
7,56
$73,71
Amount Paid
$73,71
$73,71
1/16/2009