HomeMy WebLinkAboutPermit Electrical 2009-1-16
225 Fifth Streett Springfield, OR 97477+PH(541)726-3753+FAX(541)726,3689
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Pennitno.: 0007/
I Date 1// b /0 , I
Electrical Permit Application
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,
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I Zoning approval verified? 0 Yes 0 No -
1~~C~~E(;1D'RY~0~.cPNsmB.lij<::i11IQN)jj,.~'jlj;;l'1It~1! I Residential, per nnit, service included: I
I p,tResidential .1 0 Government l 0 Commercial 11,000 sq. ft. or less (4)
1~_8PElllSlmEi!INi;..ORI\i1/J'.mICQM''<<N[):i!l!QG'Mjl0NIi_1'11l $134.00 $ I
I -n I I Each additional 500 sq. ft. or portion I
Job site adiiress: Il~~-3. ~\.."\ R "...,d ": \.N '" ~ thereof $ 25,00 $
I City:~",.o:,..,,,, I ,-_\ '" I State:o II. I ZIP:'1"l'" I I Limited energy (2) $ 32,00 $ I
::~~~~~i~~~~~~f1IW,~~~;;~lt~:i I ~:~~I~:nS~~~~~~r~~ ~e~~:r(;)odular $ 63,00 $ I.~
I I
I --c; ~ Do ..p q A..--t ~-B- (? ..I::-........... c I Services or feeders: installation, alt~ration, relocation
I . I I 200 amps or less (2) $ 81,00 $ I
I 201 to 400 amps (2) $ 95.00 $ I
I Name: Vc """" u..J ~"',.-:'-.,.~...".v I 1401 to 600 amps (2) $158.00 $ I
I Addr ' a... \.\ . MOI",'li,v\"vregon 'awreqllr~S6jJ~llbtl)OOOamps(2) , I 1$205,00 $ I
ess. J -J ~ ~ '-I. fnll('l\N'r.Jlr.H:!ll~td1-l h" th~ Q..: CL iJ 'I
I City:C'... ~ _ <-<. 'j'IStai~'-;(!liCl/ll CElnZlp.:fhI:JSe'ltJIe, at; ~:~~flP:io amps or volts (2) I I $469.00 $ I
I Phone. ~ 6;13'- ,\' lf9 '1 ~~[,f.~;~~~~L;:f~~u ~ff~ ffiF i!WOll"f.l only (2) I I $ 63,00 I $ I
I E-mail' h _I'~;""" Oil:. '-"IN'"v ',v lh ~1~avy services or feeders: installatIOn, altemtlOn, relocatIOn I
, 'J~-,> e.R 1/<0 <:>, "<SJ Illq<o"". '>4ef.' ole, IhA 'p,1 ;J,'blY!Jlii 1 - I "C'I
This mstallation is being made olilresi\le\liti!lr &f1faJrtrlj>r6peJItYi/ily ro .ifj"~fInlis or ess (2) V $ 63,00 $ to?
owned by me or a member of my immedIatliilialnilt,IT!iilD'332-23 14' . 201 to 400 amps (2) $ 8700 $ I
propert)ois not intended for sale, exchange, lease, or rent. OAR 'I' 'I
479,5.,40(1) an~6QQ). 401 to 60q amps (2) $126.00 $
Signa~ 0 lOver 600 amps or 1,000 volts, see services 'or feeders section above ,
IlIlIf~Bc:oNm~CjljORi'lINSjt~L!l!'J,\mlp.N~__j,jlij~ftfl I Branchcircuils: new, alteration, extension per panel I
I Business name: re?LA/ At E3<1-- I I a. Fee for branch circuits with purchase ofa service or feeder fee: I
I Address: I I Each branch circuit I I $ 6,00 I $ I
I City: I State:' I ZIP: I I b. fee for branch circuits without purchase ofa service or feeder fee: I
I Phone: I Fax: . ~ I I First branch circuit (2). $ 55.00 $ I
I E-mail: /" I Each additional branch circuit $, 6.00 $ I
I CCB license no.: I Bcdoli~1~C&;:.. Miscellan~ous ,{~j) service or feeder not Included I
I Signing supervisor's license ny - TH~ f't:K'!y~11 ,,~~~i. ~ P! ~~h}Jr\!i;I~!W~lOn CIrcle (2) I $ 63,00 $ I
I ~ uu I nU1ifL!:G ur",...:1 T, II, i~'!.'T' v I
Print name of sIgning s rvisor M . Ii' ,s1lll\"R8"t1me hghtmg (2) $ 63.00 $
. ~8rq"'EN8ED OR IS ^61\., r _'" r:!..
I . . . '. ~ V IYI . . SIgnal Cifcuit or a limited-energy panel, I I
Signature of 11gnmg supervisor. /\~IV 1 RO llAY PERIOD. alteration, or extension (2) $ 63,00 $
I Each additional inspection: (1) . I $68.00 I $ I
I~,'~, ,'"",~_m%V"'.'iiiil!I'I';".""N'. ",lr.,ri'S-~E'\l.";;'~liilii_~!1.'~ ,I
a;';3i!);;liiihl,;K.i.m],f~~rsr:5. ...~.~._11'!lP.\:I,_ ~~~~~~E"~-'?ifu.~
I (A) Enter subtotal of above fees $ I";'
(Minimum Permit Fee $58,00) b':>
I (B) Enter 12% surcharge (.12 x [AD $ 7 Slj-
I (C) Technology Fee.(5% of[AD . $ "';/ r
I TOTAL fees and surcharges (A through C): $ 73. 7
440-2584,J (9/08/COM)
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Status
Issued.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
. 541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF ~nuNGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00071
ISSUED: 01116/2009
APPLIED: 01/16/2009
EXPIRES: 07/16/2009
VALUE:
.'
SITE ADDRESS: 1783 BRANDY WAY
ASSESSOR'S PARCEL NO,: 1703331101200
PROJECT DESCRIPTION: Temp only
.Owner: BENSON VERN W
Address: 940 HWY 99 N
EUGENE OR 97402
Contractor Type
General
Contractor
OWNER
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback: ,
Side 2 Setback:
Rearyard. Sethack:
Solar Setbacks:
Street.Improvements: '
Storm Sewer Available: ,.., .
Special Instruction:
Notes:
i.
Description
Tvpe of Construction
Springfield TYPE OF WORK: Use Initials
TYPE OF USE: New
Residential
~T""'''''\.'--
I CON,TRA'CTORIJNI\J~-Rl'th\lTJ(W..I.
. .: -t~v "Jupr~Cl'b,I'-."res you to
NotIfIcation Center. T~Y the Oreg~J.JIi\it3'tion Date Phone
. fn OAR 952-001-0010 th ~llJl~s are seftorth
0090, Ynll ,,",0.. _', I' rough OAI'l QJ<i) en_
I Bu~niW'l~MMYIO~IS of the rules by
, ,U f.J.' rrJ 0" "the telephon
' ~ I, , regon Utility N " , e
# of Stdtlmier IS 1-800-332_234~tlflca~Size:
Height of Str'ucture ). Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:.
Water Type: Sq Ft Basement:
Range Type: sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Bnilding: nia Occnpant Load:
I DEVELOPMENT INFORMATION I ' .
, NOTlCE-. REQUIRED PARKING
l]lW~~~Ts iIiIAll EXPIRE IF THE WORK ~~~~;cap~ed:
C~~RlNDER THIS PERMIT IS NOT Compact:
ANY 180 DAY ~E~~tBANDONED FOR .
.
I ~UBLIC IMPROVEMENTS I
Sidewalk Type:
Downspouts/Drains: '
I Valuation Descriution, I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax.
541-726-3769 Inspection Line
.;
'., .'
Fee Description
+ 12 % State Surcharge
+ 5% Technology Fee
Temp Power 200 amps or less
Total Amount Paid
.j I
:'1;""
" ...
Amount Paid
$7,56
$3.15
$63.00
$73.71
Total Value of Project
Fees Paicl I
Date Paid
Plan Reviews I
1/16/09
1/16109
1/16/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00071
ISSUED: 01/16/2009
APPLiED: 01/16/2009
EXPIRES: 07/16/2009
VALUE:
Receipt Number
3200900000000000024
3200900000000000024
3200900000000000024
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 Renuired ~~~IJections I
Temporary Electric: Approval required prior to Utility Company energizing pole,
By signature, Istate 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 an 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 he 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 an
times during construction.
Owner or Contractors Signature
I:', >:. :J'
Page 2 of2
Date
225-Fifth Street
Springfield, Oregon 97477,
541-726-3759.Phone ..
Job/Journal Number
COM2009-0007 I
COM2009-0007!
COM2009-00071
Payments:
Type of Pay.ment
Check
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
3200900000000000024
Date: 01/16/2009
8:16:22AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
63,00
3.15
7,56
$73.71
Description
Temp Power 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
BENSON DEVELOPMENT CO
LLC
Amount Paid
djb
In Person
$73,71
575
Payment Total:
$73,71
Page I of I
1/16/2009