HomeMy WebLinkAboutPermit Electrical 2009-1-14
225 Fifth Street. Springfield, OR 97477tPH(54t)726-3753+ FAX(54t)726-3689
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Permil no.: 000 64
ID.~ I
Ele_ctri~al Permit Application
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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 I Residential, per unit, service included: I
o Residential 0 Government I 0 Commercial
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I Subd~ision': i 701. :33 i:ro 1 Lot no.: 01 Jao I Each manufactured home or modular $ 63.00 $ I
IY~d~~t~Jr{I~4f:ISr'l~~;;W~~\~f~~ I ~:~:;s:::i:s::~;e'::~:/;~~iOno aiteratiOn(lo;t~:noo $ :
~~Z;~'1_P,~C::!~ERiJ;lf,i[PWN..ERt~~I~~~h\~~!f~ I 201 to 400 amps (2) $ 95,00 $ I
I Name: tJ t?lJ11Jt1CiJr] c,<'dtl/lt'::> I 401 to 600 amps (2) $158,00 $ I
I Address: V I 601 to 1,000 amps (2) $205,00 $ I
I City: I State: I ZIP: I Over\OOO amps or volts (2) $469,00 $ I
I Phone: I Fax: I Reconnect only (2) . $ 63,00 . $ I
I E-mail: I Temporary services or feeders: installation, alteration, relocatiol} 1
,.<17'1:;"', I I
Th" II' . . d 'd' '[}f' -'" 'J. 200 amps or less (2) $ 6300 $ I
IS msta _ atlOn IS bemg ma e on resl enl1alAl;;;~ 12r~l'~ ' .
owned bJ: me or a member of my unmedtatuaml)~",lh\~).~ " Ore, 0 i 20 I to 400 amps (2) $ 87 00 $ I
property IS not mtended for sale, exchangedr~aS'eli\'neh!'8"':R,;ol' 0 '" , . I
479.540(1) and 479,560(1). 090, ,,952_0 ellter E 1 "q(yI.l1l~O~ amps (2) $126.00 $
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Signature: .. c. ... . 11(, ~I/IIIO (^ 11)/'11/ '\' 010 l 0, Of; vo; 6.l)~~J'8\}'OOO volts, see services or feeders secllOn above
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I Addres~H 0. brN. t..;q7 '~1-80~/t:~"4l;~~f~Gt}9{Ic'l1it I I $ 6,00 I $ I
I City: Vij'J' f'f TVllly I.State:' I ZIP:. ~r<fj>~Jfir~~~cJcircuits without purchase ofa service or feeder fee: I
I Phone:~ 'J-.7 J ,-/1 Fax: 7 'fLf /OY-1 I Firstbrancf{circuit(2) $ 55.00 $ I
I E-mail. J. ~ I I Each additional branch CIfcuit $ 6.00 $ I
I CCB license no-l~{p 'fjjp ~CD I cense no. '~-~ II Miscellaneous fees: serv,ce or feeder not Included ,
I Signing supervisor's license p<C I Each pump or tITIgatlOn CIrcle (2) I $ 63,00 $ I
.1 printnameOfSlgningSUpe~'sor: J , --. I It I/EachSlgnoroutllOehghting(2) $ 63.00 $ I
-I Signature of signing supervis :' -r I ), I c:..... I I Signal circuit or a limited-energy panel. I $ 63,00 $ I
~--9iJ -J alteratlOo, or extenSIOn (2)
rHIS ICt.' I Each additional inspection: (I) .1 $58,00 I $ I
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{1 J 011.111.1[, '/2ED U. '/i/jll €t (A) Enter subtotal of above fees I
~ ANI' '80 NeED 0 'lVDER rli. 'PIRE1J: (Minimum Permit Fee $58,00) $
(\ / I~ DAy PE%t 484~S PER:;1f(tfli~f! 12% surcharge (.12 x [A]) $ I
~ ,,\J ". OD. VONED Fl~ili<flmology Fee (5% o[[A]) " $ I
~ \ N 'ii'rOTAL fees and surcharges (A through C): $ '!'! !!
440,2584-J (9108/CO":;!-
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00064
ISSUED: 01114/2009
APPLIED: 01114/2009
EXPIRES:. 07/14/2009
VALUE: '
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5335 MAIN ST 239
ASSESSOR'S PARCEL NO,: 1702330001300
Springfield TYPE OF WORK: Electrical Work Ouly
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Pedestal swap out
Owner: SANTIAGO ESTATES ASSOCIATES LLC
Address: 11211 GOLD COUNTRY DR STE 100
GOLD RIVER CA 95670 ...
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, I CONTRACTORl~RpRMATION ,
o,\lil"" , 0\\\I,j
Contractor r;).ofl \a.~~~~Ole~~flse\ \OI\~.License
BURREL1.,MdSll~p!.\lt'1,ES i!:l;<?\S2-\)\) .:.J36446
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. . '" ,~\es fO,\\l>\'BlJUiOlNl'; lNFeRMAl1'ION'
\o\\o'l'l 'ofl Ce Ii'.) \,/....., ~~ \I IJ/[(I I.. II '"
. ~1{ICa.\1 _\)\)\- \a.\fI CO~ ,\\;'Ie \ ~1\\Ca.\IV
# of Units: ~o Or>-?- gS2 ~a.'l 0'0 el.I\~R\\\~~:~~ . .
Primary Occupancy. Group: \fI \)g\). \tOJl\\;'Ie cefl\OI~X'3~sit~clure
Secondary Occupancy Group: \) Ca.\\\fI~ \01 \\;'Ie, {i:~\l\!'Of "eat:
Primary Construction Type t\u~fil ce(\W1 IS Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: . Energy Path:
Sprinkled Building:
Expiration Date
08/20/2009
Phone
541-747-2724
Contractor Type
Electrical
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
.11:,
~~. 'icapped:
~"\'?l \~ pact:
0-\>\~'<- ~~~~ <{\,'j'?-
.. .." .. 7)'~\.\:~~:S~(\~\;.\)
I PUBLIC IMr..R0VE1\:li:J!Wf~I0~\)" S ~<o~\
'\~~~\)~~~S\) ~~\fil~hlk Type:
I" r:::j'~IJ:.S !\\ \)~ DownspoutslDrains:
\\'\'\ \'0 '
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage,; .
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
l V al~ation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or muUiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of 2
Status
Issued
225 Fifth Street, Springfield, OR
541~726-3753 Phone
54 I -726-3676 Fax
541-726-3769 Iuspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Perm Serv/Fdr 200 amps or less
Amount Paid
$9.72
$4,05
$81.00
Total Amount Paid
$94,77
Total Valne of Project
F~es ,Pa,id, ~
I Plan Reviews I
Date Paid
1/14/09
1/14/09
1/14/09
CITY OF SPRINGFIELD
Building/Combination Permi~
PERMIT NO: COM2009-00064
ISSUED: 01/1412009
APPLIED: 01/14/2009
EXPIRES: 07/14/2009
VALUE:
Receipt Numher
2200900000000000051
2200900000000000051
2200900000000000051
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.ni. will be made the same working day"inspections requested after 7:00 a.m. will be made the following
work day. '
I Rellllired Insnections ,
Electric Service: Approval required prior to utility company energizing service,
1 .
By signature, I state and agree, that I have carefuny examined the completed application and do herehy certify that an
iuformation 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 ofthe State of Oregon pertaining to the work descrihed 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 pla~s will remain on the site at all
times du.ring construction. .
Owner or Contractors Signature
Page 2 of2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
~ublic Works Department
Job/Journal Number
COM2009-00064
COM2009-00064
COM2009-00064
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200900000000000051
Date: 0111412009
Description
Perm Serv/Fdr 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JOSHUA BURRELL
Item Total:
Check.Number Authorization
Received By Batch Number Number How Received
djb 045l6b In Person
Payment Total:
Page lof I .
1:44:25PM
Amount Due
81..00
4.05
9.72
$94,77
Amount Paid
$94.77
$94.77
1/14/2009