HomeMy WebLinkAboutPermit Electrical 2009-3-5
225 Fiflh Street. Springfield. OR 97477. PH(541)726-3753' FAX(541)726-3689
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Permit no.: OdO q 0
Date: '3 -$" - ZOO, I
Electrical Permit Application
This permit is issued under OAR 918-309-0000. Permits are nontransferable. P.ermits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
. f~I!([G~.l!IGf.)."ME@MENifi'~&fiB.Q~~~I'~l. IiEE[S~ltffiEQJ:r1!!
. Z~ningappro~al..v~rified? ,_ . []Yes ... DNo. I. '!!D.~~~~~~~G)~~il:Q~I~ ,G\
'=::~I~mtz.Gi~~~~~~~i!lR~r~0~~~~~1 ~:~;~::~;=:~;=~:;:::;: ~~ ~,e
~~::;E~~~~ffilf.)~~~~~~]IEiN~~~11 ~~;;o~:i:~::II:S~O(:~ ft. or portion I :1::::::
1 City: S \" Fb I. State: 0 IL 1 ZIP: '771( 7B 1 1 Limited energy (2) 1 $ 32.00 . $
1~~i~~i~~l'l~fJ;VV~~~l.~~i I ~~~~l:~s~~i~:~~ ~e~~:r~~)odular I $ 63.00 $
I T~ r? C:> AlL'f I I Servic_es or feeders: installation, alteration, relocation
il"'~~~IBBQ~EB~Th'({f.)WNER~I~~~W!:~J I ~~~::~Oo~:: ;:; : :::::
Name: l.A-NA }/(:)4' ~ I2DE/NJ o#' 1 1 401 to 600 amps (2) $158.00
1 Address: 723b &llrc-ltYl.. ,\'a..:t_TEivTlorvl cI601 to 1,000 amps (2) $205.00
1 City: SPFP 1 State: va-- 1 ZIR:ti;;~1;;?ft'7t' dcl;'ciJ~~(o()OrampjiP/.!~~\~P) $469.00
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I Phone: _ _ 1 Fax: - - If! OAR 952:0-0" I (rR~q9.9m'H,~p~yr(2J10n Uti/it" $ 63.00 $ 1
. . ()n",,, '~O)H]fh -''''':>dfR ~
I E-mail: - -....v.. TOU may ot !~"mp"oraprJstJ~iqe~~tfeed~s: installation, alteration, relocation
eal/,nn '" , '-'w~r . ... -~<:-0UJ
This installation is being made on residential or fam.tpr.9"~~V the, Ite,. 2 I . ~d<fsll(e>nl1es-'.' I $ 63.00 $ b1.
owned by me or a member of my immediate family. This 8'''' .e O'62OJII";4lio""p'~~)1hon -y . 8
property is not intended for sale, exchange, lease, orrent. ~'Mer i; l' - ":.:""'~.! ~;;.., . e $ 7.00 $
479.540(1) and 479.560(1). 'l'djl~<6l)~li)~al1on. $126.00 $ 1
Signature: Ovc;r 600 amps or 1,000 volts, see services or feeders section above I
lili~~G.~NmIV,\CillQBIINS!fr)!:IJ!I!'.I.l:;rn~N~"lI~~~ Branch circuits: new, alleralion, exlension per panel 1
I.Business name: S[ LA..{ r f-e<,c{;-r I 1 a. Fee for branch circuits with purchase ofa service.OI feeder fee: I
I Address: 3~S'L{ ...Tr.....:"I.1H l2c1. I I EaSh branch circuit 1 1 $ 6.00 I $ 1
I City: ,<::;0(''-\ -eState: Or 1 ZIP: Q7r../7<A 1 b.Feeforbranchcircuitswithoutpurchaseofaserviceorfeederfee:.1
1 Phone: / -sq{ 7AQ-1074 1 Fax:. / 51/-. 7f./6 07).71 I First branch circuit (2) I. I $ 55.001 $ I
I E-mail: N':!T!Gl". I 1 Each additional branch circuit $ 6.00 $ I
I CCB license no.: 1t:,{;J,?J 51 BCD license nO.T~~~ Miscellanenus fees: servIce or feeder not Included 1
I Signing supervisor's license .no.: "'1100 ~JiHnR'7~n ~~ ~bfffikl1,f~!!i~~~.JntJilftKJ I $ 63.00$ 1
I Print name of signing supervisor: i ~f.'I/~illo c." ~\ibt\I~t!tiWI# 1 $ 83.00 $ I
I Signature of signing supervisor: igwl circUlt -.;; JaSYmlt~~nergy panel, I $ 63 00 I $ I
ftllr2tlon, or extensIOn (2) .
I Each additional inspectinn: (1) 1 $58.00 I $ I
. ~~~~l~gfIi'!iG~~it~UJ~:e_j[~
(A) Enter suhtotal of above fees
(Minimum Permit Fee $58.00)
1 (B) Enter 12% surcharge (.12 x [A])
1 (C) Technology Fee (5% of [A])
] TOTAL fees and surcharges (A through q,
$
$
$
$
$
.~~
~~'AY
~LfJ(
~
$
b?>
$ f~b 1
$ 3" I
.$ 7") ~
440-2584-J (9/08/COM)
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00048
ISSUED: 01/21/2009
APPLIED: 01/1212009
EXPIRES: 07/21/2009
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 7236 GLACIER DR
ASSESSOR'S PARCEL NO.: 1802022102500
SPRINGFIETYPE OF WORK: Single Family Residence
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Fire Damage
Owner:
Address:
NESKE-ROBINSON DANA S
7236 GLACIER DR
SPRINGFIELD OR 97478
# of Units:
Primary Occupancy Group:
Secondary Occupancy Gronp:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
. ..\0
I. CONTRACTO.RIN!?RM~ti0JN! ~
la"" 0169u \ \Olt, .
Contractor n,\.OI6'00~ 'O'l ,"61l'es -O:tit6en~\'
~\ \~. il.6" 1 .\ a .,,"~ 'o'l
THORNTON 1j',J:;J::CTR.~!=)Ne? \"oS~,'r\" Of1.!g~~S _
\O'~\o:"1 ~BUI~D'.NG' iNFORMA:iIbN,~~~\O(\
~o\\'" ?, \J"~ :J: 0"'-. ~o'~...\ \~\.,. ,\
\'"O~ '(ol/t\f~t-'fl.. ~ \\ 1.\\\\\~Z,Ali).
r;I21J. ,y('" '" or r~le'0o <>,'32...
R-3 () ca\l\\\'0Hfdgij~l{)fS\(l\efure
\\1l\"\\'OElf~IW6J\ Preat:
VB Water Type:
Range Type:.
Energy Path:
Sprinkled Building:
Expiration Date
08/21/2010
Phone
541-686-4151
Contractor Type
Electrical
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
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Sctbacks:
Overlay Dist: Total:
# Street Trees Rqd: ~a . pped:
Paved Drive Rqd: ~~~:
% of Lot coverar.: tf-.'r\?t. \~ ~\\ \<2> el
~~~\~:?~~\\ <2>~j:;p. \~\<2> ;~~I~D ~()?
I PUBLIC IMPROVi;;MEN'I1~ \J "? \<2> r>,'Pi'l1
"J n:~\l\l \J ;"o\(\\l
C()~~t. ~~ 'rtiRl'eWalk Type:
r>,~'l ~ 'O\) Downspouts/Drains:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of 2
Status
Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541 ~ 726~3676 Fax
541-726-37691nspection Line
CITY OF SPRINGFIELD
B uildin g/ Com b inatio nPermi t
PERMIT NO: COM2009~00048
ISSUED: 01/21/2009
APPLIED: 01/1212009
EXPIRES: 07/21/2009
VALUE:
Tntal Value of Project
Fees Paid ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Temp Power 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Temp Power 200 amps or less
Amount Paid
$7.56
$3.15
$63.00
$7.56
$3.15
$63.00
Total Amount Paid
$147.42
Plan Reviews I
,
Date Paid
1/21/09
1/21/09
1/21/09
3/5/09
3/5/09 .
3/5/09
Receipt Nnmber
2200900000000000072
2200900000000000072
2200900000000000072
1200900000000000159
1200900000000000159
1200900000060000159
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.
Re(JlJirerlll1snecti~~s I
Temporary Electric: Approval required prior to Utility Company energizing pole.
By signature, I state 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 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
Pa2e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00048
COM2009-00048
COM2009-00048
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
. Public Works Department.
1200900000000000159
Date: 03/05/2009
Description
Temp Power 200 amps or less
+ 5% Technology Fee.
+ 12% State Surcharge
Paid By
JEM ELECTRIC
Itc_m Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
142245 In Person
Payment Total:
Page I of I
8:15:24AM
Amount Due
63.00
3.15
7.56
$73.71
Amount Paid
$73.71
$73.71
3/5/2009