HomeMy WebLinkAboutPermit Electrical 2009-3-2
Electrical Permit Application
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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1 Permit no.: C 9 /' Go 2-511
I Date: S /00-/00 I
This permit is issned 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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" Residential "I 0 Government", "I mommercial, I I Residential, per nnit, service inclnded: I
~4_d0BllslmEjINIiQB:r\ii/f,.mIQNrM"D]lI!ClG';6;'I1IClNi!~!.f'~11 11,000 sq, ft. or less (4) $134.00 $ I
I Job site address: /0 2.6- j..Vc~'r 1\1. I I' ~~~~oafdditionaI500 sq, ft, or portion $ 25.00 $ 'I
ICity:SPfl-,>.J I-"c.( d IState:Oi{. IZIP:Q7,0771 I Limited energy (2) $32.00 $ I
1~~;~if~~E~{G.Rlemr~fN([QE.-I!twJ~K~~~~j 1 ~~~71~:"s~~~~~~r~~ ~e~~:r (~fodular $ 63.00 $ I
I i'J _ 7~J../O II",., [I" Ci~'~ tJ /''.IIL /(T""q r I I Services or feeders: instaUdtion, alteration, relocation I
I ' - , - 0- , I I 200amps or less (2) $ 81.00 $ I
1~~~~RROp.E:RJ]1(f0WNER~D"\!.~~1~1~~~1 1201 to 400 amps (2) $ 95,00 $ I
I Name:W, 851 t....1 CAl(V)fY'P"":J" C'hilVd)" I I 401 to 600 amps (2) $158.00 $ I
I Address:+-t') (2,0){ q I \(' "1 I I 601 to 1,000 amps (2) $205.00 $ I
I City: ~It ~ r State:Q'2i I ZIPQ71.f7-{ Over 1,000 amps or volts (2) $469.00 $ I
I Phone: "_ \1- I Fax: Reconnect only (2), $ 63.00 $ I
I E-mail: .j Temporary services or feeders: insuillation, alteration, relocation I
This installation is being made on residential or farm property I 200 amps or less (2) $ 63.00 $ I
owned by me or a member of my immediate family, This I 201 to 400 amps (2) $ 87.00 $ I
property is not intended for sale, exchange, lease, or rent. OAR
479,540(1) and 479,560(1). I 401 to 600 amps (2) I $126.00 $ I
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I
~':1Ilil!!~~1[C:~0NIII~c:mOI~'l:!INS1T:/f,.1!1!J.(11IQN~_'ii-~;~:U4\l1l:1 I Branch circuits: new, alteration. extension per panel I
Business n~me: 1Kfvt-v~ G,^/:r~IILj;....... LL C I .1 a. Fee for branch circuits with purchase ofaservice or feeder fee: \
I Address: fJ. (I) anY" 7 -i. I I I Each branch circuit I $ 6.00 I $ I
I Cjty:C,Les~ If I Stat<(}l1-. I ZIP: 9'7tfW I b,Feeforbranchcircuitswithoutpurchaseofaserviceorfeederfee: I
I Phone,JL, t ' ,1,-; fry _y ~-y?,ax: !f'l)-,~7 '2..1 I First branch circuit (2) / $ 55,00 I $ ,.o-Q'
E-matl: ,I Each additional branch circuit d $ 6.00 I $ /2...1
CCB license noJIi'~701-. I BCD license no,:C -/ 1 () I Miscellaneous fees: service or feeder not included I
I Signing supervisor's license no,: Ji Cj i> 9' _ ') I Each pump or irrigation circle (2) $ 63.00 $ I
I Print name of signing supervisor: lYIf vi.. t<,. oJ) r' l-, I Each sign,or outline lighting (2) $ 63.00 $ I
1 Signature of signing supp~, ;,~ '" I Signal circuit or a limited-energy panel, $ 63,00 $ 1
~: -;;--- } alteration, or extension (2) .
-j Each additional inspection: (I) I $58.00 $ I
.~1;
~'g
440-2584-J (9/08/COM)
I (A) Enter subtotal of above rees
(Minimum Permit Fee $58.00)
I (8) Enter 12% surcharge (,12 x [A])
I (C) Technology Fee (5% of [A])
I TOTAL fees and surcharges (A through C):
$ &, 7. 60
$ 8'. e> :V
$ 3_3$
$ ""7l(-....f9
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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SITE ADDRESS: 1025 W N ST
ASSESSOR'S PARCEL NO.: 1703273401602
PROJECT DESCRIPTION:
Owner: WEST N COMMUNITY CHURCH
Address: PO BOX 918
SPRINGFIELD OR ,97477
Contractor Type
Electrical
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00289
ISSUED: 03/02/2009
APPLIED: 03/02/2009
EXPIRES: 09/02/2009
VALUE:
Springfield TYI'E OF WORK: Electrical Work Only
TYPE OF USE: Ne,v
Commercial
I CONTRACT~R INFORMAT!ON I
Contractor
BIRCH CONSTRUCTION
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type,
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
License
165702
Expiration Date
08/0112009
Phone
541-895-5721
BUILDING INFORMATION'
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:,
Energy Patb:
Sprinkled Building:
nla
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
, DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
, Compact:
I PUBLIC IMPROVEMENT~.1
, ITENTION: Oregon law requires you to
follow nSid~walkpf~pe:y the Oregon Utility
, Notificati"Dn Center, Tz'hOSB rules are set forth
, OAR 9 ownsnoutslDrams:
In ,,"-uu I"UU I U "II uugh OAR 952-001-
0090, You may obtain copies of the rules by
catling the center, (Note: tile telephone
number for the Oregon Utility Notification
C,mtRr is 1-Rfl(}-:1:1??:144)
Paee I 01'2
Value
Date Calculated
NU ll,,~., IRr:IF- l.tIt ~vuni\ 1
THIS PERMIT SHALL EXP~\:'aJu-a,tionrBescrintion
AUTHORIZED UNDER THIS _(1...,1,' 1
COI\l1\me\\il'rcilllUfl.J~f.i~AND($f'm\l~.p~ Square Footage
ANY'180 DAY PERIOD. or multIplIer 01' Bid Amount
."
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00289
ISSUED: 03/02/2009
APPLIED: 03/0212009
EXPIRES: 09/02/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Pai~ .
Fee. Description
+ 12% State Surcbarge
+ 5% Technology Fce
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Paid
Receipt Number
$8.04
$3.35
$55.00
$12.00
3/2/09
312109
312/09
3/2109
1200900000000000145
1200900000000000145
1200900000000000145
1200900000000000145
Total Amount Paid
$78.39
I Plan Reviews I
To Request an inspecfion 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 Re,,,~ired. I":'necti?ns I
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, tbat I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I fnrther certify that any and all work performed shall be done in accordance with
tbe 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 all
times during construction.
Owner or Contractors Signature
Date
Paee 2 of2
225 Fifth .Street
. .
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00289
COM2009-00289
COM2009-00289
COM2009-00289
Payments:
Type of Payment
Check
cRcceintl
RECEIPT #:
1200900000000000145
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
BIRCH CONSTRUCTION, LLC
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 03/02/2009
I :58:33PM
Amount Due
55,00
12,00
3,35
8,04
$78.39
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm
Page I of I
2003
Amount Paid
In Pe'rson
Payment Total:
$78,39
$78.39
3/2/2009